27-1.1-0.5. Purpose. The purpose of this chapter is to protect the interest of insureds, claimants, ceding insurers, assuming insurers and the public generally. The legislature hereby declares its intent is to ensure adequate regulation of insurers and reinsurers and adequate protection for those to whom they owe obligations. In furtherance of that state interest, the legislature hereby provides a mandate that upon the insolvency of a non-U.S. insurer or reinsurer that provides security to fund its U.S. obligations in accordance with this chapter, the assets representing the security shall be maintained in the United States and claims shall be filed with and valued by the state insurance commissioner with regulatory oversight, and the assets shall be distributed, in accordance with the insurance laws of the state in which the trust is domiciled that are applicable to the liquidation of domestic U.S. insurance companies. The legislature declares that the matters contained in this chapter are fundamental to the business of insurance in accordance with 15 U.S.C.  1011-1012.  History of Section.P.L. 2013, ch. 84,  3; P.L. 2013, ch. 91,  3. 
 27-1.1-1. Credit allowed a domestic ceding insurer. (a) Credit for reinsurance shall be allowed a domestic ceding insurer as either an asset or a reduction from liability on account of reinsurance ceded only when the reinsurer meets the requirements of subsections (b), (c), (d), (e), (f), (g), or (h) of this section; provided, further, that the commissioner may adopt by regulation pursuant to  27-1.1-4 specific additional requirements relating to or setting forth:  (1) The valuation of assets or reserve credits;  (2) The amount and forms of security supporting reinsurance arrangements described in  27-1.1-4; and  (3) The circumstances pursuant to which credit will be reduced or eliminated.  Credit shall be allowed under subsections (b), (c), or (d) of this section only as respects cessions of those kinds or classes of business which the assuming insurer is licensed or otherwise permitted to write or assume in its state of domicile or, in the case of a United States branch of an alien assuming insurer, in the state through which it is entered and licensed to transact insurance or reinsurance. Credit shall be allowed under subsections (d) or (e) of this section only if the applicable requirements of subsection (i) of this section have been satisfied.  (b) Credit shall be allowed when the reinsurance is ceded to an assuming insurer that is licensed to transact insurance or reinsurance in this state.  (c) Credit shall be allowed when the reinsurance is ceded to an assuming insurer that is accredited by the commissioner as a reinsurer in this state. In order to be eligible for an accreditation a reinsurer must:  (1) File with the commissioner evidence of its submission to this states jurisdiction;  (2) Submit to this states authority to examine its books and records;  (3) Be licensed to transact insurance or reinsurance in at least one state, or in the case of a United States branch of an alien assuming insurer, be entered through and licensed to transact insurance or reinsurance in at least one state;  (4) Annually file with the commissioner a copy of its annual statement filed with the insurance department of its state of domicile and a copy of its most recent audited financial statement; and  (5) Demonstrate to the satisfaction of the commissioner that it has adequate financial capacity to meet its reinsurance obligations and is otherwise qualified to assume reinsurance from domestic insurers. An assuming insurer is deemed to meet this requirement as of the time of its application if it maintains a surplus as regards policyholders in an amount not less than twenty million dollars ($20,000,000) and its accreditation has not been denied by the commissioner within ninety (90) days after submission of its application.  (d)(1) Credit shall be allowed when the reinsurance is ceded to an assuming insurer that is domiciled in, or in the case of a United States branch of an alien assuming insurer is entered through, a state that employs standards regarding credit for reinsurance substantially similar to those applicable under this statute and the assuming insurer or United States branch of an alien assuming insurer:  (i) Maintains a surplus regarding policyholders in an amount not less than twenty million dollars ($20,000,000); and  (ii) Submits to the authority of this state to examine its books and records.  (2) Provided, that the requirement of subsection (d)(1)(i) of this section does not apply to reinsurance ceded and assumed pursuant to pooling arrangements among insurers in the same holding company system.  (e)(1) Credit shall be allowed when the reinsurance is ceded to an assuming insurer that maintains a trust fund in a qualified United States financial institution, as defined in  27-1.1-3(b), for the payment of the valid claims of its United States ceding insurers, their assigns, and successors in interest. To enable the commissioner to determine the sufficiency of the trust fund, the assuming insurer shall report annually to the commissioner information substantially the same as that required to be reported on the National Association of Insurance Commissioners (NAIC) annual statement form by licensed insurers. The assuming insurer shall submit to examination of its books and records by the commissioner and bear the expense of examination.  (2)(i) Credit for reinsurance shall not be granted under this subsection unless the form of the trust and any amendments to the trust have been approved by:  (A) The commissioner of the state where the trust is domiciled; or  (B) The commissioner of another state who, pursuant to the terms of the trust instrument, has accepted principal regulatory oversight of the trust.  (ii) The form of the trust and any trust amendments shall also be filed with the commissioner of every state in which the ceding insurer beneficiaries of the trust are domiciled. The trust instrument shall provide that contested claims shall be valid and enforceable upon the final order of any court of competent jurisdiction in the United States. The trust shall vest legal title to its assets in its trustees for the benefit of the assuming insurers United States ceding insurers, their assigns, and successors in interest. The trust and the assuming insurer shall be subject to examination as determined by the commissioner.  (iii) The trust shall remain in effect for as long as the assuming insurer has outstanding obligations due under the reinsurance agreements subject to the trust. No later than February 28 of each year the trustee of the trust shall report to the commissioner in writing the balance of the trust and listing the trusts investments at the preceding year end and shall certify the date of termination of the trust, if so planned, or certify that the trust will not expire prior to the following December 31.  (3) The following requirements apply to the following categories of assuming insurer:  (i) The trust fund for a single assuming insurer shall consist of funds in trust in an amount not less than the assuming insurers liabilities attributable to reinsurance ceded by United States ceding insurers, and, in addition, the assuming insurer shall maintain a trusteed surplus of not less than twenty million dollars ($20,000,000), except as provided in subsection (e)(3)(ii);  (ii) At any time after the assuming insurer has permanently discontinued underwriting new business secured by the trust for at least three (3) full years, the commissioner with principal regulatory oversight of the trust may authorize a reduction in the required trusteed surplus, but only after a finding, based on an assessment of the risk, that the new required surplus level is adequate for the protection of United States ceding insurers, policyholders, and claimants in light of reasonably foreseeable adverse loss development. The risk assessment may involve an actuarial review, including an independent analysis of reserves and cash flows, and shall consider all material risk factors, including, when applicable, the lines of business involved; the stability of the incurred loss estimates; and the effect of the surplus requirements on the assuming insurers liquidity or solvency. The minimum required trusteed surplus may not be reduced to an amount less than thirty percent (30%) of the assuming insurers liabilities attributable to reinsurance ceded by United States ceding insurers covered by the trust;  (iii)(A) In the case of a group including incorporated and individual unincorporated underwriters:  (I) For reinsurance ceded under reinsurance agreements with an inception, amendment or renewal date on or after January 1, 1993, the trust shall consist of a trusteed account in an amount not less than the respective underwriters several liabilities attributable to business ceded by United States domiciled ceding insurers to any underwriter of the group;  (II) For reinsurance ceded under reinsurance agreements with an inception date on or before December 31, 1992, and not amended or renewed after that date, notwithstanding the other provisions of this chapter, the trust shall consist of a trusteed account in an amount not less than the respective underwriters several insurance and reinsurance liabilities attributable to business written in the United States;  (III) In addition to these trusts, the group shall maintain in trust a trusteed surplus of which one hundred million dollars ($100,000,000) shall be held jointly for the benefit of the United States domiciled ceding insurers of any member of the group for all years of account;  (B) The incorporated members of the group shall not be engaged in any business other than underwriting as a member of the group and shall be subject to the same level of regulation and solvency control by the groups domiciliary regulator as are the unincorporated members;  (C) Within ninety (90) days after its financial statements are due to be filed with the groups domiciliary regulator, the group shall provide to the commissioner an annual certification by the groups domiciliary regulator of the solvency of each underwriter member; or if a certification is unavailable, financial statements, prepared by independent public accountants, of each underwriter member of the group; and  (iv) In the case of a group of incorporated underwriters under common administration the group shall:  (A) Have continuously transacted an insurance business outside the United States for at least three (3) years immediately prior to making application for accreditation;  (B) Maintain an aggregate policyholders surplus of ten billion dollars ($10,000,000,000);  (C) Maintain a trust fund in an amount not less than the groups several liabilities attributable to business ceded by United States domiciled ceding insurers to any member of the group pursuant to reinsurance contracts issued in the name of the group;  (D) In addition, maintain a joint trusteed surplus of which one hundred million dollars ($100,000,000) shall be held jointly for the benefit of United States domiciled ceding insurers of any member of the group as additional security for these liabilities; and  (E) Within ninety (90) days after its financial statements are due to be filed with the groups domiciliary regulator, make available to the commissioner an annual certification of each underwriter members solvency by the members domiciliary regulator and financial statements of each underwriter member of the group prepared by its independent public accountant.  (f) Credit shall be allowed when the reinsurance is ceded to an assuming insurer that has been certified by the commissioner as a reinsurer in this state and secures its obligations in accordance with the requirements of this subsection.  (1) In order to be eligible for certification, the assuming insurer shall meet the following requirements:  (i) The assuming insurer must be domiciled and licensed to transact insurance or reinsurance in a qualified jurisdiction, as determined by the commissioner pursuant to paragraph (f)(3) of this subsection;  (ii) The assuming insurer must maintain minimum capital and surplus, or its equivalent, in an amount to be determined by the commissioner pursuant to regulation;  (iii) The assuming insurer must maintain financial strength ratings from two or more rating agencies deemed acceptable by the commissioner pursuant to regulation;  (iv) The assuming insurer must agree to submit to the jurisdiction of this state, appoint the commissioner as its agent for service of process in this state, and agree to provide security for one hundred percent (100%) of the assuming insurers liabilities attributable to reinsurance ceded by United States ceding insurers if it resists enforcement of a final United States judgment;  (v) The assuming insurer must agree to meet applicable information filing requirements as determined by the commissioner, both with respect to an initial application for certification and on an ongoing basis; and  (vi) The assuming insurer must satisfy any other requirements for certification deemed relevant by the commissioner.  (2) An association including incorporated and individual unincorporated underwriters may be a certified reinsurer. In order to be eligible for certification, in addition to satisfying requirements of subsection (f)(1) above:  (i) The association shall satisfy its minimum capital and surplus requirements through the capital and surplus equivalents (net of liabilities) of the association and its members, which shall include a joint central fund that may be applied to any unsatisfied obligation of the association or any of its members, in an amount determined by the commissioner to provide adequate protection;  (ii) The incorporated members of the association shall not be engaged in any business other than underwriting as a member of the association and shall be subject to the same level of regulation and solvency control by the associations domiciliary regulator as are the unincorporated members; and  (iii) Within ninety (90) days after its financial statements are due to be filed with the associations domiciliary regulator, the association shall provide to the commissioner an annual certification by the associations domiciliary regulator of the solvency of each underwriter member; or if a certification is unavailable, financial statements, prepared by independent public accountants, of each underwriter member of the association.  (3) The commissioner shall create and publish a list of qualified jurisdictions, under which an assuming insurer licensed and domiciled in such jurisdiction is eligible to be considered for certification by the commissioner as a certified reinsurer.  (i) In order to determine whether the domiciliary jurisdiction of a non-United States assuming insurer is eligible to be recognized as a qualified jurisdiction, the commissioner shall evaluate the appropriateness and effectiveness of the reinsurance supervisory system of the jurisdiction, both initially and on an ongoing basis, and consider the rights, benefits, and the extent of reciprocal recognition afforded by the non-United States jurisdiction to reinsurers licensed and domiciled in the United States. A qualified jurisdiction must agree to share information and cooperate with the commissioner with respect to all certified reinsurers domiciled within that jurisdiction. A jurisdiction may not be recognized as a qualified jurisdiction if the commissioner has determined that the jurisdiction does not adequately and promptly enforce final United States judgments and arbitration awards. Additional factors may be considered in the discretion of the commissioner;  (ii) A list of qualified jurisdictions shall be published through the NAIC committee process. The commissioner shall consider this list in determining qualified jurisdictions. If the commissioner approves a jurisdiction as qualified that does not appear on the list of qualified jurisdictions, the commissioner shall provide thoroughly documented justification in accordance with criteria to be developed under regulations;  (iii) United States jurisdictions that meet the requirement for accreditation under the NAIC financial standards and accreditation program shall be recognized as qualified jurisdictions; and  (iv) If a certified reinsurers domiciliary jurisdiction ceases to be a qualified jurisdiction, the commissioner has the discretion to suspend the reinsurers certification indefinitely, in lieu of revocation.  (4) The commissioner shall assign a rating to each certified reinsurer, giving due consideration to the financial strength ratings that have been assigned by rating agencies deemed acceptable to the commissioner pursuant to regulation. The commissioner shall publish a list of all certified reinsurers and their ratings.  (5) A certified reinsurer shall secure obligations assumed from United States ceding insurers under this subsection at a level consistent with its rating, as specified in regulations promulgated by the commissioner.  (i) In order for a domestic ceding insurer to qualify for full financial statement credit for reinsurance ceded to a certified reinsurer, the certified reinsurer shall maintain security in a form acceptable to the commissioner and consistent with the provisions of section (3), or in a multi-beneficiary trust in accordance with subsection (e) of this section, except as otherwise provided in this subsection;  (ii) If a certified reinsurer maintains a trust to fully secure its obligations subject to subsection (e) of this section, and chooses to secure its obligations incurred as a certified reinsurer in the form of a multi-beneficiary trust, the certified reinsurer shall maintain separate trust accounts for its obligations incurred under reinsurance agreements issued or renewed as a certified reinsurer with reduced security as permitted by this subsection or comparable laws of other United States jurisdictions and for its obligations subject to subsection (e) of this section. It shall be a condition to the grant of certification under subsection (f) of this section that the certified reinsurer shall have bound itself, by the language of the trust and agreement with the commissioner with principal regulatory oversight of each such trust account, to fund, upon termination of any such trust account, out of the remaining surplus of such trust any deficiency of any other such trust account;  (iii) The minimum trusteed surplus requirements provided in subsection (e) are not applicable with respect to a multi-beneficiary trust maintained by a certified reinsurer for the purpose of securing obligations incurred under this subsection, except that such trust shall maintain a minimum trusteed surplus of ten million dollars ($10,000,000);  (iv) With respect to obligations incurred by a certified reinsurer under this subsection, if the security is insufficient, the commissioner shall reduce the allowable credit by an amount proportionate to the deficiency, and has the discretion to impose further reductions in allowable credit upon finding that there is a material risk that the certified reinsurers obligations will not be paid in full when due; and  (v) For purposes of this subsection, a certified reinsurer whose certification has been terminated for any reason shall be treated as a certified reinsurer required to secure one hundred percent (100%) of its obligations.  (A) As used in this subsection, the term terminated refers to revocation, suspension, voluntary surrender and inactive status; and  (B) If the commissioner continues to assign a higher rating as permitted by other provisions of this section, this requirement does not apply to a certified reinsurer in inactive status or to a reinsurer whose certification has been suspended.  (6) If an applicant for certification has been certified as a reinsurer in an NAIC-accredited jurisdiction, the commissioner has the discretion to defer to that jurisdictions certification, and has the discretion to defer to the rating assigned by that jurisdiction, and such assuming insurer shall be considered to be a certified reinsurer in this state.  (7) A certified reinsurer that ceases to assume new business in this state may request to maintain its certification in inactive status in order to continue to qualify for a reduction in security for its in-force business. An inactive certified reinsurer shall continue to comply with all applicable requirements of this subsection, and the commissioner shall assign a rating that takes into account, if relevant, the reasons why the reinsurer is not assuming new business.  (g)(1) Credit shall be allowed when the reinsurance is ceded to an assuming insurer, meeting each of the conditions set forth below.  (i) The assuming insurer must have its head office or be domiciled in, as applicable, and be licensed in a reciprocal jurisdiction. A reciprocal jurisdiction is a jurisdiction that meets one of the following:  (A) A non-United States jurisdiction that is subject to an in-force covered agreement with the United States, each within its legal authority, or, in the case of a covered agreement between the United States and European Union, is a member state of the European Union. For purposes of this subsection, a covered agreement is an agreement entered into, pursuant to the Dodd-Frank Wall Street Reform and Consumer Protection Act, 31 U.S.C.  313 and 314, that is currently in effect or in a period of provisional application and addresses the elimination, under specified conditions, of collateral requirements, as a condition for entering into any reinsurance agreement with a ceding insurer domiciled in this state or for allowing the ceding insurer to recognize credit for reinsurance;  (B) A United States jurisdiction that meets the requirements for accreditation under the NAIC financial standards and accreditation program; or  (C) A qualified jurisdiction, as determined by the commissioner pursuant to subsection (f)(3) of this section, that is not otherwise described in subsection (g)(1)(i)(A) or (g)(1)(i)(B) of this section and that meets certain additional requirements, consistent with the terms and conditions of in-force covered agreements, as specified by the commissioner in regulation.  (ii) The assuming insurer must have and maintain, on an ongoing basis, minimum capital and surplus, or its equivalent, calculated according to the methodology of its domiciliary jurisdiction, in an amount to be set forth in regulation. If the assuming insurer is an association, including incorporated and individual unincorporated underwriters, it must have and maintain, on an ongoing basis, minimum capital and surplus equivalents (net of liabilities), calculated according to the methodology applicable in its domiciliary jurisdiction, and a central fund containing a balance in amounts to be set forth in regulation.  (iii) The assuming insurer must have and maintain, on an ongoing basis, a minimum solvency or capital ratio, as applicable, that will be set forth in regulation. If the assuming insurer is an association, including incorporated and individual unincorporated underwriters, it must have and maintain, on an ongoing basis, a minimum solvency or capital ratio in the reciprocal jurisdiction where the assuming insurer has its head office or is domiciled, as applicable, and is also licensed.  (iv) The assuming insurer must agree and provide adequate assurance to the commissioner, in a form specified by the commissioner, pursuant to regulation, as follows:  (A) The assuming insurer must provide prompt written notice and explanation to the commissioner, if it falls below the minimum requirements set forth in subsections (g)(1)(ii) or (g)(1)(iii) of this section, or if any regulatory action is taken against it, for serious noncompliance with applicable law;  (B) The assuming insurer must consent in writing to the jurisdiction of the courts of this state and to the appointment of the commissioner as agent for service of process. The commissioner may require that consent for service of process be provided to the commissioner and included in each reinsurance agreement. Nothing in this provision shall limit, or in any way alter, the capacity of parties to a reinsurance agreement to agree to alternative dispute resolution mechanisms, except to the extent the agreements are unenforceable under applicable insolvency or delinquency laws;  (C) The assuming insurer must consent in writing to pay all final judgments, wherever enforcement is sought, obtained by a ceding insurer or its legal successor, that have been declared enforceable in the jurisdiction where the judgment was obtained;  (D) Each reinsurance agreement must include a provision requiring the assuming insurer to provide security in an amount equal to one hundred percent (100%) of the assuming insurers liabilities, attributable to reinsurance ceded pursuant to that agreement, if the assuming insurer resists enforcement of a final judgment that is enforceable under the law of the jurisdiction in which it was obtained or a properly enforceable arbitration award, whether obtained by the ceding insurer or by its legal successor on behalf of its resolution estate; and  (E) The assuming insurer must confirm that it is not presently participating in any solvent scheme of arrangement that involves this states ceding insurers, and agree to notify the ceding insurer and the commissioner and to provide security in an amount equal to one hundred percent (100%) of the assuming insurers liabilities to the ceding insurer, should the assuming insurer enter into such a solvent scheme of arrangement. Such security shall be in a form consistent with the provisions of subsection (f) of this section and  27-1.1-2 and as specified by the commissioner in regulation.  (v) The assuming insurer or its legal successor must provide, if requested by the commissioner, on behalf of itself and any legal predecessors, certain documentation to the commissioner, as specified by the commissioner in regulation.  (vi) The assuming insurer must maintain a practice of prompt payment of claims under reinsurance agreements, pursuant to criteria set forth in regulation.  (vii) The assuming insurers supervisory authority must confirm to the commissioner on an annual basis, as of the preceding December 31 or at the annual date otherwise statutorily reported to the reciprocal jurisdiction, that the assuming insurer complies with the requirements set forth in subsections (g)(1)(ii) and (g)(1)(iii) of this section.  (viii) Nothing in this provision precludes an assuming insurer from providing the commissioner with information on a voluntary basis.  (2) The commissioner shall timely create and publish a list of reciprocal jurisdictions.  (i) A list of reciprocal jurisdictions is published through the NAIC committee process. The commissioners list shall include any reciprocal jurisdiction as defined under subsections (g)(1)(i)(A) and (g)(1)(i)(B) of this section, and shall consider any other reciprocal jurisdiction included on the NAIC list. The commissioner may approve a jurisdiction that does not appear on the NAIC list of reciprocal jurisdictions, in accordance with criteria to be developed under regulations issued by the commissioner.  (ii) The commissioner may remove a jurisdiction from the list of reciprocal jurisdictions, upon a determination that the jurisdiction no longer meets the requirements of a reciprocal jurisdiction, in accordance with a process set forth in regulations issued by the commissioner, except that the commissioner shall not remove from the list a reciprocal jurisdiction as defined under subsections (g)(1)(i)(A) and (g)(1)(i)(B) of this section. Upon removal of a reciprocal jurisdiction from this list, credit for reinsurance ceded to an assuming insurer which has its home office or is domiciled in that jurisdiction shall be allowed, if otherwise allowed pursuant to this chapter.  (3) The commissioner shall timely create and publish a list of assuming insurers that have satisfied the conditions set forth in this subsection and to which cessions shall be granted credit in accordance with this subsection. The commissioner may add an assuming insurer to such list, if an NAIC accredited jurisdiction has added such assuming insurer to a list of such assuming insurers or if, upon initial eligibility, the assuming insurer submits the information to the commissioner, as required under subsection (g)(1)(iv) of this section and complies with any additional requirements that the commissioner may impose by regulation, except to the extent that they conflict with an applicable covered agreement.  (4) If the commissioner determines that an assuming insurer no longer meets one or more of the requirements under this subsection, the commissioner may revoke or suspend the eligibility of the assuming insurer for recognition under this subsection in accordance with procedures set forth in regulation.  (i) While an assuming insurers eligibility is suspended, no reinsurance agreement issued, amended, or renewed after the effective date of the suspension qualifies for credit except to the extent that the assuming insurers obligations under the contract are secured in accordance with  27-1.1-2.  (ii) If an assuming insurers eligibility is revoked, no credit for reinsurance may be granted after the effective date of the revocation, with respect to any reinsurance agreements entered into by the assuming insurer, including reinsurance agreements entered into prior to the date of revocation, except to the extent that the assuming insurers obligations, under the contract, are secured in a form acceptable to the commissioner and consistent with the provisions of  27-1.1-2.  (5) If subject to a legal process of rehabilitation, liquidation, or conservation, as applicable, the ceding insurer, or its representative, may seek and, if determined appropriate by the court in which the proceedings are pending, may obtain an order requiring that the assuming insurer post security for all outstanding ceded liabilities.  (6) Nothing in this subsection shall limit or in any way alter the capacity of parties to a reinsurance agreement to agree on requirements for security or other terms in that reinsurance agreement, except as expressly prohibited by this chapter or other applicable law or regulation.  (7) Credit may be taken under this subsection only for reinsurance agreements entered into, amended, or renewed on or after the effective date of the statute adding this subsection, and only with respect to losses incurred and reserves reported on or after the later of:  (i) The date on which the assuming insurer has met all eligibility requirements, pursuant to subsection (g)(1) of this section; and  (ii) The effective date of the new reinsurance agreement, amendment, or renewal.  (A) This subsection (g)(7) does not alter or impair a ceding insurers right to take credit for reinsurance, to the extent that credit is not available under this subsection, as long as the reinsurance qualifies for credit, under any other applicable provision of this chapter.  (B) Nothing in this subsection shall authorize an assuming insurer to withdraw or reduce the security provided under any reinsurance agreement, except as permitted by the terms of the agreement.  (C) Nothing in this subsection shall limit, or in any way alter, the capacity of parties to any reinsurance agreement to renegotiate the agreement.  (h) Credit shall be allowed when the reinsurance is ceded to an assuming insurer not meeting the requirements of subsections (b), (c), (d), (e), (f), or (g) of this section, but only as to the insurance of risks located in jurisdictions where the reinsurance is required by applicable law or regulation of that jurisdiction.  (i) If the assuming insurer is not licensed, accredited, or certified to transact insurance or reinsurance in this state, the credit permitted by subsections (d) and (e) of this section shall not be allowed unless the assuming insurer agrees in the reinsurance agreements:  (1)(i) That in the event of the failure of the assuming insurer to perform its obligations under the terms of the reinsurance agreement, the assuming insurer, at the request of the ceding insurer, shall submit to the jurisdiction of any court of competent jurisdiction in any state of the United States, will comply with all requirements necessary to give the court jurisdiction, and will abide by the final decision of the court or of any appellate court in the event of an appeal; and  (ii) To designate the commissioner or a designated attorney as its true and lawful attorney upon whom may be served any lawful process in any action, suit, or proceeding instituted by or on behalf of the ceding insurer.  (2) This subsection is not intended to conflict with or override the obligation of the parties to a reinsurance agreement to arbitrate their disputes, if this obligation is created in the agreement.  (j) If the assuming insurer does not meet the requirements of subsections (b), (c), (d), or (g), the credit permitted by subsection (e) or (f) of this section shall not be allowed unless the assuming insurer agrees in the trust agreements to the following conditions:  (1) Notwithstanding any other provisions in the trust instrument, if the trust fund is inadequate because it contains an amount less than the amount required by subsection (e)(3) of this section, or if the grantor of the trust has been declared insolvent or placed into receivership, rehabilitation, liquidation, or similar proceedings under the laws of its state or country of domicile, the trustee shall comply with an order of the commissioner with regulatory oversight over the trust or with an order of a court of competent jurisdiction directing the trustee to transfer to the commissioner with regulatory oversight all of the assets of the trust fund;  (2) The assets shall be distributed by and claims shall be filed with and valued by the commissioner with regulatory oversight in accordance with the laws of the state in which the trust is domiciled that are applicable to the liquidation of domestic insurance companies;  (3) If the commissioner with regulatory oversight determines that the assets of the trust fund or any part thereof are not necessary to satisfy the claims of the United States ceding insurers of the grantor of the trust, the assets or part thereof shall be returned by the commissioner with regulatory oversight to the trustee for distribution in accordance with the trust agreement; and  (4) The grantor shall waive any right otherwise available to it under United States law that is inconsistent with this provision.  (k) If an accredited or certified reinsurer ceases to meet the requirements for accreditation or certification, the commissioner may suspend or revoke the reinsurers accreditation or certification.  (1) The commissioner must give the reinsurer notice and opportunity for hearing. The suspension or revocation may not take effect until after the commissioners order on hearing, unless:  (i) The reinsurer waives its right to hearing;  (ii) The commissioners order is based on regulatory action by the reinsurers domiciliary jurisdiction or the voluntary surrender or termination of the reinsurers eligibility to transact insurance or reinsurance business in its domiciliary jurisdiction or in the primary certifying state of the reinsurer under subparagraph (f)(6) of this section; or  (iii) The commissioner finds that an emergency requires immediate action and a court of competent jurisdiction has not stayed the commissioners action.  (2) While a reinsurers accreditation or certification is suspended, no reinsurance contract issued or renewed after the effective date of the suspension qualifies for credit except to the extent that the reinsurers obligations under the contract are secured in accordance with  27-1.1-2. If a reinsurers accreditation or certification is revoked, no credit for reinsurance may be granted after the effective date of the revocation except to the extent that the reinsurers obligations under the contract are secured in accordance with subsection (f)(5) or  27-1.1-2.  (l) Concentration Risk. (1) A ceding insurer shall take steps to manage its reinsurance recoverables proportionate to its own book of business. A domestic ceding insurer shall notify the commissioner within thirty (30) days after reinsurance recoverables from any single assuming insurer, or group of affiliated assuming insurers, exceeds fifty percent (50%) of the domestic ceding insurers last reported surplus to policyholders, or after it is determined that reinsurance recoverables from any single assuming insurer, or group of affiliated assuming insurers, is likely to exceed this limit. The notification shall demonstrate that the exposure is safely managed by the domestic ceding insurer.  (2) A ceding insurer shall take steps to diversify its reinsurance program. A domestic ceding insurer shall notify the commissioner within thirty (30) days after ceding to any single assuming insurer, or group of affiliated assuming insurers, more than twenty percent (20%) of the ceding insurers gross written premium in the prior calendar year, or after it has determined that the reinsurance ceded to any single assuming insurer, or group of affiliated assuming insurers, is likely to exceed this limit. The notification shall demonstrate that the exposure is safely managed by the domestic ceding insurer.  History of Section.P.L. 1991, ch. 257,  1; P.L. 1991, ch. 348,  1; P.L. 1993, ch. 180,  26; P.L. 1994, ch. 404,  15; P.L. 1999, ch. 22,  2; P.L. 2013, ch. 84,  1; P.L. 2013, ch. 91,  1; P.L. 2017, ch. 389,  1; P.L. 2017, ch. 434,  1; P.L. 2021, ch. 230,  1, effective July 8, 2021; P.L. 2021, ch. 231,  1, effective July 8, 2021. 
 27-1.1-10. Payment by assuming company. (a) No credit shall be allowed for reinsurance unless the reinsurance agreement provides that payments by the assuming company shall be made directly to the ceding company or to its liquidator, receiver, or statutory successor, except where the contract specifically provides direct payment of the reinsurance to the insured or a claimant on behalf of the insured in the event of the insolvency of the ceding company, or where the assuming company, with the consent of the direct insured or insureds, has assumed the policy obligations of the ceding company to the payees under the policies and in substitution for the obligations of the ceding company to the payees.  (b) Except as provided in this section, no assuming company may pay or settle, or agree to pay or settle, any policy claim, or any portion of a claim, directly to or with a policyholder of any ceding company if an order of rehabilitation or liquidation has been entered against the ceding company.  History of Section.P.L. 2015, ch. 82,  18; P.L. 2015, ch. 105,  18. 
 27-1.1-2. Asset or reduction from liability for reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of 27-1.1-1. An asset or a reduction from liability for the reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of  27-1.1-1 shall be allowed in an amount not exceeding the liabilities carried by the ceding insurer; provided, further, that the commissioner may adopt by regulation pursuant to  27-1.1-4 specific additional requirements relating to or setting forth:  (1) The valuation of assets or reserve credits;  (2) The amount and forms of security supporting reinsurance arrangements described in  27-1.1-4; and  (3) The circumstances pursuant to which credit will be reduced or eliminated.  The reduction shall be in the amount of funds held by or on behalf of the ceding insurer, including funds held in trust for the ceding insurer, under a reinsurance contract with the assuming insurer as security for the payment of obligations thereunder, if the security is held in the United States subject to withdrawal solely by, and under the exclusive control of, the ceding insurer, or, in the case of a trust, held in a qualified United States financial institution as defined in  27-1.1-3(b). This security may be in the form of:  (1) Cash;  (2) Securities listed by the securities valuation office of the National Association of Insurance Commissioners, including those deemed exempt from filing as defined by the Purposes and Procedures Manual of the Securities Valuation Office, and qualifying as admitted assets;  (3)(i) Clean, irrevocable, unconditional letters of credit, issued or confirmed by a qualified United States financial institution as defined in  27-1.1-3(a), no later than December 31st of the year for which the filing is being made, and in the possession of, or in trust for, the ceding insurer on or before the filing date of its annual statement.  (ii) Letters of credit meeting applicable standards of issuer acceptability as of the dates of their issuance or confirmation shall, notwithstanding the issuing or confirming institutions subsequent failure to meet applicable standards of issuer acceptability, continue to be acceptable as security until their expiration, extension, renewal, modification, or amendment, whichever first occurs; or  (4) Any other form of security acceptable to the commissioner.  History of Section.P.L. 1991, ch. 257,  1; P.L. 1991, ch. 348,  1; P.L. 2013, ch. 84,  2; P.L. 2013, ch. 91,  2; P.L. 2017, ch. 389,  1; P.L. 2017, ch. 434,  1. 
 27-1.1-3. Qualified United States financial institutions. (a) For the purposes of  27-1.1-2(3), qualified United States financial institution means an institution that:  (1) Is organized, or in the case of a U.S. office of a foreign banking organization is licensed, under the laws of the United States or any of its states;  (2) Is regulated, supervised, and examined by United States federal or state authorities having regulatory authority over banks and trust companies; and  (3) Has been determined by either the commissioner or the securities valuation office of the National Association of Insurance Commissioners to meet those standards of financial condition and that are considered necessary and appropriate to regulate the quality of financial institutions whose letters of credit will be acceptable to the commissioner.  (b) Qualified United States financial institution means, for the purposes of those provisions of this law specifying those institutions that are eligible to act as a fiduciary of a trust, an institution that:  (1) Is organized, or in the case of a United States branch or agency office of a foreign banking organization is licensed, under the laws of the United States or any of its states and has been granted authority to operate with fiduciary powers; and  (2) Is regulated, supervised, and examined by federal or state authorities having regulatory authority over banks and trust companies.  History of Section.P.L. 1991, ch. 257,  1; P.L. 1991, ch. 348,  1. 
 27-1.1-4. Rules and regulations. (a) The commissioner may adopt reasonable rules and regulations implementing the provisions of this law.  (b) The commissioner is further authorized to adopt rules and regulations applicable to reinsurance arrangements described in subsection (b)(1) of this section.  (1) A regulation adopted pursuant to this section may apply only to reinsurance relating to:  (i) Life insurance policies with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits;  (ii) Universal life insurance policies with provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period;  (iii) Variable annuities with guaranteed death or living benefits;  (iv) Long-term-care insurance policies; or  (v) Other life and health insurance and annuity products as to which the NAIC adopts model regulatory requirements with respect to credit for reinsurance.  (2) A regulation adopted pursuant to subsection (b)(1)(i) or (b)(1)(ii) of this section may apply to any treaty containing:  (i) Policies issued on or after January 1, 2015; and  (ii) Policies issued prior to January 1, 2015, if risk pertaining to the pre-2015 policies is ceded in connection with the treaty, in whole or in part, on or after January 1, 2015.  (3) A regulation adopted pursuant to subsection (b) of this section may require the ceding insurer, in calculating the amounts or forms of security required to be held under regulations promulgated under this authority, to use the Valuation Manual adopted by the NAIC under Section 11B(1) of the NAIC Standard Valuation Law, including all amendments adopted by the NAIC and in effect on the date as of which the calculation is made, to the extent applicable.  (4) A regulation adopted pursuant to subsection (b) of this section shall not apply to cessions to an assuming insurer that:  (i) Meets the conditions set forth in  27-1.1-1(g); or  (ii) Is certified in this state; or  (iii) Maintains at least two hundred fifty million dollars ($250,000,000) in capital and surplus when determined in accordance with the NAIC Accounting Practices and Procedures Manual, including all amendments thereto adopted by the NAIC, excluding the impact of any permitted or prescribed practices; and is:  (A) Licensed in at least twenty-six (26) states; or  (B) Licensed in at least ten (10) states, and licensed or accredited in a total of at least thirty-five (35) states.  (5) The authority to adopt regulations pursuant to subsection (b) of this section does not limit the commissioners general authority to adopt regulations pursuant to subsection (a) of this section.  History of Section.P.L. 1991, ch. 257,  1; P.L. 1991, ch. 348,  1; P.L. 2002, ch. 292,  6; P.L. 2017, ch. 389,  1; P.L. 2017, ch. 434,  1; P.L. 2021, ch. 230,  1, effective July 8, 2021; P.L. 2021, ch. 231,  1, effective July 8, 2021. 
 27-1.1-5. Reinsurance agreements affected. This chapter shall apply to all cessions after the effective date of this chapter under reinsurance agreements that have an inception, anniversary, or renewal date not less than six (6) months after the effective date of this chapter.  History of Section.P.L. 1991, ch. 257,  1; P.L. 1991, ch. 348,  1; P.L. 1993, ch. 180,  26; P.L. 2013, ch. 84,  2; P.L. 2013, ch. 91,  2. 
 27-1.1-6. Repealed. History of Section.P.L. 1993, ch. 180,  27; Repealed by P.L. 2013, ch. 84,  4, effective June 17, 2013; P.L. 2013, ch. 91,  4, effective June 17, 2013. 
 27-1.1-7. Repealed. History of Section.P.L. 1993, ch. 180,  27; Repealed by P.L. 2013, ch. 84,  4, effective June 17, 2013; P.L. 2013, ch. 91,  4, effective June 17, 2013. 
 27-1.1-8. Repealed.
 27-1.1-9. Asset or deduction from liability. No credit shall be allowed as an admitted asset or as a deduction from liability to any ceding company for reinsurance unless the reinsurance is payable by the assuming company on the basis of the liability of the ceding company under the contractor contracts reinsured without diminution because of the insolvency of the ceding company.  History of Section.P.L. 2015, ch. 82,  18; P.L. 2015, ch. 105,  18. 
 27-1.2-1. Purpose and scope. (a) The purpose of this chapter is to:  (1) Provide the insurance commissioner a summary of an insurer or insurance groups corporate governance structure, policies, and practices to permit the commissioner to obtain and maintain an understanding of the insurers corporate governance framework;  (2) Outline the requirements for completing a corporate governance annual disclosure with the insurance commissioner; and  (3) Provide for the confidential treatment of the corporate governance annual disclosure and related information that will contain private, confidential, and sensitive information related to an insurer or insurance groups internal operations and proprietary and trade secret information which, if made public, could potentially cause the insurer or insurance group competitive harm or disadvantage.  (b) Nothing in this chapter shall be construed to prescribe or impose additional corporate governance standards and internal procedures beyond that which is required under applicable state corporate and insurance laws. This chapter shall not be construed to limit the commissioners authority, or the rights or obligations of third parties, under chapter 13.1 of this title.  (c) The requirements of this chapter shall apply to all insurers domiciled in this state.  History of Section.P.L. 2016, ch. 98,  1; P.L. 2016, ch. 107,  1. 
 27-1.2-2. Definitions. As used in this chapter: (1) Commissioner means the director of the department of business regulation and any assistant to the director.  (2) Corporate governance annual disclosure (CGAD) means a confidential report filed by the insurer or insurance group made as required by this chapter.  (3) Insurance group means those insurers and affiliates included within an insurance holding company system as defined in chapter 35 of this title.  (4) Insurer shall have the same meaning as set forth in  27-54.1-1, except that it shall not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state.  (5) ORSA summary report means the report filed in accordance with chapter 77 of this title.  History of Section.P.L. 2016, ch. 98,  1; P.L. 2016, ch. 107,  1. 
 27-1.2-3. Disclosure requirement. (a) An insurer, or the insurance group of which the insurer is a member, shall, no later than June 1 of each calendar year, submit to the commissioner a corporate governance annual disclosure (CGAD) that contains the information described in this section and  27-1.2-5(b). Notwithstanding any request from the commissioner made pursuant to subsection (c), if the insurer is a member of an insurance group, the insurer shall submit the report required by this section to the commissioner of the lead state for the insurance group, in accordance with the laws of the lead state, as determined by the procedures outlined in the most recent Financial Analysis Handbook adopted by the National Association of Insurance Commissioner (NAIC).  (b) The CGAD must include a signature of the insurer or insurance groups chief executive officer or corporate secretary attesting to the best of that individuals belief and knowledge that the insurer has implemented the corporate governance practices and that a copy of the disclosure has been provided to the insurers board of directors or the appropriate committee thereof.  (c) An insurer not otherwise required to submit a CGAD under this section shall do so upon the commissioners request.  (d) For purposes of completing the CGAD, the insurer or insurance group may provide information regarding corporate governance at the ultimate controlling parent level, an intermediate holding company level and/or the individual legal entity level, depending upon how the insurer or insurance group has structured its system of corporate governance. The insurer or insurance group is encouraged to make the CGAD disclosures at the level at which the insurers or insurance groups risk appetite is determined; or at which the earnings, capital, liquidity, operations, and reputation of the insurer are overseen collectively and at which the supervision of those factors are coordinated and exercised; or the level at which legal liability for failure of general corporate governance duties would be placed. If the insurer or insurance group determines the level of reporting based on these criteria, it shall indicate which of the three (3) criteria was used to determine the level of reporting and explain any subsequent changes in level of reporting.  (e) The review of the CGAD and any additional requests for information shall be made through the lead state as determined by the procedures within the most recent Financial Analysis Handbook referenced in subsection (a).  (f) Insurers providing information substantially similar to the information required by this chapter in other documents provided to the commissioner, including proxy statements filed in conjunction with form B requirements, or other state or federal filings provided to this division of insurance shall not be required to duplicate that information in the CGAD, but shall only be required to cross reference the document in which the information is included.  History of Section.P.L. 2016, ch. 98,  1; P.L. 2016, ch. 107,  1. 
 27-1.2-4. Rules and regulations. The commissioner may, in accordance with the administrative procedures act, chapter 35 of title 42, issue such rules, regulations, and orders as shall be necessary to carry out the provisions of this chapter.  History of Section.P.L. 2016, ch. 98,  1; P.L. 2016, ch. 107,  1. 
 27-1.2-5. Contents of corporate governance annual disclosure. (a) The insurer or insurance group shall have discretion over the responses to the CGAD inquiries, provided the CGAD shall contain the material information necessary to permit the commissioner to obtain an understanding of the insurers or groups corporate governance structure, policies, and practices. The commissioner may request additional information that the commissioner deems material and necessary to provide the commissioner with a clear understanding of the corporate governance policies; the reporting or information system; or controls implementing those policies.  (b) Notwithstanding subsection (a), the CGAD shall be prepared consistent with the corporate governance annual disclosure regulation adopted by the division of insurance and supporting information shall be maintained and made available upon examination or upon request of the commissioner.  History of Section.P.L. 2016, ch. 98,  1; P.L. 2016, ch. 107,  1; P.L. 2017, ch. 451,  12. 
 27-1.2-6. Confidentiality. (a) Documents, materials, or other information, including the CGAD, in the possession or control of the division of insurance that are obtained by, created by, or disclosed to the commissioner or any other person under this chapter, are recognized by this state as being proprietary and to contain trade secrets. Subject to the disclosure requirements of  27-1.2-5(b), all such documents, materials, or other information shall be confidential by law and privileged; shall not be subject to access pursuant to chapter 2 of title 38; shall not be subject to subpoena; and shall not be subject to discovery or admissible in evidence in any private civil action. However, the commissioner is authorized to use the documents, materials, or other information in the furtherance of any regulatory or legal action brought as a part of the commissioners official duties. The commissioner shall not otherwise make the documents, materials, or other information public without the prior, written consent of the insurer. Nothing in this section shall be construed to require written consent of the insurer before the commissioner may share or receive confidential documents, materials, or other CGAD-related information pursuant to subsection (c) to assist in the performance of the commissioners regular duties.  (b) Neither the commissioner, nor any person who received documents, materials, or other CGAD-related information, through examination or otherwise, while acting under the authority of the commissioner, or with whom such documents, materials, or other information are shared pursuant to this chapter, shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subsection (a).  (c) In order to assist in the performance of the commissioners regulatory duties, the commissioner may:  (1) Upon request, share documents, materials, or other CGAD-related information, including the confidential and privileged documents, materials, or information subject to subsection (a), including proprietary and trade-secret documents and materials, with other state, federal, and international financial regulatory agencies, including members of any supervisory college, as described in  27-35-5.5, with the National Association of Insurance Commissioners (NAIC), and with third-party consultants pursuant to  27-1.2-7, provided that the recipient agrees in writing to maintain the confidentiality and privileged status of the CGAD-related documents, material, or other information and has verified in writing the legal authority to maintain confidentiality; and  (2) Receive documents, materials, or other CGAD-related information, including otherwise confidential and privileged documents, materials, or information, including proprietary and trade-secret information or documents, from regulatory officials of other state, federal, and international financial regulatory agencies, including members of any supervisory college, as described in  27-35-5.5, and from the NAIC, and shall maintain as confidential or privileged any documents, materials, or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information.  (d) The sharing of information and documents by the commissioner pursuant to this chapter shall not constitute a delegation of regulatory authority or rulemaking, and the commissioner is solely responsible for the administration, execution, and enforcement of the provisions of this chapter.  (e) No waiver of any applicable privilege or claim of confidentiality in the documents, proprietary, and trade-secret materials or other CGAD-related information shall occur as a result of disclosure of such CGAD-related information or documents to the commissioner under this section or as a result of sharing as authorized in this chapter.  History of Section.P.L. 2016, ch. 98,  1; P.L. 2016, ch. 107,  1. 
 27-1.2-7. NAIC and third-party consultants. (a) The commissioner may retain, at the insurers expense, third-party consultants, including attorneys, actuaries, accountants, and other experts, not otherwise a part of the commissioners staff, as may be reasonably necessary to assist the commissioner in reviewing the CGAD and related information or the insurers compliance with this chapter.  (b) Any persons retained pursuant to subsection (a) shall be under the direction and control of the commissioner and shall act in a purely advisory capacity.  (c) The National Association of Insurance Commissioners (NAIC) and third-party consultants shall be subject to the same confidentiality standards and requirements as the commissioner.  (d) As part of the retention process, a third-party consultant shall verify to the commissioner, with notice to the insurer, that it is free of a conflict of interest and that it has internal procedures in place to monitor compliance with a conflict and to comply with the confidentiality standards and requirements of this chapter.  (e) A written agreement with the NAIC and/or a third-party consultant governing sharing and use of information provided pursuant to this chapter shall contain the following provisions and expressly require the written consent of the insurer prior to making public information provided under this chapter:  (1) Specific procedures and protocols for maintaining the confidentiality and security of CGAD-related information shared with the NAIC or a third-party consultant pursuant to this chapter;  (2) Procedures and protocols for sharing by the NAIC only with other state regulators from states in which the insurance group has domiciled insurers. The agreement shall provide that the recipient agrees in writing to maintain the confidentiality and privileged status of the CGAD-related documents, materials or other information and has verified in writing the legal authority to maintain confidentiality;  (3) A provision specifying that ownership of the CGAD-related information shared with the NAIC or a third-party consultant remains with the division of insurance and the NAICs or third-party consultants use of the information is subject to the direction of the commissioner;  (4) A provision that prohibits the NAIC or a third-party consultant from storing the information shared pursuant to this chapter in a permanent database after the underlying analysis is completed;  (5) A provision requiring the NAIC or third-party consultant to provide prompt notice to the commissioner and to the insurer or insurance group regarding any subpoena, request for disclosure, or request for production of the insurers CGAD-related information; and  (6) A requirement that the NAIC or a third-party consultant consent to intervention by an insurer in any judicial or administrative action in which the NAIC or a third-party consultant may be required to disclose confidential information about the insurer shared with the NAIC or a third-party consultant pursuant to this chapter.  History of Section.P.L. 2016, ch. 98,  1; P.L. 2016, ch. 107,  1. 
 27-1.2-8. Sanctions. Any insurer failing, without just cause, to timely file the CGAD as required in this chapter shall be required, after notice and hearing, to pay a penalty of two hundred and fifty dollars ($250) for each days delay, to be recovered by the commissioner, and the penalty so recovered shall be paid into the general revenue fund of this state. The maximum penalty under this section is two hundred and fifty thousand dollars ($250,000). The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.  History of Section.P.L. 2016, ch. 98,  1; P.L. 2016, ch. 107,  1. 
 27-1.2-9. Severability clause. If any provision of this chapter other than  27-1.2-6, or the application thereof to any person or circumstance, is held invalid, such determination shall not affect the provisions or applications of this chapter which can be given effect without the invalid provision or application, and to that end the provisions of this chapter, with the exception of  27-1.2-6, are severable.  History of Section.P.L. 2016, ch. 98,  1; P.L. 2016, ch. 107,  1. 
 27-1-1.1. Telephone number  Toll free or collect. Every third party health insurer doing business within this state shall have a toll free telephone number or provide collect charge telephone service for use by the general public when calling the insurer from any location within the state.  History of Section.P.L. 1987, ch. 229,  1. 
 27-1-1. Site of principal office and records. (a) Every insurance company organized after May 3, 1956, under the laws of this state shall have its principal office and maintain all of its records, or duplicates of those records, in this state; provided, that the director of business regulation may, after a public hearing, allow any insurance company, upon application, to locate its principal office and maintain certain original records outside of this state if it is determined that it is not inconsistent with the public interest of the people of the state of Rhode Island. In determining what is not inconsistent with the public interest of the people of the state of Rhode Island, the director shall make findings of fact, reduced to writing and filed with the secretary of state, which findings shall include, but are not limited to the following:  (1) The number of full time employees currently located within the state, and the number of full time employees anticipated to be located within the state if the petition is granted;  (2) That no detriment nor prejudice will inure to any current or anticipated future policyholders of the company by granting the application;  (3) That the granting of the application is not inimical to the ability of policyholders to file claims with and against the company, and, in furtherance of this finding, may require that the company maintain a toll free number for registering claims, and may require a claims office to be located within the state, staffed by a person authorized to issue payment on behalf of the company on approved claims; and  (4) That a review of the financial records of the company and the records relied upon by the director in making the determination have satisfied the director that the company is able to meet its obligations to current policyholders. In the event that there is any risk associated with the granting the application the director may deny the application or may, in furtherance of the application, require the posting of bonds and/or securities with the general treasurer, in an amount to be determined by the director, sufficient to protect the interest of the policyholders within the state.  (b) The director is authorized to promulgate regulations as provided for by the Administrative Procedures Act, chapter 35 of title 42, not inconsistent with this section, in furtherance of the authority granted in this section.  History of Section.G.L. 1938, ch. 150,  41; P.L. 1956, ch. 3793,  1; G.L. 1956,  27-1-1; P.L. 1966, ch. 254,  1; P.L. 1976, ch. 280,  1; P.L. 1999, ch. 253,  1; P.L. 2002, ch. 292,  5. 
 27-1-10. State not liable for deposits. Nothing in this chapter shall be construed to render this state liable for the value of any stocks or other securities deposited by any insurance company according to the provisions of this chapter.  History of Section.G.L. 1896, ch. 181,  22; G.L. 1909, ch. 219,  22; G.L. 1923, ch. 255,  22; G.L. 1938, ch. 150,  21; G.L. 1956,  27-1-10. 
 27-1-11. Visitation and examination of insurance companies. The insurance commissioner shall, whenever requested by the governor, visit any insurance company incorporated in this state. He or she shall have free access to its vaults and all of its books and papers, and shall, if the insurance commissioner deems it expedient, thoroughly inspect and examine all of the affairs of the company and make all inquiries as may in the commissioners opinion be necessary to ascertain the condition of the company and its ability to fulfill all of its engagements, and whether it has complied with the provisions of law applicable to its transactions.  History of Section.G.L. 1896, ch. 181,  2; G.L. 1909, ch. 219,  2; G.L. 1923, ch. 255,  2; G.L. 1938, ch. 150,  1; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-1-11. 
 27-1-12. Summons of witnesses  Obstruction or refusal to testify. The insurance commissioner, or the commissioners duly authorized agent, may summon and examine under oath all directors, officers, and other agents of the insurance company and any other witnesses as the commissioner may think proper in relation to the affairs, transactions, and condition of the company. Any director, officer, agent, or other person who refuses without justifiable cause to appear and testify whenever required, or who in any way obstructs the commissioner or the commissioners agent in the discharge of his or her duties as prescribed in this chapter, shall be fined not exceeding five thousand dollars ($5,000) or be imprisoned not exceeding two (2) years, and if the person refusing or obstructing is a director, officer, or agent of the company, the company may also be proceeded against.  History of Section.G.L. 1896, ch. 181,  3; G.L. 1909, ch. 219,  3; G.L. 1923, ch. 255,  3; G.L. 1938, ch. 150,  2; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-1-12. 
 27-1-13. Citation for forfeiture of charter for unsafe practices. The superior court, upon complaint in writing from the insurance commissioner under oath setting forth that, in the commissioners 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.  History of Section.G.L. 1896, ch. 181,  4; C.P.A. 1905,  1220; G.L. 1909, ch. 219,  4; G.L. 1923, ch. 255,  4; G.L. 1938, ch. 150,  3; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-1-13; P.L. 1991, ch. 348,  5. 
 27-1-14. Decree of forfeiture  Receiver. If, upon the examination of the president, secretary, or treasurer and of any other witnesses and evidence as may be introduced by the insurance commissioner and defendants, the court is of the opinion that the charter of the company is forfeited at law, or that the company is managed in a manner that the public or those having funds in its custody or who hold policies of insurance issued by it are in danger of being defrauded, or the continued operation of its business would be hazardous to the public or its policyholders, or that the company has become insolvent, the court shall issue an injunction to the president, secretary, or treasurer and other officers of the corporation, enjoining them from proceeding further in transacting the business of the company, and shall appoint a discreet and proper person to be receiver of all the evidences of debt, goods, effects, and property of every description belonging to the corporation. The court may require the receiver to give bond with surety to the satisfaction of the court for the faithful execution of his or her trusts. The person once appointed as the receiver may, subject to the discretion of the court, continue to be receiver for the duration of the receivership proceedings.  History of Section.G.L. 1896, ch. 181,  5; G.L. 1909, ch. 219,  5; G.L. 1923, ch. 255,  5; G.L. 1938, ch. 150,  4; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-1-14; P.L. 1980, ch. 338,  1; P.L. 1991, ch. 348,  5. 
 27-1-15. Collection and distribution of assets by receiver  Reinsurance. The receiver may take evidence and property into his or her possession and shall collect the debts, dispose of the property, and pay out of the proceeds of the disposition, if the proceeds are sufficient, all of the debts of the corporation, first reserving to himself or herself a reasonable compensation that shall be allowed by the court for his or her services; provided, the receiver may reinsure, upon the written consent of the insurance commissioner and the attorney general, all the policy obligations of the corporation in any solvent corporation authorized to do business in this state, if the assets of the corporation of which he or she is a receiver are sufficient to effect the reinsurance. If the assets are insufficient for that purpose, the receiver, upon the written consent of the insurance commissioner and the attorney general, may reinsure a percentage of each policy obligation of the corporation outstanding to the extent that its assets may be sufficient for that purpose. No contract of reinsurance shall be entered into by the receiver except in pursuance of an order of the court in which the receiver was appointed directing the reinsurance and establishing the general form of the contract for the reinsurance.  History of Section.G.L. 1896, ch. 181,  6; G.L. 1909, ch. 219,  6; G.L. 1923, ch. 255,  6; P.L. 1928, ch. 1219,  1; G.L. 1938, ch. 150,  5; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-1-15; P.L. 1998, ch. 441,  18. 
 27-1-16.1. Sale by receiver of charter and licenses. (a) Notwithstanding any decree of forfeiture or finding of insolvency and order of liquidation, the receiver may, subject to court approval, sell or dispose of the charter and/or licenses of the insolvent insurer separate and apart from its outstanding liabilities or remaining assets.  (b) The sale may be made after proper advertisement in a national publication on terms and conditions the court deems appropriate. The order approving the sale shall provide that the proceeds of the sale shall become part of the assets of the liquidation estate, to be distributed in the manner set forth in the pertinent provisions of law governing distribution of the estate and the order shall provide that the charter and licenses shall after this be free and clear from the claims or interests of all claimants, creditors, policyholders, and stockholders of the corporation under liquidation.  (c) Nothing in this section of law shall be deemed a waiver of capitalization or surplus requirements, or any other condition of licensure imposed by this title which is necessary to obtain approval to do insurance business in this state, or which is necessary to obtain approval for the change in control of a foreign or domestic insurer.  (d) This section applies retrospectively and shall be liberally construed to accomplish its purpose to provide a more expeditious and effective procedure for marshalling the assets of the estate in order to realize the maximum amount possible from the sale of those assets and ensure that the purchasers receive clear and marketable titles. It shall not be construed as a limitation upon the receiver, nor shall it exclude in any manner the receivers right to do other acts not specifically enumerated.  History of Section.P.L. 1992, ch. 404,  1. 
 27-1-16.2. Court approved settlements. Notwithstanding any provisions of law to the contrary, a person, corporation, or other entity who has resolved its liability to the receiver in a judicially-approved good faith settlement shall not be liable for claims for contribution or equitable indemnity regarding matters addressed in the settlement. The settlement does not discharge any other joint tortfeasors unless its terms provide for this discharge, but it reduces the potential liability of joint tortfeasors by the amount of the settlement.  History of Section.P.L. 1994, ch. 86,  2. 
 27-1-16. Powers of receiver  Removal and control by court. The receiver shall be clothed with all of the powers and rights, in respect of the collection of debts due to the corporation, which the corporation possessed by virtue of its charter or otherwise before the injunction issued, and may be removed and another may be appointed by the court in his or her stead. The court shall have the same power and authority over the receiver, his or her acts, proceedings, and accounts, as is exercised by courts of equity in similar cases.  History of Section.G.L. 1896, ch. 181,  7; C.P.A. 1905,  1127; G.L. 1909, ch. 219,  7; G.L. 1923, ch. 255,  7; G.L. 1938, ch. 150,  6; G.L. 1956,  27-1-16. 
 27-1-17. Stay of executions and process against company. As long as the injunction is in force against any corporation, all executions and other final process against the corporation for the collection of debts shall be stayed.  History of Section.G.L. 1896, ch. 181,  8; G.L. 1909, ch. 219; G.L. 1923, ch. 255,  8; G.L. 1938, ch. 150,  7; G.L. 1956,  27-1-17. 
 27-1-18. Limited injunction without receivership. The court may also issue a limited or temporary injunction, staying proceedings in any particulars and for any length of time as in the opinion of the court may be necessary for the safety of the public and the proper management of the affairs of the corporation, without proceeding to the appointment of a receiver.  History of Section.G.L. 1896, ch. 181,  9; G.L. 1909, ch. 219,  9; G.L. 1923, ch. 255,  9; G.L. 1938, ch. 150,  8; G.L. 1956,  27-1-18. 
 27-1-19. Declaration of forfeiture. The court shall, upon hearing of the parties to the complaint, if it sees cause, declare the charter of the corporation forfeited.  History of Section.G.L. 1896, ch. 181,  10; G.L. 1909, ch. 219,  10; G.L. 1923, ch. 255,  10; G.L. 1938, ch. 150,  9; G.L. 1956,  27-1-19. 
 27-1-2.1. Corporate governance standards. (a) The importance of good corporate governance is crucial in promoting integrity in an insurance companys business practices and in maintaining public confidence and policyholder trust. The size and ownership structure of a company often determines the corporate governance standards employed by the company. All Rhode Island domestic insurers, regardless of their size or ownership structure, shall establish the following minimum corporate governance standards:  (1) The board of directors must be comprised of a minimum of five (5) and a maximum of twenty-one (21) members.  (2) The board must meet at least two (2) times per year, however, four (4) times per year is encouraged.  (3) The board must establish a written attendance policy.  (4) The board shall have authority to meet in executive session.  (5) There must be an audit committee established by and amongst the board of directors for the purpose of overseeing the accounting and financial reporting processes of the insurer and audits of the financial statement of the insurer. If no such committee exists, the entire board of directors shall act as the audit committee.  (6) The board must review the minutes of the audit committee.  (7) The audit committee must meet at least two (2) times per year.  (8) There must be a written audit committee charter.  (9) At least one member of the audit committee must have knowledge of statutory accounting principles or generally accepted accounting principles.  (10) The internal audit function should have a direct reporting relationship to the audit committee for critical matters such as the audit plan, resources and budgets.  (11) The audit committee must approve the selection of the independent auditor that performs any audit required by the Rhode Island regulation governing annual audited financial reports.  (12) The audit committee shall require the independent accountant that performs any audit required by Rhode Island regulation governing annual audited financial reports, to timely report to the audit committee in accordance with the requirements of Statement of Auditing Standards No. 61, communications with audit committee, or its replacement, including:  (i) All significant accounting policies and material permitted practices;  (ii) All material alternative treatments of financial information within statutory accounting principles that have been discussed with management officials of the insurer, ramifications of the use of the alternative disclosures and treatments, and the treatment preferred by the accountant; and  (iii) Other material written communications between the accountant and the management of the insurer, such as any management letter or schedule of unadjusted differences.  (13) There must be a written code of ethics covering directors and officers that includes the insurers conflict of interest policy.  (14) There should be a written policy encouraging employees to come forward with observations of improprieties or other malfeasance.  (15) On or after July 1, 2008 no domestic insurer or any affiliate member of its holding company system (as defined in  27-35-1 et seq.) may extend or maintain credit, arrange for the extension of credit, or renew an extension of credit in the form of a personal loan to or for any director or officer of a domestic insurer. The terms and purpose of any such existing extensions of credit made to any director or officer of a domestic insurer must be disclosed to the director. For purposes of this subsection, benefits that are offered to directors or officers as policyholders of a domestic insurer, or benefits that are offered to the general public in the insurers normal course of business, shall not be considered a violation of this subsection.  (b) In addition to the standards enumerated in subsection (a) of this section, the following corporate governance standards must be employed by all Rhode Island domestic mutual insurance companies and all domestic insurance companies writing more than one hundred million dollars ($100,000,000) in premium, in any jurisdiction, on a direct and/or assumed basis, as determined at the end of the previous calendar year:  (1) The board must have an independent majority of members.  (2) The audit committee must have an independent majority of members.  (3) The audit committee must approve all related party transactions, which include transaction between the company and its affiliates and those between the company and its officers and directors. The company may establish materiality thresholds, however, they must be clearly stated in its audit committee charter as required by subdivision (a)(8), but in no event shall the materiality thresholds exceed those established in chapter 35 of title 27.  (c) For purposes of this section, an independent board or audit committee member is defined as an individual: (1) who is not being compensated by the domestic insurer or any company within its holding company system (organization), other than any reasonable compensation and benefits for services as a director, and has not been compensated within the past twelve (12) months including full-time and part-time compensation as an employee or an independent contractor, except for reasonable compensation as a director; (2) whose own compensation is not determined by individuals who are compensated by the organization, except for reasonable compensation paid to the director; (3) who does not receive material financial benefits; (i.e. service contracts, grants or other payments) from the organization; or (4) who is not related to (as a spouse, sibling, parent, or child) or the domestic partner of an individual compensated by or who receives material financial benefits from the organization. Policyholders of a domestic insurer may be considered independent providing they meet the requirements as defined in this subsection.  (d) Any Rhode Island domestic insurer that does not currently employ one or more of the standards enumerated in subsections (a) and (b) of this section, must submit a plan of corrective action to the director for his or her approval. The director, at his or her discretion, may waive any of the requirements in this section for a period not exceeding thirty-six (36) months. The directors refusal to approve a plan of corrective action after reviewing such plan of corrective action for a period of sixty (60) days shall, constitute a final order for purposes of the Rhode Island administrative procedures act allowing the party to appeal to the superior court.  (e) Nothing contained in the companys by-laws shall conflict with the corporate governance standards set forth in this act. Any amendments to a domestic insurance companys by-laws shall be submitted in writing to the department.  (f) A domestic insurer that is a member of an insurance holding company system as defined in chapter 35 of title 27, is exempt from this section if it can demonstrate that it is, or is controlled by an entity that either is required to be compliant with, or voluntarily is compliant with, all of the following provisions of the Sarbanes-Oxley Act of 2002: (i) the preapproval requirements of  201 ( 10A(i) of the Securities Exchange Act of 1934); (ii) the audit committee independence requirements of  301 ( 10A(m)(3) of the Securities Exchange Act of 1934); and (iii) the internal control over financial reporting requirements of  404 (Item 308 of SEC regulation S-K)  (SOX Compliant Entity). If the department makes a determination, as a result of its statutory examination or financial analysis, that the domestic insurer is not controlled by a SOX Compliant entity or that the insurers interests and affairs are not adequately considered and evaluated by the SOX Compliant Entity, the domestic insurer must take steps to comply with this act.  (g) A Rhode Island domestic insurer that is a wholly-owned subsidiary of another Rhode Island domestic insurer that is compliant with the provisions of subsection (a), and if applicable the requirements of subsection (b), shall be exempt from compliance with any other requirements of this act.  (h) The requirements of this section, 27-1-2.1, shall not apply to entities regulated pursuant to chapters 19, 20, 20.1, 20.2, 20.3 and 41 of title 27 and shall not supersede or replace any specific statutory corporate governance standards otherwise applicable to domestic insurance companies.  History of Section.P.L. 2007, ch. 240,  1; P.L. 2008, ch. 240,  1; P.L. 2008, ch. 310,  1; P.L. 2008, ch. 475,  72. 
 27-1-2. Special stockholders meetings  Notice  Quorum. The board of directors or the president and secretary of any insurance company may call special meetings of the stockholders of the company whenever they may deem it expedient so to do, first giving thirty (30) days notice of the time, place, and purpose of the meeting in a newspaper published in the county where the company is established, or, if there is no newspaper published in the county, then in a newspaper published in an adjoining county. At all of these special meetings, not less than two-thirds (23) of the shares shall be represented either in person or by proxy in order to constitute a quorum for doing business. The stockholders of the company, when so assembled, may act on the business for which they were specially called together, and also on any other business as may be transacted by law at any regular meeting of the company.  History of Section.G.L. 1896, ch. 181,  15; G.L. 1909, ch. 219,  15; G.L. 1923, ch. 255,  15; G.L. 1938, ch. 150,  14; G.L. 1956,  27-1-2. 
 27-1-20. Temporary injunction. The citation may also contain a temporary injunction against the corporation and all of its officers, restraining them from proceeding in any business of the corporation, except under the direction of the court, which injunction unless removed shall continue until the complaint is finally disposed of.  History of Section.G.L. 1896, ch. 181,  11; G.L. 1909, ch. 219,  11; G.L. 1923, ch. 255,  11; G.L. 1938, ch. 150,  10; G.L. 1956,  27-1-20. 
 27-1-21. Failure to deliver property or records to receiver. If the president, secretary, treasurer, agent, or servant of any insurance company which 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.  History of Section.G.L. 1896, ch. 181,  12; G.L. 1909, ch. 219,  12; G.L. 1923, ch. 255,  12; G.L. 1938, ch. 150,  11; G.L. 1956,  27-1-21. 
 27-1-22. Assessments by receiver of mutual company. The receiver of any mutual insurance company shall, under decree of the superior court, make and assess, pursuant to the provisions of the charter of the company of which he or she shall be a receiver, any further assessments, in addition to those which may have been made by the company, as may be necessary for the payment of the debts of the corporation, with the incidental expense of assessing and collecting the assessments and the cost and expenses of closing up the business of the corporation, including any reasonable compensation of the receiver that may be allowed by the court, and may demand, receive, sue for, and collect the assessments. For the purpose of the assessment and collection, the receiver shall have all the powers and rights in these respects which the corporation possessed by virtue of its charter or otherwise; provided, these provisions shall not apply to policies issued by mutual insurance companies that do not render the holders of the policies liable to assessment.  History of Section.G.L. 1896, ch. 181,  13; C.P.A. 1905,  1220; G.L. 1909, ch. 219,  13; G.L. 1923, ch. 255,  13; G.L. 1938, ch. 150,  12; P.L. 1953, ch. 3174,  1; G.L. 1956,  27-1-22. 
 27-1-23. Plan for reorganization of company in receivership  Application for submission of plan to creditors and stockholders. Whenever a receiver has been appointed for an insurance company incorporated under the laws of this state, any creditor or creditors or any stockholder or stockholders of the company may propose to the receiver a plan of compromise or arrangement between the company and its creditors or classes of creditors and stockholders or classes of stockholders. If the receiver is satisfied that the adoption of the plan would be more advantageous to the creditors than any other course of procedure available to the receiver under the laws of this state, and if the receiver is further satisfied that the plan is, in other respects, fair and equitable to all creditors or classes of creditors and stockholders or classes of stockholders, the receiver may apply to the superior court having jurisdiction over the receivership proceedings for the entry of an order determining the various classes, if more than one, of creditors and stockholders and calling a meeting of the creditors, or classes of creditors and stockholders, or classes of stockholders, or separate meetings of the creditors or classes of creditors and stockholders or classes of stockholders.  History of Section.G.L. 1938, ch. 150,  38; P.L. 1955, ch. 3586,  1; G.L. 1956,  27-1-23. 
 27-1-24. Meetings to approve reorganization plan  Filing of approved plan. On the application by a receiver, the court may enter an order determining, in accordance with the provisions of  27-1-26, the various classes of creditors and stockholders, and may order a meeting of the creditors or classes of creditors and stockholders or classes of stockholders, or separate meetings of the creditors or classes of creditors and stockholders or classes of stockholders, the meeting or meetings to be summoned in a manner or upon any notice as the court may direct. The receiver shall preside at all meetings of creditors and/or stockholders held pursuant to the order. If the holders of two thirds (23) in value of the claims held by each class of creditors, acting in person or by proxy, and the holders of a majority in number of shares of each class of stockholders, acting in person or by proxy, agree to the plan or to any amendment and to any reorganization of the company as a consequence of the plan, the receiver shall, within five (5) days after the approval, file the plan as originally submitted or as amended and his or her petition for instructions with reference to the plan with the court. The court shall order the plan as filed or as amended and the petition set down for hearing before it at a time and subject to further notice as may be provided in the order.  History of Section.G.L. 1938, ch. 150;  39, P.L. 1955, ch. 3586,  1; G.L. 1956,  27-1-24. 
 27-1-25. Decree approving reorganization plan  Binding effect. Upon the hearing, the court shall determine the regularity of all proceedings taken under this chapter in connection with the plan as originally submitted or as amended and the fairness and equity of the plan, and may enter an appropriate decree. Upon entry of any decree by the court approving a compromise or arrangement and any reorganization as a consequence of a compromise or arrangement, then the compromise or arrangement and any reorganization as a consequence of the compromise or arrangement shall be binding upon the company, on every other company issuing securities or acquiring property under the reorganization, and on all creditors and stockholders of the company, whether or not the creditors and stockholders are affected by the reorganization or have accepted it or have filed proofs of their claims or interests and whether or not their claims or interests have been scheduled or allowed or are allowable.  History of Section.G.L. 1938, ch. 150;  40, by P.L. 1955, ch. 3586,  1; G.L. 1956,  27-1-25; P.L. 1998, ch. 441,  18. 
 27-1-26. Principles for classification of creditors and stockholders. For the purposes of  27-1-23  27-1-25, the following principles shall be applied in determining classes of creditors and stockholders; provided, that as to any situation not covered by the principles, the court may make any further determination of classes, not inconsistent with the principles, that may be fair and equitable:  (1) Creditors. No creditor whose claim is wholly secured shall be included in any class provided for under this chapter, nor have any right to vote at any meeting of creditors as long as the plan does not impair that security. Any creditor whose claim is partially secured shall, unless the creditor releases his or her right to the security, be included in the class of general creditors, but shall be entitled to vote only as to the portion of his or her claim in excess of the value of the security; and  (2) Stockholders. Common or capital stock and preferred stock shall be classified as separate classes of stock. Common or capital stock of the same par value, regardless of series or number of issues, and preferred stock of the same par value, regardless of series or number of issues, shall constitute only one class of common or capital or preferred stock, unless the charter of the company specifically otherwise provides, in which event the provisions of the charter shall be controlling.  History of Section.G.L. 1938, ch. 150,  41; P.L. 1955, ch. 3586,  1; G.L. 1956,  27-1-26. 
 27-1-27. Severability. If any provision of  27-1-23  27-1-26, or the application of those sections to any person or circumstances is held invalid, the invalidity shall not affect other provisions or applications of  27-1-23  27-1-26 which can be given effect without the invalid provision or application; to this end the provisions of  27-1-23  27-1-26 are declared to be severable.  History of Section.P.L. 1955, ch. 3586,  2; G.L. 1956,  27-1-27. 
 27-1-28. Proxies, consents, and authorizations in respect to any equity security issued by a domestic insurer. (a) The commissioner may by regulations prescribe the form, content, and manner of solicitation of any proxy, consent, or authorization in respect of any equity security issued by a domestic insurer, which regulations when and if issued and in force shall substantially conform to those prescribed by the National Association of Insurance Commissioners.  (b) No domestic insurer, or any director, officer, or employee of the insurer or any other person shall solicit or permit the use of his or her name to solicit, by mail or otherwise, any person to give or to refrain from giving any proxy, consent, or authorization in respect of any equity security issued by the insurer in contravention of any regulations the commissioner may prescribe pursuant to this section.  (c) From and after the date of issuance of any regulations by the commissioner, every proxy, consent, or authorization, and every form of written solicitation, announcement or advertisement to be used to obtain the proxy, consent, or authorization, which is intended to be used in respect of any meeting or procedure of equity security holders of a domestic insurer and is not exempted from the operation of the regulations by its terms shall be filed with the commissioner in the manner and at the times provided by the regulations by the person intending to use the written solicitation, announcement, or advertisement. For the purposes of this section, the term person means an individual, a corporation, a partnership, an association, a joint stock company, a business trust, or an unincorporated organization.  (d) Failure to comply with any regulation of the commissioner made pursuant to this section shall be unlawful and any proxy, consent, or authorization obtained in violation of this section or in contravention of any regulation issued pursuant to this section shall be void. Any domestic insurer or any person legally entitled to vote or to give his or her consent or authorization with respect to the equity security, or the commissioner, may enforce compliance with the regulations of the commissioner made pursuant to this section by appropriate action at law or in equity; provided, that no action shall be brought more than fifteen (15) days after the date of the meeting at which a vote, consent, or authorization was purported to have been recorded.  History of Section.P.L. 1965, ch. 102,  1. 
 27-1-29. Reports of directors, officers, and principal shareholders. Every person who is directly or indirectly the beneficial owner of more than ten percent (10%) of any class of any equity security of a domestic stock insurance company, or who is a director or an officer of a domestic stock insurance company, shall file in the office of the commissioner within ten (10) days after he or she becomes the beneficial owner, director, or officer, a statement, in a form as the commissioner may prescribe, of the amount of all equity securities of the company of which he or she is the beneficial owner. Within ten (10) days after the close of each calendar month, if there has been a change in ownership during the month, he or she shall file in the office of the commissioner a statement, in a form as the commissioner may prescribe, indicating his or her ownership at the close of the calendar month and any changes in his or her ownership as have occurred during the calendar month.  History of Section.P.L. 1965, ch. 101,  1; P.L. 2002, ch. 292,  5. 
 27-1-3. Stock assessments to meet deficits. Whenever the capital stock of any insurance company is diminished by reason of losses or from any other cause, the stockholders of the company, at any legal meeting called for the purpose, may, after making due allowance from the assets of the company of the amount as may be required to reinsure its outstanding risks, assess on the several stockholders a further sum as may be necessary to fill up the capital stock to its original amount in proportion to the amount of stock owned by each, and the stock of every stockholder shall be pledged and liable for the assessment. In case any stockholder refuses to pay the assessment, the stock standing in the name of the delinquent stockholder may be sold at public auction after thirty (30) days notice, in a manner as may be provided in the bylaws of the company.  History of Section.G.L. 1896, ch. 181,  14; G.L. 1909, ch. 219,  14; G.L. 1923, ch. 255,  14; G.L. 1938, ch. 150,  13; G.L. 1956,  27-1-3. 
 27-1-30. Liability of directors, officers, and shareholders. For the purpose of preventing the unfair use of information which may have been obtained by a beneficial owner, director, or officer by reason of his or her relationship to the company, any profit realized by him or her 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.  History of Section.P.L. 1965, ch. 101,  1. 
 27-1-31. Prohibited sales of securities. It shall be unlawful for any beneficial owner, director, or officer, directly or indirectly, to sell any equity security of the company if the person selling the security or his or her principal: (1) does not own the security sold, or (2) if owning the security, does not deliver it against the sale within twenty (20) days thereafter, or does not within five (5) days after the sale deposit it in the mails or other usual channels of transportation. No person shall be deemed to have violated this section if he or she proves that notwithstanding the exercise of good faith he or she was unable to make the delivery or deposit within time, or that to do this would cause undue inconvenience or expense.  History of Section.P.L. 1965, ch. 101,  1. 
 27-1-32. Exempted sales of dealers. The provisions of  27-1-30 shall not apply to any purchase and sale, or sale and purchase, and the provisions of  27-1-31 shall not apply to any sale, of an equity security of a domestic stock insurance company not then or previously held by a beneficial owner, director, or officer in an investment account by a dealer in the ordinary course of his or her business, and incident to the establishment or maintenance by the dealer of a primary or secondary market, otherwise than on an exchange referred to in 15 U.S.C.  78l(d) for the security. The commissioner may, by any rules and regulations that the commissioner deems necessary or appropriate in the public interest, define and prescribe terms and conditions with respect to securities held in an investment account and transaction made in the ordinary course of business and incident to the establishment or maintenance of a primary or secondary market.  History of Section.P.L. 1965, ch. 101,  1. 
 27-1-33. Exempted arbitrage transactions. The provisions of  27-1-30, 27-1-31, 27-1-32, and 27-1-34 shall not apply to foreign or domestic arbitrage transactions unless made in contravention of the rules and regulations that the commissioner may adopt in order to carry out the purposes of  27-1-29  27-1-36.  History of Section.P.L. 1965, ch. 101,  1. 
 27-1-34. Definitions. When used in  27-1-28  27-1-36: (1) Equity security means any stock or similar security, or any security convertible with or without consideration into a security, or carrying any warrant or right to subscribe to or purchase a security, or any warrant or right; or any other security which the commissioner shall deem to be of similar nature and consider necessary or appropriate, by the rules and regulations the commissioner may prescribe in the public interest or for the protection of investors, to treat as an equity security;  (2) Officer means a president, vice president, treasurer, actuary, secretary, controller, and any other person who performs for the company functions corresponding to those performed by the foregoing officers.  History of Section.P.L. 1965, ch. 101,  1. 
 27-1-35. Companies not subject to securities regulations. The provisions of  27-1-29  27-1-31 shall not apply to equity securities of a domestic stock insurance company if: (1) the securities shall be registered, pursuant to 15 U.S.C.  78l, or if (2) the domestic stock insurance company shall not have any class of its equity securities held of record by five hundred (500) or more persons on the last business day of the year next preceding the year in which equity securities of the company would be subject to the provisions of  27-1-29  27-1-31 except for the provisions of this clause.  History of Section.P.L. 1965, ch. 101,  1. 
 27-1-36. Regulations of insider trading. The commissioner shall have the power to make any rules and regulations that may be necessary for the execution of the functions vested in the commissioner by  27-1-29  27-1-35, and may for that purpose classify domestic stock insurance companies, securities, and other persons or matters within the commissioners jurisdiction. No provision of  27-1-29  27-1-31 imposing any liability shall apply to any act done or omitted in good faith in conformity with any rule or regulation of the commissioner, notwithstanding that the rule or regulation may, after the act or omission, be amended or rescinded or determined by judicial or other authority to be invalid for any reason.  History of Section.P.L. 1965, ch. 101,  1. 
 27-1-37. Minimum capital and surplus requirement  Charters. (a) No domestic insurance corporation shall commence business and write, issue, or effect any policy of insurance unless the capital stock of the company is at least equal to one million dollars ($1,000,000) and the gross paid in and contributed surplus of the company is at least equal to two million dollars ($2,000,000), or, if a mutual company, its net assets over all liabilities amount to not less than three million dollars ($3,000,000), or, if a mono line business company, has a combined capital and surplus of two million dollars ($2,000,000), and until it has secured from the commissioner of insurance a certificate in compliance with the provisions of its charter and this section. Commence business as used in this section means the date of issuance of a certificate in compliance by the insurance commissioner.  (b) The provisions of this section relating to capital and surplus requirements shall also apply to all charters for domestic insurance companies which have not commenced business prior to June 18, 1991. The provisions of this section relating to capital and surplus requirements shall also apply to domestic insurance companies which have undergone a change in control subsequent to August 1, 1995, except that the commissioner of insurance may require lesser capital and surplus, but in no event less than one million dollars ($1,000,000) as he or she deems appropriate for the protection of all policyholders and the general public, based upon his or her review of the transaction resulting in the change in control of the insurer. Control as used in this section shall be defined in accordance with  27-35-1(c).  History of Section.P.L. 1974, ch. 144,  1; P.L. 1977, ch. 186,  1: P.L. 1978, ch. 349,  1; P.L. 1991, ch. 348,  5; P.L. 1996, ch. 188,  1; P.L. 2001, ch. 122,  1. 
 27-1-38. Acquisition of minority interests in subsidiary insurers. (a) Any parent corporation directly or indirectly owning at least ninety-five percent (95%) of the aggregate issued and outstanding shares of all classes of voting stock of an insurance company created by special act of the general assembly may, pursuant to a plan for acquisition of minority interests in the insurance company adopted pursuant to this section, acquire all of the remaining issued and outstanding shares of voting stock of the insurance company, by exchange of stock, other securities, cash, other consideration, or any combination of these.  (b) The board of directors, trustees, or other governing body of the parent corporation may adopt a plan for the acquisition of minority interests in a subsidiary insurer. Every plan shall set forth:  (1) The name of the company whose shares are to be acquired;  (2) The total number of issued and outstanding shares of each class of voting stock of the company, the number of its shares owned by the parent corporation and, if either of these is subject to change prior to the effective date of acquisition, the manner in which any change may occur;  (3) The terms and conditions of the plan, including the manner and basis of exchanging the shares to be acquired for shares or other securities of the parent corporation, for cash, other consideration, or any combination of these, the proposed effective date of acquisition, and a statement clearly describing the rights of dissenting shareholders to demand appraisal;  (4) If the parent corporation that has adopted the plan is neither a domestic corporation nor an authorized insurer, its consent to the enforcement against it in this state of the rights of shareholders pursuant to the plan, and a designation of the insurance commissioner as the agent upon whom process may be served against the parent corporation in the same manner as if the parent corporation were a foreign insurance company licensed to do business in this state; and  (5) The other provisions with respect to the plan that the board of directors, trustees or other governing body deems necessary or desirable, or which the director of the department of business regulation may prescribe.  (c) Upon adoption of the plan, it shall be duly executed by the president and attested by the secretary, or the executive officers corresponding to the president and the secretary, under the corporate seal of the parent corporation which has adopted the plan. A certified copy of the plan, together with a certificate of its adoption subscribed by the officers and affirmed by them as true under the penalties of perjury and under the seal of the parent corporation, shall be submitted to the director of business regulation for his or her approval. The director of business regulation shall consider the plan and, if satisfied that it complies with this section, is fair and equitable and not inconsistent with law, the director of business regulation shall approve the plan. The director of business regulation shall approve, modify, or disapprove the plan within sixty (60) days of its submission to him or her. If the director of business regulation modifies or disapproves the plan, notification of his or her modification or disapproval, assigning the reasons for that action, shall be given in writing by him or her to the parent corporation that submitted the plan. No plan shall take effect unless the approval of the director of the department of business regulation has been obtained.  (d) If the director of business regulation approves the plan as submitted or modified, the parent corporation which has adopted the plan shall deliver to each person who as of the date of delivery is a holder of record of stock to be acquired pursuant to the plan a copy of the plan, or a summary of the plan approved by the director of the department of business regulation in person or by depositing a copy or a summary of the plan in the post office, postage prepaid, addressed to the shareholder at the shareholders address of record. On or before the date of acquisition proposed in the plan, the parent corporation which has adopted the plan shall file with the director of the department of business regulation a certificate, executed by its president and attested by its secretary, or the executive officers corresponding to the president and the secretary, and subscribed by the officers and affirmed by them as true under the penalties of perjury and under the seal of the parent corporation, attesting to compliance with this subsection.  (e) Upon compliance with this section, ownership of the shares to be acquired pursuant to the plan shall vest in the parent corporation which has adopted the plan on the date of acquisition proposed in the plan whether or not the certificates for the shares have been surrendered for exchange. The parent corporation shall be entitled to have new certificates registered in its name. Shareholders whose shares have been acquired in this manner shall after this retain only the right either to receive the consideration to be paid in exchange for their shares pursuant to the plan or to demand appraisal pursuant to subsection (g).  (f) Neither the right granted by this section nor the exercise of that right by a parent corporation shall preclude the exercise by the parent corporation of any other rights it may have under any other applicable law.  (g)(1) Any shareholder of an insurance company whose shares are to be acquired by a parent corporation pursuant to a plan for the acquisition of minority interests adopted under this section shall have the right to dissent from the plan.  (2) A shareholder may not dissent as to less than all of the shares registered in the shareholders name which are owned beneficially by the shareholder. A nominee or fiduciary may not dissent on behalf of any beneficial owner as to less than all of the shares of the owner registered in the name of the nominee or fiduciary.  (3) Any shareholder electing to exercise the right of dissent shall file with the parent corporation a written demand for payment of the fair value of the shareholders shares within fifteen (15) days after the plan shall have been mailed to the shareholder.  (4) Any shareholder failing to make demand within the fifteen (15) day period shall be bound by the terms of the plan. Any shareholder making a demand shall be entitled only to payment as provided in this section and shall not be entitled to vote or to exercise any other rights of a shareholder.  (5) No demand may be withdrawn unless the parent corporation consents. If, the demand shall be withdrawn upon consent, or if the plan shall be abandoned, or if no demand or petition for the determination of fair value by a court shall have been made or filed within the time provided in this section, or if a court of competent jurisdiction shall determine that the shareholder is not entitled to the relief provided by this section, then the right of the shareholder to be paid the fair value of his or her shares shall cease and his or her status as a shareholder shall be restored, without prejudice to any corporate proceedings which may have been taken during the interim.  (6) Within ten (10) days after the effective date of the acquisition under the plan, the parent corporation shall make a written offer to each shareholder who has made demand to pay for the shares at a specified price deemed by the corporation to be fair value of the shares. The notice and offer shall be accompanied by a balance sheet of the insurance company as of the latest available date and not more than twelve (12) months prior to the making of the offer, and a profit and loss statement of the insurance company for the twelve (12) month period ended on the date of the balance sheet.  (7) If within thirty (30) days after the effective date of the acquisition under the plan the fair value of the shares is agreed upon between any dissenting shareholder and the parent corporation, payment for the shares shall be made within ninety (90) days after the effective date of the acquisition under the plan upon surrender of the certificate or certificates representing the shares. Upon payment of the agreed value, the dissenting shareholder shall cease to have any interest in the shares.  (8) If within the period of thirty (30) days a dissenting shareholder and the parent corporation do not agree as provided in subdivision (7) of this subsection, then the parent corporation shall file a petition in any court of competent jurisdiction in the county in this state where the insurance company maintains its principal office praying that the fair value of the shares be found and determined; provided, that the parent corporation shall have received a written request for the filing from any dissenting shareholder given within sixty (60) days after the effective date of the acquisition under the plan, and the parent corporation shall file the petition within thirty (30) days after receipt of the request. If no request is made, the parent corporation may at its election file a petition at any time within sixty (60) days after the effective date of the acquisition date of the plan. If the parent corporation shall fail to institute the proceeding, any dissenting shareholder may do so in the name of the parent corporation.  (9) The subsidiary insurance company shall join as a party petitioner in the proceeding, and in the event that the insurance company shall fail to do so, the court upon the motion of any party shall join the insurance company as a party petitioner.  (10) All dissenting shareholders, wherever residing, shall be made parties to the proceeding as an action against their shares quasi in rem. A copy of the petition shall be served on each dissenting shareholder who is a resident of this state and shall be served by registered or certified mail on each dissenting shareholder who is a nonresident. Service on nonresidents shall also be made by publication as provided by law. The jurisdiction of the court shall be plenary and exclusive. All shareholders who are parties to the proceeding shall be entitled to judgment against the parent corporation and the subsidiary insurance company jointly and severally for the amount of the fair value of their shares, and execution shall issue upon the motion of any party respondent against either or both of the parent corporation and the subsidiary insurance company and their respective assets, and any execution so issued against the insurance company shall have priority over the claims of any other shareholder.  (11) The court may, if it elects, appoint one or more persons as appraisers to receive evidence and recommend a decision on the question of fair value. The appraisers shall have the power and authority specified in the order of their appointment or an amendment of the order. The judgment shall be payable only upon and concurrently with the surrender to the parent corporation of the certificate or certificates representing the shares. Upon payment of the judgment, the dissenting shareholder shall cease to have any interest in the shares.  (12) The judgment shall include an allowance for interest at a rate that the court may find to be fair and equitable in all the circumstances, from the date of acquisition proposed in the plan to the date of payment.  (13) The costs and expenses of any proceeding shall be determined by the court and shall be assessed against the parent corporation, but all or any part of the costs and expenses may be apportioned and assessed as the court may deem equitable against any or all of the dissenting shareholders who are parties to the proceeding to whom the parent corporation shall have made an offer to pay for the shares, if the court shall find that the action of the shareholders in failing to accept the offer was arbitrary or vexatious or not in good faith. The expenses shall include reasonable compensation for and reasonable expenses of the counsel for any experts employed by any party; but if the fair value of the share as determined materially exceeds the amount which the parent corporation offered to pay, or if no offer was made, the court in its discretion may award to any shareholder who is a party to the proceeding the sum as the court may determine to be reasonable compensation to any expert or experts employed by the shareholder in the proceeding.  (14) Within twenty (20) days after demanding payment for his or her shares, each shareholder demanding payment shall submit the certificate or certificates representing his or her shares to the parent corporation for notation on the certificate or certificates that the demand has been made. The shareholders failure to do this shall, at the option of the parent corporation, terminate the shareholders rights under this subsection unless a court of competent jurisdiction, for good and sufficient cause shown, otherwise directs. If shares represented by a certificate on which notation has been made in this manner shall be transferred, each new certificate issued shall bear similar notation, together with the name of the original dissenting holder of the shares, and a transferee of the shares shall acquire by transfer no rights in the insurance company other than those which the original dissenting shareholder had after making demand for payment of the fair value of the shares.  History of Section.P.L. 1975, ch. 146,  1; P.L. 2002, ch. 292,  5. 
 27-1-39. Discrimination in rates prohibited. (a) No insurance company organized to do business within this state shall make any distinction or discrimination as to the premiums or rates charged for policies of casualty, fire, home owners, accident and health, or marine insurance, nor shall the company make or permit the rejection of an individuals application for insurance coverage, and the determination of the rate class for the individual, solely on the basis of a disability unless the disability is relevant to the risk of loss, nor shall any insurance company make or require any rebate, diminution, or discount upon the sum to be paid on any policy based on any disability discrimination, nor insert in the policy any condition nor make any stipulation, where the person insured shall bind himself or herself, his or her heirs, executors, administrators, and assigns, to accept any less sum than the full value or amount of the policy in case of a claim accruing on the policy by reason of the claim of the person insured, other than those stipulations or conditions as are imposed upon all persons in similar cases, and any stipulation or condition made in this manner or inserted shall be void.  (b) No insurance company organized to do business within this state shall make any distinction or discrimination as to the premiums or rates charged for automobile insurance policies, nor shall the company make or permit the rejection of an individuals application for insurance coverage, and the determination of the rate class of the individual, solely on the basis of a disability or the modification of the automobile with specialized equipment that permits an individual with a disability to operate the automobile, unless the disability or modification of the automobile is relevant to the risk or loss, nor shall any insurance company make or require any rebate, diminution, or discount upon the sum to be paid on any policy based on any disability discrimination, nor insert in the policy any condition nor make any stipulation where the person insured shall bind himself or herself, his or her heirs, executors, administrators, and assigns, to accept any less sum than the full value or amount of the policy in case of a claim accruing on the policy by reason of the claim of the person insured, other than those stipulations or conditions as are imposed upon all persons in similar cases, and any stipulation or condition made in this manner or inserted shall be void. The department of business regulation shall enforce the provisions of this section.  History of Section.P.L. 1981, ch. 216,  1; P.L. 1993, ch. 127,  1; P.L. 1993, ch. 285,  1; P.L. 1999, ch. 83,  60; P.L. 1999, ch. 130,  60. 
 27-1-4. Power of companies to comply with tax and license laws not held invalid. Every domestic insurance company and its officers, directors, agents, and employees shall have power and authority to comply with any statute, ordinance, or other law of any state, territory, or political subdivision of a state or territory, including the District of Columbia, imposing any license, excise, privilege, occupation, premium, or other tax, fee, or deposit requirement and to pay the tax or fee and make the deposit unless prior to payment the statute, ordinance, or other law shall have been expressly held invalid by the Supreme Court of the United States. No company, officer, director, employee, or agent shall be subject to liability by reason of any compliance or payment either previously or subsequently made.  History of Section.P.L. 1945, ch. 1622,  1; G.L. 1956,  27-1-4. 
 27-1-40.1. Mutual insurance holding companies. (a)(1) Any domestic mutual insurance company, upon approval of the commissioner, may reorganize by forming or merging into a mutual insurance holding company based upon a plan of reorganization and continuing the corporate existence of the reorganizing insurance company as a stock insurance company. The commissioner, after a public hearing as provided in  27-35-2(d), if satisfied that the interests of the policyholders are properly protected and that the plan of reorganization is fair and equitable to the policyholders, may approve the proposed plan of reorganization or may require as a condition of approval such modifications of the proposed plan of reorganization as the commissioner finds necessary for the protection of the policyholders interests. The commissioner may retain consultants as provided in  27-35-2(d)(5). A reorganization pursuant to this section is subject to  27-35-1, 27-35-1.5, 27-35-2 and 27-35-2.5. The commissioner shall retain jurisdiction over a mutual insurance holding company organized pursuant to this section to assure that policyholder interests are protected.  (2) A plan of reorganization must be approved by two-thirds (23) vote of the board of directors or other governing body, the director of the department of business regulation, and the affirmative vote of a majority of those members or policyholders, (subscribers in the case of a health service corporation) constituting a quorum, present in person or by proxy at a meeting called by the board of directors or other governing body.  (3) All of the initial shares of the capital stock of the reorganized insurance company shall be issued to the mutual insurance holding company. The membership interests of the policyholders of the reorganized insurance company shall become membership interests in the mutual insurance holding company. Policyholders of the reorganized insurance company shall be members of the mutual insurance holding company in accordance with the articles of incorporation and bylaws of the mutual insurance holding company. The mutual insurance holding company shall at all times own a majority of the voting shares of the capital stock of the reorganized insurance company.  (4) A merger of policyholders membership interests in a mutual insurance company into a mutual insurance holding company shall be deemed to be a merger of insurance companies pursuant to  27-35-2 and that chapter is also applicable.  (b) A foreign mutual insurance company or a foreign health service corporation, which if a domestic corporation would be organized under chapters 19, 20, 20.1, 20.2 or 20.3 of title 27, may reorganize upon the approval of the commissioner and in compliance with the requirements of any law or regulation which is applicable to the foreign mutual insurance company or foreign health service corporation by merging its policyholders or subscribers membership interests into a domestic mutual insurance holding company in the same manner as under subsection (a) above.  (c) A mutual insurance holding company resulting from the reorganization of a domestic mutual insurance company organized under chapter 1 of title 27 shall be incorporated pursuant to chapter 1 of title 27. The articles of incorporation and any amendments to such articles of the mutual insurance holding company shall be subject to approval of the commissioner in the same manner as those of an insurance company.  (d) A mutual insurance holding company is deemed to be an insurer subject to chapters 14.1, 14.2, 14.3 and 14.4 of title 27 and shall automatically be a party to any proceeding under chapters 14.3 or 14.4 of title 27 involving an insurance company which as a result of a reorganization pursuant to subsection (a) or (b) is a subsidiary of the mutual insurance holding company. In any proceeding under chapters 14.3 or 14.4 of title 27 involving the reorganized insurance company, the assets of the mutual insurance holding company are deemed to be assets of the estate of the reorganized insurance company for purposes of satisfying the claims of the reorganized insurance companys policyholders. A mutual insurance holding company shall not dissolve or liquidate without the approval of the commissioner or as ordered by the superior court pursuant to chapters 14.3 or 14.4 of title 27.  (e) Section 27-1-40 is not applicable to a reorganization or merger pursuant to this section.  (f) A membership interest in a domestic mutual insurance holding company shall not constitute a security as defined in chapter 11 of title 7.  (g) The majority of the voting shares of the capital stock of the reorganized insurance company, which is required by this section to be at all times owned by a mutual insurance holding company, shall not be conveyed, transferred, assigned, pledged, subjected to a security interest or lien, encumbered, or otherwise hypothecated or alienated by the mutual insurance holding company or intermediate holding company. Any conveyance, transfer, assignment, pledge, security interest, lien, encumbrance, or hypothecation or alienation of, in or on the majority of the voting shares of the reorganized insurance company which is required by this section to be at all times owned by a mutual insurance holding company, is in violation of this section and shall be void in inverse chronological order of the date of such conveyance, transfer, assignment, pledge, security interest, lien, encumbrance, or hypothecation or alienation, as to the shares necessary to constitute a majority of such voting shares. The majority of the voting shares of the capital stock of the reorganized insurance company which is required by this section to be at all times owned by a mutual insurance holding company shall not be subject to execution and levy. The shares of the capital stock of the surviving or new company resulting from a merger or consolidation of two (2) or more reorganized insurance companies or two (2) or more intermediate holding companies which were subsidiaries of the same mutual insurance holding company are subject to the same requirements, restrictions, and limitations as provided in this section to which the shares of the merging or consolidating reorganized insurance companies or intermediate holding companies were subject by this section prior to the merger or consolidation.  As used in this section, majority of the voting shares of the capital stock of the reorganized insurance company means shares of the capital stock of the reorganized insurance company which carry the right to cast a majority of the votes entitled to be cast by all of the outstanding shares of the capital stock of the reorganized insurance company for the election of directors and on all other matters submitted to a vote of the shareholders of the reorganized insurance company. The ownership of a majority of the voting shares of the capital stock of the reorganized insurance company which are required by this section to be at all times owned by a parent mutual insurance holding company includes indirect ownership through one or more intermediate holding companies in a corporate structure approved by the commissioner. However, indirect ownership through one or more intermediate holding companies shall not result in the mutual insurance holding company owning less than the equivalent of a majority of the voting shares of the capital stock of the reorganized insurance company. The commissioner shall have jurisdiction over an intermediate holding company as if it were a mutual insurance holding company. As used in this section, intermediate holding company means a holding company which is a subsidiary of a mutual insurance holding company, and which either directly or through a subsidiary intermediate holding company has one or more subsidiary reorganized insurance companies of which a majority of the voting shares of the capital stock would otherwise have been required by this section to be at all times owned by the mutual insurance holding company.  History of Section.P.L. 1996, ch. 231,  1; P.L. 2012, ch. 66,  2; P.L. 2012, ch. 84,  2; P.L. 2012, ch. 308,  1; P.L. 2012, ch. 335,  1. 
 27-1-40. Conversion to stock form of organization. (a) Any mutual insurance company created under the laws of this state which meets or exceeds all capital and surplus funds required by law for the transaction of business in Rhode Island may convert to and become an insurance company with a capital stock form of organization upon adoption of a plan of conversion by two-thirds (23) vote of the board of directors or other governing body and approval of the plan by the director of the department of business regulation and the affirmative vote of one half (12) of its members or policyholders present in person or by proxy at a meeting called by the board of directors or other governing body. Unless otherwise provided in its charter or bylaws or plan of conversion, each member or policyholder shall have one vote, and in the case of any policy or contract of group life or other group insurance, the employer or other person to whom or in whose name the master policy or contract has been issued shall be deemed to be the member or policyholder and shall be entitled to one vote for each policy or contract of group insurance irrespective of the number of individuals insured. The plan of conversion shall provide that the insurance company shall issue and sell the stock issued in connection with the conversion at a price which represents its pro forma market value, as determined by an independent appraisal, and shall offer its stock, initially, in a subscription offering to the members or policyholders, individuals in the insurance companys management, and employee groups of the insurance company on an eligibility record date established by the board of directors, giving the members or policyholders, individuals in the insurance companys management, and employee groups priority rights to purchase the shares over the general public pro rata. The plan of conversion may provide for the establishment of accounts for the benefit of members or policyholders pursuant to which the converting insurance company shall provide for the continued maintenance of its dividend practices required by existing charter, bylaws, or policy provisions relative to its then existing lines of business, but assets in the account will be assets of the converting insurance company, subject to liabilities in the same manner and priority as all other assets of the company. The plan of conversion may provide for restrictions on the amount of stock which any person or entity may purchase in the conversion, or own or control after this, which may also be incorporated into the stock charter or agreement of association of the converted entity.  (b) In connection with the conversion, the insurance company may form a holding company or utilize an existing holding company to hold all the shares of the converted entity, and offer to its members or policyholders and the general public, subject to subscription rights in favor of members or policyholders as stated in subsection (a), all of the stock of the holding company in lieu of the capital stock of the converting insurance company. The converting insurance company may, at the time of the conversion, merge any insurance company subsidiary into the capital stock entity resulting from the conversion, or cause the subsidiary to become a separate subsidiary of a holding company.  (c) The corporate existence of an insurance company converting to the stock form of organization shall not terminate, but the converted institution shall be deemed to be a continuation of entity of the converted insurance company.  (d) The director of the department of business regulation, upon finding that the requirements of this section and applicable regulations have been met, that the terms and conditions of the plan are fair and equitable, and that the conversion has been completed with the sale of all shares offered in the conversion, shall issue a certificate of approval of the conversion to the converted entity. Upon the payment of fifty dollars ($50.00), the certificate of approval shall be filed in the office of the secretary of state, together with the certificate of the general treasurer that the converted entity has paid into the treasury for the use of the state a sum equal to one-tenth of one percent (.1%) of the capital stock, but in no event less than ten thousand dollars ($10,000). Upon the filing of the certificate with the secretary of state and payment of fifty dollars ($50.00), the secretary of state shall immediately record the certificate of approval and stock charter or agreement of association, then the stock charter or agreement of association will become effective.  (e) The director of the department of business regulation may employ staff personnel and professional consultants and other persons to assist in the review of the plan of conversion and may hold public hearings as, in the directors discretion, are desirable prior to granting approval of the plan of conversion. All reasonable costs related to the review of the plan of conversion, including the costs attributable to staff personnel and professional consultants, shall be borne by the insurance company filing a plan of conversion for approval.  (f) The department of business regulation shall issue rules and regulations implementing this section, which shall be administered by the director of the department of business regulation.  (g) To the extent not inconsistent with this section, each insurance company converted into a capital stock insurance company shall have all the powers, privileges, including the right to merge, convert, or otherwise restructure its corporate form upon a two-thirds (23) vote of its stockholders and subject to any regulatory approval as required by law, and duties and liabilities imposed upon insurance companies generally under the laws of this state, as applicable. Unless otherwise governed by the laws of this state specifically applicable to insurance companies, a capital stock entity converted pursuant to this section shall be subject to the general provisions of the Rhode Island Business Corporation Act, chapter 1.2 of title 7, with respect to its corporate governance.  History of Section.P.L. 1987, ch. 357,  1; P.L. 2002, ch. 292,  5; P.L. 2005, ch. 36,  20; P.L. 2005, ch. 72,  20. 
 27-1-41. Repealed.
 27-1-42. Maximum amount of single risk. No company organized under the laws of this state, other than a life insurance company, shall incur in any one risk a greater hazard than one-tenth (1/10) part of its capital and surplus if a stock company or of its net assets if a mutual company. Any risk incurred on or before June 18, 1991, which is not in compliance with the provisions in this section shall not be subject to the established limitations.  History of Section.P.L. 1991, ch. 348,  2. 
 27-1-43. Applicability. The general provisions of law relating to the duties, obligations, prohibitions, or penalties which appertain to insurance companies incorporated under the authority of this state, and defining the powers and duties of the insurance commissioner in reference to those companies, shall be and are applicable to all corporations, companies and associations incorporated under the authority of this state, and to all partnerships and individuals, doing, as principals or otherwise, in this state, any insurance business of any name, kind or description, including the transaction of reinsurance.  History of Section.P.L. 1996, ch. 188,  2. 
 27-1-44. Prohibition on the pledging of stock. No domestic insurance company, and no holding company as defined in  27-35-1(f), 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.  History of Section.P.L. 1996, ch. 188,  2; P.L. 1999, ch. 141,  1. 
 27-1-45. Determination of premium tax rate. The department of business regulation may participate in proceedings under  44-17-1(d) to implement guidelines, directives, criteria, and may promulgate additional resulting rules and regulations pursuant to chapter 35 of title 42 as are necessary to implement  44-17-1(d).  History of Section.P.L. 2016, ch. 538,  2. 
 27-1-5. Deposits with general treasurer to comply with laws of other states. In all cases in which the laws of any other state of the United States now require and may subsequently require that the insurance companies incorporated by the laws of other states shall deposit, with some officer of the state in which the insurance company is incorporated, stocks or other securities in trust or for the benefit of policyholders of the companies as a condition for doing business in the other state, the general treasurer, or his or her custodian, shall receive from any insurance company incorporated under the laws of this state stocks or other securities, including mortgages insured and debentures issued by the federal housing administration and obligations of national mortgage associations, in an amount as may be required by the laws of the other state or states, on deposit and in trust for the benefit of the policyholders of the company. In the event the security required under this section is one which is maintained in the federal reserve book entry system or by the depository trust company book entry system or any similar entity, then the insurance company required to make the deposit shall designate the general treasurer as the pledgee of the security and provide written notification to the general treasurer identifying the security.  History of Section.G.L. 1896, ch. 181,  17; P.L. 1908, ch. 1552,  1; G.L. 1909, ch. 219,  17; G.L. 1923, ch. 255,  17; P.L. 1938, ch. 2584,  1; G.L. 1938, ch. 150,  16; G.L. 1956,  27-1-5; P.L. 1990, ch. 73,  1. 
 27-1-6. Holding of deposits  Income  Replacement. The general treasurer shall hold stocks or securities deposited as security for policyholders in the company, but any company depositing stocks or securities shall be permitted to receive and to collect the interest and dividends on its securities deposited, and to withdraw the securities upon depositing with the general treasurer other securities of the same character, the market value of which at the time of the deposit shall equal or exceed the amount required to be deposited.  History of Section.G.L. 1896, ch. 181,  18; P.L. 1908, ch. 1552,  2; G.L. 1909, ch. 219,  18; G.L. 1923, ch. 255,  18; G.L. 1938, ch. 150,  17; G.L. 1956,  27-1-6. 
 27-1-7. Certificate of deposits. Whenever any insurance company has deposited the requisite stocks or other securities in conformity with the laws of the state in which the company is desirous of transacting business, the general treasurer shall furnish the company at its expense a certificate under seal of the deposit for each state which shall require the deposit, which certificate shall embrace the items of security and the amount of each deposited, and shall state that the general treasurer is satisfied that the stocks are of the market value represented, but no stocks or other securities deposited in this manner shall be withdrawn except as provided in  27-1-6.  History of Section.G.L. 1896, ch. 181,  19; G.L. 1909, ch. 219,  19; G.L. 1923, ch. 255,  19; G.L. 1938, ch. 150,  18; G.L. 1956,  27-1-7. 
 27-1-8. Return of deposit on termination of business. Whenever any insurance company which has deposited stocks or other securities with the general treasurer desires to relinquish its business, the general treasurer shall, on application of the company, under the oath of the president or principal officer and secretary, give notice of that intention in two (2) newspapers published in this state, to be inserted at least twice a week for six (6) months. After the publication, the general treasurer, on being satisfied by an examination of the books and of the officers of the company under oath that all of its debts and liabilities are paid or extinguished upon any contract or agreement, shall deliver up to the company from whom the general treasurer received the securities, the stocks or other securities held by the general treasurer belonging to the company.  History of Section.G.L. 1896, ch. 181,  20; G.L. 1909, ch. 219,  20; G.L. 1923, ch. 255,  20; G.L. 1938, ch. 150,  19; G.L. 1956,  27-1-8. 
 27-1-9. Examinations to ascertain market value of securities deposited  Deficiencies. Whenever it becomes necessary, on application of any company, for the general treasurer or any person appointed by the general treasurer to examine and ascertain the value and condition of any stocks or other securities deposited with the general treasurer by any insurance company, the expenses of the examination shall be borne by the company applying, and the general treasurer shall be allowed to charge for his or her time and expense or for the time and expense of the person the general treasurer shall appoint to make the examination; the examination shall be made annually by the general treasurer. In case it appears at any time that the stocks or other securities deposited in this manner amount to less than the sum required for the purposes for which the deposit has been made, the general treasurer shall notify the company, and unless the deficiency is made up within thirty (30) days, the general treasurer shall countermand all of the certificates he or she may have issued and notify the treasurer, comptroller, or other financial officer of the states to which the general treasurer has transmitted his or her certificate, and shall, as soon as possible, publish notice of his or her actions in one newspaper published in the city of Providence for three (3) weeks.  History of Section.G.L. 1896, ch. 181,  21; G.L. 1909, ch. 219,  21; G.L. 1923, ch. 255,  21; G.L. 1938, ch. 150,  20; G.L. 1956,  27-1-9. 
 27-10.1-1.1. Emergency licenses. (a) Notwithstanding any of the provisions of this chapter, the commissioner may permit an experienced motor vehicle appraiser to act as a motor vehicle physical damage appraiser in this state without a Rhode Island license if:  (1) The appraiser is either a licensed appraiser in another state which requires a license or regularly appraises motor vehicle damage in another state where such licensing is not required and works for an insurance company authorized to do business in Rhode Island; and  (2) He or she is engaged in emergency insurance appraisal work during the period of emergency only, as determined by the commissioner.  (b) The experienced appraiser may work in this state either for an employer who is an appraiser licensed by this state, or for a regular employer of one or more appraisers licensed by this state, or for an insurance company authorized to do business in this state; provided, that the employer or insurer shall furnish to the commissioner a notice, in writing or electronically, promptly after the beginning of any emergency insurance appraisal work. The appraiser may appraise claims within or outside the state. Emergency licenses permitted under this section shall not exceed one hundred twenty (120) days, unless extended by the commissioner.  (c) As used in this section, emergency insurance appraisal work means and includes, but is not limited to, appraisal of motor vehicle damage during the term of an emergency license following an event or catastrophe, as determined by the commissioner, based on consumer need or demand, or a state of disaster declared by the governor of the state of Rhode Island or by the president of the United States under applicable federal law.  History of Section.P.L. 2012, ch. 298,  3; P.L. 2012, ch. 329,  3. 
 27-10.1-1. Purpose of chapter  Issuance of license  Penalties  Renewal  Revocation or suspension. (a) The purpose of this chapter is to subject certain individuals to the jurisdiction of the insurance commissioner. The legislature declares that it is concerned with the business of appraising damaged automobiles and to this end authorizes the insurance commissioner to regulate that business. No person shall act as an appraiser for motor vehicle physical damage claims on behalf of any insurance company or firm or corporation engaged in the adjustment or appraisal of motor vehicle claims unless that person has first secured a license from the insurance commissioner and has paid a license fee of one hundred fifty dollars ($150) for each biennial license term or fraction thereof. The license shall be issued only upon the successful passage of the examination that shall be administered at the discretion of the insurance commissioner, but in no event less than quarterly. The commissioner may prescribe reasonable regulations concerning standards for qualifications, suspension, or revocation, and the methods with which licensees conduct their business, in addition to the requirements specifically delineated within this chapter.  (b) Any person who violates any provision of this chapter shall be subject to administrative penalties pursuant to  42-14-16.  (c) A license shall be renewed upon the payment of the appropriate renewal fee unless a finding is made pursuant to subsection (d) of this section. The fee for the total term of the licensure or renewal shall be paid at the time of initial application or renewal.  (d) Nothing in this section shall be construed to limit the authority of the insurance commissioner to sooner suspend or revoke any license issued pursuant to this chapter. Any action for suspension or revocation of any license shall be in accordance with Administrative Procedures Act, chapter 35 of title 42, upon proof that the license was obtained by fraud or misrepresentation, or that the interests of the insurer or the interests of the public are not properly served under the license, or for cause.  History of Section.P.L. 1973, ch. 241,  1; P.L. 1979, ch. 174, art. 7,  4; P.L. 1979, ch. 349,  6; P.L. 1980, ch. 36,  1; P.L. 1980, ch. 406,  7; P.L. 1985, ch. 181, art. 14,  2; 1987, ch. 166,  15; P.L. 1988, ch. 350,  2; P.L. 2004, ch. 595, art. 30,  10; P.L. 2009, ch. 68, art. 12,  7; P.L. 2015, ch. 82,  11; P.L. 2015, ch. 105,  11. 
 27-10.1-10. Inspection at policy inception required. No motor vehicle liability policy or endorsement insuring a private passenger motor vehicle weighing less than ten thousand (10,000) pounds for physical damage coverage, shall be issued in the state of Rhode Island unless the insurer has inspected and photographed the motor vehicle in accordance with rules and regulations set forth by the insurance division of the department of business regulation. This section does not apply to motor vehicles rated or insured under a commercial motor vehicle insurance policy. An insurer may elect to waive inspections and photographs for all motor vehicles upon written notice to the department of business regulation.  History of Section.P.L. 1993, ch. 256,  1; P.L. 1994, ch. 408,  1; P.L. 2004, ch. 65,  1; P.L. 2004, ch. 114,  1. 
 27-10.1-11. Emergency licenses. (a) Notwithstanding any of the provisions of this chapter, the commissioner may grant emergency licenses to permit an experienced motor vehicle appraiser to act as a motor vehicle physical damage appraiser in this state without a Rhode Island license if:  (1) The appraiser is either a licensed appraiser in another state which requires a license or regularly appraises motor vehicle damage in another state where such licensing is not required and works for an insurance company authorized to do business in Rhode Island;  (2) He or she is engaged in emergency insurance appraisal work during the period of emergency only, as determined by the commissioner.  (b) The experienced appraiser may work in this state either for an employer who is an appraiser licensed by this state, or for a regular employer of one or more appraisers licensed by this state, or for an insurance company authorized to do business in this state; provided, that the employer or insurer shall furnish to the commissioner a notice in writing or electronically promptly after the beginning of any emergency insurance appraisal work. The appraiser may appraise claims within or outside the state.  Emergency licenses permitted under this section shall not exceed one hundred twenty (120) days, unless extended by the commissioner.  (c) As used in this section, emergency insurance appraisal work means and includes, but is not limited to, appraisal of motor vehicle damage during the term of an emergency license following an event or catastrophe as determined by the commissioner, or a state of disaster declared by the governor of the state of Rhode Island or by the president of the United States under applicable federal law.  History of Section.P.L. 2012, ch. 321,  1; P.L. 2012, ch. 330,  1. 
 27-10.1-2. Motor vehicle physical damage appraiser defined. (a) Motor vehicle physical damage appraiser means any person that practices as a business the appraising of damages to motor vehicles insured under automobile physical damage policies on or on behalf of third party claimants.  (b) A Rhode Island resident business entity acting as a motor vehicle physical damage appraiser may elect to obtain a motor vehicle physical damage appraiser license. Application shall be made using the uniform business entity application. Prior to approving the application, the commissioner shall find both of the following:  (1) The business entity has paid the appropriate fees.  (2) The business entity has designated a licensed motor vehicle physical damage appraiser responsible for the business entitys compliance with the insurance laws and rules of this state.  History of Section.P.L. 1973, ch. 241,  1; P.L. 2008, ch. 144,  4; P.L. 2008, ch. 198,  4; P.L. 2012, ch. 66,  3; P.L. 2012, ch. 84,  3. 
 27-10.1-3. Independent status required. All persons, partnerships, corporations, or individuals engaged in the motor vehicle physical damage appraisal business shall operate separate and apart from any body repair shop, or motor vehicle repair shop, of any new or used automobile dealership. Those engaged in this business shall retain a permanent established address affording themselves to the general public during normal business hours.  History of Section.P.L. 1973, ch. 241,  1. 
 27-10.1-4. Repealed.
 27-10.1-5. Repealed.
 27-10.1-6. Conduct of motor vehicle damage appraisers. (a) Each appraiser, while engaged in appraisal duties, shall carry the license issued to that appraiser by the department of business regulation and shall display it, upon request, to an owner whose vehicle is being inspected, to the auto body shop representative involved, or to any authorized representative of the department of business regulation.  (b) The appraiser shall leave a legible copy of his or her appraisal with the auto body shop selected to make the repairs, which appraisal shall contain the name of the insurance company ordering it, if any, the insurance file number, the number of the appraisers license, and the proper identification number of the vehicle being inspected, and notice in boldface type, reading as follows:  PURSUANT TO RHODE ISLAND LAW, THE CONSUMER HAS THE RIGHT TO CHOOSE THE REPAIR FACILITY TO COMPLETE REPAIRS TO A MOTOR VEHICLE; AND AN INSURANCE COMPANY MAY NOT INTERFERE WITH THE CONSUMERS CHOICE OF REPAIRER. All damage unrelated to the incident or accident that occasioned the appraisal of the vehicle, or old damage, shall be clearly indicated in the appraisal.  (c) The appraiser shall not obtain a competitive estimate from another auto body shop unless the owner of that other shop, or his or her authorized agent, has inspected the vehicle. No competitive estimate shall be obtained by the use of photographs, telephone calls, or in any manner other than a personal inspection.  (d) No appraiser shall request that repairs be made in a specified auto body shop.  (e) Every appraiser shall re-inspect damaged vehicles when supplementary allowances are requested by the auto body shops.  (f) No appraiser shall receive directly or indirectly any gratuity or other consideration in connection with his or her appraisal services from any person except his or her employer, or, if self-employed, his or her customers.  (g) No appraiser shall traffic in automobile salvage if it is obtained in any way as a result of appraisal services rendered by the appraiser.  (h) No appraiser shall obtain an estimate from an unlicensed automobile body repair shop nor shall any appraiser agree on a price for repairing a damaged motor vehicle with an unlicensed automobile body repair shop. Nothing contained in this section shall be construed to preclude an appraiser from dealing with any entity not subject to the licensing provisions of  5-38-4.  History of Section.P.L. 1973, ch. 241,  1; P.L. 1979, ch. 137,  1; P.L. 1982, ch. 277,  1; P.L. 2006, ch. 42,  1. 
 27-10.1-7. Violations  Penalties. Any person licensed under this chapter who violates the provisions of  27-10.1-6, 27-10.1-8 or 27-10.1-8.1 or any rules and regulations promulgated by the department of business regulation shall be subject to administrative penalties pursuant to  42-14-16.  History of Section.P.L. 1979, ch. 349,  7; P.L. 1987, ch. 491,  2; P.L. 2006, ch. 42,  1; P.L. 2015, ch. 82,  11; P.L. 2015, ch. 105,  11. 
 27-10.1-8.1. Notices required to be displayed. A sign in boldfaced type letters at least two (2) inches high must be displayed in a conspicuous location in every drive-in claim center as defined in  27-10.1-8, reading as follows:  PURSUANT TO RHODE ISLAND LAW, THE CONSUMER HAS THE RIGHT TO CHOOSE THE REPAIR FACILITY TO COMPLETE REPAIRS TO A MOTOR VEHICLE; AND AN INSURANCE COMPANY MAY NOT INTERFERE WITH THE CONSUMERS CHOICE OF REPAIRER.  History of Section.P.L. 2006, ch. 42,  2. 
 27-10.1-8. Drive-in claim centers. (a) No insurance company employee or property damage appraiser shall request or advise any motor vehicle owner or operator to operate his or her vehicle on any public thoroughfare for the purpose of obtaining a written estimate of damage at a drive-in claims center, unless it is ascertained that the vehicle meets safety requirements as determined by the department of transportation.  (b) A vehicle shall be deemed unsafe for driving pursuant to the provisions of this section if the vehicle has:  (1) Damage to its unitized body construction;  (2) Damage to its hood catch which would probably result in an unexpected opening;  (3) Damage to the front suspension;  (4) Metal in contact with any tire;  (5) Any door which cant be easily opened or which opens unexpectedly;  (6) Inoperable tail lights;  (7) Broken glass affixed to the vehicle or a cracked windshield; or  (8) Any other condition deemed to be unsafe by the department of transportation pursuant to rules and regulations.  History of Section.P.L. 1987, ch. 491,  1. 
 27-10.1-9. Re-inspection of collision damage. (a) The director of the department of business regulation is authorized and empowered to promulgate rules and regulations which allow re-inspection of ten percent (10%) of all automobile insurance carrier claims after collision damage is repaired. The required percentage shall be reviewed by the department of business regulation on an annual basis.  (b) All automobile repair facilities shall, upon reasonable request by the insurer or consumer, present proof of authenticity through invoices and/or receipts for all new and used collision repair parts excluding price of the part or parts. Insurance carriers shall obtain from auto body repair facilities proof of purchase of the new or used collision repair parts, either by authenticated invoices and/or receipts excluding price.  (c) Each insurance carrier or its agents assigned to or conducting a re-inspection shall be a licensed motor vehicle physical damage appraiser, and shall conduct the inspection in a professional manner consistent with training required to obtain DBR certification or licensing. If body shop testing equipment is required, a fee to be set by the director of the department of business regulation will be paid by the insurance carrier to the body shop.  History of Section.P.L. 1993, ch. 256,  1; P.L. 1994, ch. 86,  4; P.L. 2012, ch. 298,  2; P.L. 2012, ch. 329,  2. 
 27-10.2-1. Definitions. As used in this chapter: (1) Aftermarket part means a motor vehicle replacement part that is not an original equipment manufacturer part; and  (2) Original equipment manufacturer part or OEM part means a motor vehicle replacement part manufactured by the manufacturer of the motor vehicle being repaired.  History of Section.P.L. 1987, ch. 338,  1; P.L. 2018, ch. 298,  1; P.L. 2018, ch. 321,  1. 
 27-10.2-2. Aftermarket parts  Time limit prohibition. (a) Whenever an insurance company, in adjusting a claim for motor vehicle physical damage, intends to specify the use of aftermarket parts, it shall notify the vehicle owner in writing. Any auto body repair shop conducting business in the state of Rhode Island shall not use non-original equipment manufactured (OEM) parts, also referred to as aftermarket parts, in the repair of any persons automobile, without that person giving the repairer his or her express written consent.  (b) No insurance company may require the use of aftermarket parts when negotiating repairs with any repairer unless the repairer has written consent from the vehicle owner to install aftermarket parts. The provisions of this section shall apply only to automobiles that are less than forty-eight (48) months beyond the date of manufacture.  (c) For any automobile that is less than forty-eight (48) months beyond the date of manufacture, the insurer and the auto body repair shop must provide a written notice to the vehicle owner that: (i) He or she may require the insurer to pay for and the auto body shop to install original equipment manufacturer parts or OEM parts in the repair of a motor vehicle; or (ii) He or she may require the insurer to pay for and the auto body shop to install non-original equipment manufacturer parts (non-OEM parts) in the repair of a motor vehicle. To comply with this provision, written notice may be provided on the appraisal written on behalf of the insurer and the estimate prepared by the auto body repair shop.  (d) When OEM part(s) are used in the repair of a motor vehicle, no insurance company may require any repairer to use repair procedures that are not in compliance with the recommendations of the original equipment manufacturer.  (e) This chapter shall not apply to the repair or replacement of motor vehicle glass performed by licensed motor vehicle glass repair shops pursuant to chapter 38.5 of title 5.  History of Section.P.L. 1987, ch. 338,  1; P.L. 1994, ch. 116,  1; P.L. 2006, ch. 621,  1; P.L. 2007, ch. 313,  1; P.L. 2007, ch. 418,  1; P.L. 2008, ch. 475,  6; P.L. 2018, ch. 298,  1; P.L. 2018, ch. 321,  1. 
 27-10.2-3. Standards for use of aftermarket parts. Whenever aftermarket parts are used for repairs to physically damaged motor vehicles, the following standards shall apply:  (1) The aftermarket parts shall be at least equal in kind and quality to the OEM parts in terms of fit, quality and performance;  (2) To the extent practical, an insurance company shall not require the use of multiple aftermarket parts distributors to provide parts for a single repair;  (3) Insurers specifying the use of aftermarket parts shall make allowances for the reasonable cost of any modifications to the aftermarket parts which may become necessary when making the repair, and for the cost of fitting, removing, and/or handling aftermarket parts which do not result in the vehicle being repaired to its condition prior to the loss;  (4) If the aftermarket part specified by the insurer does not result in the vehicle being repaired to its condition prior to the loss, the insurer shall then specify the use of an OEM part;  (5) The automobile body shop shall promptly notify the appraiser if the aftermarket part specified by the insurer does not result in the vehicle being repaired to its condition prior to the loss and permit the appraiser to reinspect the vehicle and make appropriate supplemental authorizations, if necessary;  (6) The automobile body shop shall provide documentation of aftermarket parts, which do not meet the requirements of this section, as reasonably requested by the insurer. The insurer shall be permitted to exercise any available rights of recovery against the aftermarket parts distributor.  History of Section.P.L. 2003, ch. 239,  1; P.L. 2003, ch. 368,  2. 
 27-10.3-1. Arbitration provision. (a) Every contract of motor vehicle liability insurance, issued in the state by an insurance carrier authorized to do business in the state, shall contain the following provisions:  (1) Any person, referred to in this section as the plaintiff, suffering a loss, allegedly resulting out of the ownership, maintenance, or use of a motor vehicle by an insured or self-insured, and allegedly resulting from liability imposed by law for property damage, bodily injury, or death, may, at his or her election, whenever the claim is for fifty thousand dollars ($50,000) or less, submit the matter to arbitration pursuant to chapter 3 of title 10;  (2) Selection of arbitrator. After submission to arbitration by the plaintiff, one arbitrator shall be selected from the list of qualified arbitrators of the court annexed arbitration program of the superior court in the same manner as arbitrators are selected in accordance with the rules of that program. Each party shall share the expenses of arbitration in accordance with the rules of the court annexed arbitration program;  (3) Hearings. The arbitrator shall call a hearing and provide seven (7) days notice of the time and place of the hearing to the parties. The hearing shall be informal, and the rules of evidence prevailing in judicial proceedings shall be binding. Any and all documentary evidence and other data deemed relevant by the arbitrators may be received in evidence. The arbitrators shall have the power to administer oaths and to require by subpoena the attendance and testimony of witnesses, and the production of books, records, and other evidence, relative or pertinent to the issues presented to them for determination. The decision of the arbitrators shall be binding upon the parties unless:  (i) In the event that suit has not been instituted, either party reserves his or her right to a jury trial by giving notice of this reservation of right to the other party or parties and to the arbitrators within sixty (60) days of the arbitrators award by certified mail return receipt requested; or  (ii) In the event that suit has been instituted, either party files a request for a jury trial with the court and with notice to the other party or parties within sixty (60) days of the arbitrators award. If the case proceeds to trial subsequent to arbitration, the decision of the arbitrators shall not be admissible;  (4) Statute of limitations. Notwithstanding the foregoing, a suit shall be instituted in order to bring the action within any applicable statute of limitations, but the suit will be stayed until an arbitrators award has been made or the case reached for trial;  (5) Agreements to arbitrate. Uninsured motorist contracts shall be governed by the provisions of  10-3-2.  (b) Every person who maintains motor vehicle liability insurance shall, when making an application for a motor vehicle operators license, or the renewal of that license, or when registering a motor vehicle, agree in writing on a form provided by the director of the department of transportation to be bound by the provisions of this chapter.  History of Section.P.L. 1989, ch. 364,  1; P.L. 1993, ch. 255,  3; P.L. 2002, ch. 391,  1; P.L. 2013, ch. 183,  1; P.L. 2013, ch. 230,  1. 
 27-10-1.1. Definitions. (a) Adjuster means an individual licensed as either a public company or independent adjuster.  (b) Catastrophic disaster according to the Federal Response Plan, means an event that results in large numbers of deaths and injuries; causes extensive damage or destruction of facilities that provide and sustain human needs; produces an overwhelming demand on state and local response resources and mechanisms; causes a severe long-term effect on general economic activity; and severely affects state, local, and private sector capabilities to begin and sustain response activities. A catastrophic disaster shall be declared by the President of the United States, the governor of the state, or the insurance commissioner.  (c) Company adjuster means a person who:  (1) Is an individual who contracts for compensation with insurers or self-insurers as an employee; and  (2) Investigates, negotiates, or settles property, casualty, or workers compensation claims for insurers or for self-insurers as an employee.  (d) Department means the insurance division of the department of business regulation.  (e) Home state means the District of Columbia and any state or territory of the United States in which the adjusters principal place of residence or principal place of business is located. If neither the state in which the public adjuster maintains the principal place of residence, nor the state in which the adjuster maintains the principal place of business, has a substantially similar law governing adjusters, the adjuster may declare another state in which it becomes licensed and acts as a public adjuster to be the home state.  (f) Independent adjuster means a person who:  (1) Is an individual who contracts for compensation with insurers or self-insurers as an independent contractor; or  (2) Investigates, negotiates, or settles property, casualty, or workers compensation claims for insurers or for self-insurers as an independent contractor.  (g) Insurance commissioner means the director of the department of business regulation or his or her designee.  (h) NAIC means the National Association of Insurance Commissioners.  (i) Public adjuster means any person who, for compensation or any other thing of value on behalf of the insured:  (1) Acts or aids, solely in relation to first-party claims arising under insurance contracts that insure the real or personal property of the insured, other than automobile, on behalf of an insured in negotiating for, or effecting the settlement of, a claim for loss or damage covered by an insurance contract;  (2) Advertises for employment as a public adjuster of insurance claims or solicits business or represents himself or herself to the public as a public adjuster of first-party insurance claims for losses or damages arising out of policies of insurance that insure real or personal property; or  (3) Directly or indirectly solicits business, investigates or adjusts losses, or advises an insured about first-party claims for losses or damages arising out of policies of insurance that insure real or personal property for another person engaged in the business of adjusting losses or damages covered by an insurance policy, for the insured.  (j) Uniform individual application means the current version of the National Association of Insurance Commissioners (NAIC) Uniform Individual Application for resident and nonresident individuals.  History of Section.P.L. 2014, ch. 107,  2; P.L. 2014, ch. 195,  2. 
 27-10-1.2. License required. (a) A person shall not act or hold himself 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 he or she is an adjuster representing an insurer in any capacity, including acting as an employee of the insurer or acting as an independent adjuster.  History of Section.P.L. 2014, ch. 107,  2; P.L. 2014, ch. 195,  2. 
 27-10-1. Purpose and scope. This chapter governs the qualifications and procedures for the licensing of: (1) Public adjusters; (2) Company adjusters; and (3) Independent adjusters. It specifies the duties of, and restrictions on, public, company, and independent adjusters. The restrictions on public adjusters include limiting their licensure to assisting insureds in first-party claims.  History of Section.P.L. 1956, ch. 3790,  1; G.L. 1956,  27-10-1; P.L. 1985, ch. 169,  1, 2; P.L. 2007, ch. 404,  1; P.L. 2008, ch. 475,  79; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1. 
 27-10-10. Orders for discontinuance of unlawful practices. If, after a hearing, the commissioner finds that the furnishing of any information or assistance to a claims adjuster involves any act or practice which is unfair or unreasonable or inconsistent with the provisions of this chapter, the commissioner may issue a written order specifying in what respects that act or practice is unfair or unreasonable or inconsistent with the provisions of this chapter, and requiring the discontinuance of that act or practice.  History of Section.P.L. 1956, ch. 3790,  4; G.L. 1956,  27-10-10. 
 27-10-11. Penalty for violations. 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.  History of Section.P.L. 1956, ch. 3790,  5; G.L. 1956,  27-10-11; P.L. 1985, ch. 169,  3; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1. 
 27-10-12. License denial, nonrenewal, or revocation. (a) The insurance commissioner may place on probation, suspend, revoke, or refuse to issue or renew an adjusters license or may levy a civil penalty in accordance with  42-14-16 or any combination of actions for any one or more of the following causes:  (1) Providing incorrect, misleading, incomplete, or materially untrue information in the license application;  (2) Violating any insurance laws, or violating any regulation, subpoena, or order of the insurance commissioner or of another states insurance commissioner;  (3) Obtaining or attempting to obtain a license through misrepresentation or fraud;  (4) Improperly withholding, misappropriating, or converting any monies or properties received in the course of doing insurance business;  (5) Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance;  (6) Having been convicted of a felony;  (7) Having admitted, or been found to have committed, any insurance unfair trade practice or insurance fraud;  (8) Using fraudulent, coercive, or dishonest practices; or demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of business in this state or elsewhere;  (9) Having an insurance license, or its equivalent, denied, suspended, or revoked in any other state, province, district, or territory;  (10) Forging anothers name to an application for insurance or to any document related to an insurance transaction;  (11) Cheating, including improperly using notes or any other reference material, to complete an examination for an insurance license;  (12) Knowingly accepting insurance business from an individual who is not licensed but who is required to be licensed by the department;  (13) Failing to comply with an administrative or court order imposing a child support obligation; or  (14) Failing to pay state income tax or comply with any administrative or court order directing payment of state income tax.  (b) In the event that the action by the department is to deny an application for or not renew a license, the department shall notify the applicant or licensee and advise, in writing, the applicant or licensee of the reason for the nonrenewal or denial of the applicants or licensees license. The applicant or licensee may make written demand upon the department within ten (10) days for a hearing before the department to determine the reasonableness of the insurance commissioners action. The hearing shall be held pursuant to the Administrative Procedures Act, chapter 35 of title 42.  (c) The license of a business entity may be suspended, revoked, or refused if the department finds, after hearing, that an individual licensees violation was known, or should have been known, by one or more of the partners, officers, or managers acting on behalf of the business entity and the violation was neither reported to the department nor corrective action taken.  (d) In addition to, or in lieu of, any applicable denial, suspension or revocation of a license, a person may, after hearing, be subject to a civil fine according to  42-14-16.  (e) The department shall retain the authority to enforce the provisions of and impose any penalty or remedy authorized by this chapter and  42-14-16 against any person who is under investigation for, or charged with, a violation of this chapter or title even if the persons license has been surrendered or has lapsed by operation of law.  History of Section.P.L. 1956, ch. 3790,  7; G.L. 1956,  27-10-12; P.L. 1978, ch. 123,  1; P.L. 1985, ch. 169,  3; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1. 
 27-10-13. Rules and regulations. The insurance commissioner shall have the authority to promulgate all reasonable rules and regulations necessary to effect and to enforce the purposes and provisions of this chapter. Included within this authority is the power to set standards for public adjuster fees, the terms of the contract between a public adjuster and a consumer, and requirements for escrow accounts held by public adjusters for funds held on behalf of others.  History of Section.P.L. 1978, ch. 123,  2; P.L. 1985, ch. 169,  4, 5; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1. 
 27-10-14. Other conduct prohibited. Nothing in this chapter shall be construed to authorize any conduct prohibited by the provisions of chapter 27 of title 11.  History of Section.P.L. 1985, ch. 169,  5. 
 27-10-15. Repealed.
 27-10-2. Persons exempt. The provisions of this chapter shall not apply to the following: (1) An attorney at law admitted to practice in this state, acting in his or her professional capacity as an attorney;  (2) Either an insurance producer of a domestic insurance company or an insurance producer duly licensed by the insurance commissioner, when the insurance producer adjusts, or assists in the adjustment of, claims arising only under policies of insurance or fidelity or surety bonds negotiated, solicited, or effected by him or her or by the insurance producer, whether the insurance producer is a person, partnership, or corporation, for which he or she acts;  (3) A person who negotiates or settles claims arising under a life or health insurance policy or an annuity contract;  (4) A person employed only for the purpose of obtaining facts surrounding a loss or furnishing technical assistance to a licensed adjuster, including photographers, estimators, private investigators, engineers, and handwriting experts;  (5) An individual who is employed to investigate suspected fraudulent insurance claims but who does not adjust losses or determine claims payments;  (6) A person who solely performs executive, administrative, managerial, or clerical duties, or any combination thereof, and who does not investigate, negotiate, or settle claims with policyholders, claimants, or their legal representative;  (7) A licensed healthcare provider or its employee who provides managed care services as long as the services do not include the determination of compensability;  (8) A managed care organization or any of its employees or an employee of any organization providing managed care services so long as the services do not include the determination of compensability;  (9) A person who settles only reinsurance or subrogation claims;  (10) A person who investigates, negotiates, or settles life, accident and health, annuity, or disability insurance claims;  (11) An individual employee, under a self-insured arrangement, who adjusts claims on behalf of their employer;  (12) A person authorized to adjust workers compensation or disability claims under the authority of a third-party administrator (TPA) license pursuant to chapter 20.7 of title 27;  (13) A person who adjusts claims for portable electronic insurance offered pursuant to chapter 2.7 of title 27.  History of Section.P.L. 1956, ch. 3790,  1; G.L. 1956,  27-10-2; P.L. 1978, ch. 123,  1; P.L. 1982, ch. 182,  1; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1. 
 27-10-3. Issuance of license. (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 individuals 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 his or her 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 entitys 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.  History of Section.P.L. 1956, ch. 3790,  2; G.L. 1956,  27-10-3; P.L. 1977, ch. 220,  1; P.L. 1979, ch. 174, art. 7,  3; P.L. 1998, ch. 122,  3; P.L. 2007, ch. 404,  1; P.L. 2008, ch. 144,  3; P.L. 2008, ch. 198,  3; P.L. 2009, ch. 68, art. 12,  6; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1; P.L. 2018, ch. 47, art. 7,  3. 
 27-10-4. Veterans license. The commissioner shall issue a license as an insurance claim adjuster, other than for life and accident and health insurance, without the payment of a fee, to any honorably discharged soldier, sailor, or marine who has at any time served the United States in time of war, and who shall present proof that he or she is the person who served and provides the certificate of his or her honorable discharge.  History of Section.P.L. 1956, ch. 3790,  4; G.L. 1956,  27-10-4. 
 27-10-5. License. (a) Unless denied licensure, persons who have met the requirements of  27-10-3 shall be issued either a public, company, or independent adjuster license.  (b) A company or independent adjuster may qualify for a license in one or more of the following lines of authority:  (1) Property and casualty;  (2) Workers Compensation; or  (3) Crop.  (c) An individual may not hold both a public adjuster and a company or independent adjuster license at the same time.  (d) An adjuster license shall remain in effect unless probated, suspended, revoked, or refused as long as a biennial application for renewal and fee set forth in  27-10-3(a)(6) is paid and all other requirements for license renewal are met by the due date; otherwise, the license expires.  (e) An adjuster whose license expires may, within twelve (12) months of the renewal date, be reissued an adjuster license upon receipt of the renewal request, as prescribed by the department. However, a penalty in the amount of fifty dollars ($50.00) in addition to the renewal fee shall be required to reissue the expired license.  (f) An adjuster who is unable to comply with license renewal procedures and requirements due to military service, long-term medical disability, or some other extenuating circumstance may request a waiver of same and a waiver of any examination requirement, fine, or other sanction imposed for failure to comply with renewal procedures.  (g) An adjuster shall be subject to chapters 9.1 and 29 of title 27.  (h) The adjuster shall inform the department by any means acceptable of any change in resident or business address(es) for the home state or in legal name within thirty (30) days of the change.  (i) In order to assist in the performance of the departments duties, the department may contract with non-governmental entities, including the National Association of Insurance Commissioners (NAIC), its affiliates or subsidiaries, to perform any ministerial functions, including the collection of fees and data, related to licensing that the insurance commissioner may deem appropriate.  History of Section.P.L. 1956, ch. 3790,  3; G.L. 1956,  27-10-5; P.L. 1993, ch. 180,  11; P.L. 2007, ch. 404,  1; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1. 
 27-10-6. Examination. [Effective until January 1, 2023.] (a) The department shall subject the applicant to a written examination as to his or her 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 non-refundable 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.  History of Section.P.L. 1956, ch. 3790,  3; G.L. 1956,  27-10-6; P.L. 1960, ch. 71, art. 1,  5; P.L. 1971, ch. 276; P.L. 1977, ch. 220,  1; P.L. 1978, ch. 123,  1; P.L. 1983, ch. 62,  1; P.L. 1985, ch. 169,  3; P.L. 1985, ch. 181, art. 15,  1; P.L. 1987, ch. 166,  13; P.L. 1988, ch. 350,  1; P.L. 2004, ch. 595, art. 30,  11; P.L. 2007, ch. 404,  1; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1.   27-10-6. Examination. [Effective January 1, 2023.] (a) The department shall subject the applicant to a written examination as to his or her 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.  History of Section.P.L. 1956, ch. 3790,  3; G.L. 1956,  27-10-6; P.L. 1960, ch. 71, art. 1,  5; P.L. 1971, ch. 276; P.L. 1977, ch. 220,  1; P.L. 1978, ch. 123,  1; P.L. 1983, ch. 62,  1; P.L. 1985, ch. 169,  3; P.L. 1985, ch. 181, art. 15,  1; P.L. 1987, ch. 166,  13; P.L. 1988, ch. 350,  1; P.L. 2004, ch. 595, art. 30,  11; P.L. 2007, ch. 404,  1; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1; P.L. 2022, ch. 119,  1, effective January 1, 2023; P.L. 2022, ch. 120,  1, effective January 1, 2023. 
 27-10-7.1. Nonresident license reciprocity. [Effective until January 1, 2023.] (a) Unless denied licensure, a nonresident person shall receive a nonresident adjuster license if:  (1) The person is currently licensed as a resident adjuster and is in good standing in his or her home state;  (2) The person has submitted the proper request for licensure and has paid the fees required by  27-10-3(a)(6);  (3) The person has submitted or transmitted to the department the appropriate, completed application for licensure for the equivalent type of license and lines of authority; and  (4) The persons home state awards nonresident adjuster licenses to residents of this state on the same basis.  (b) The insurance commissioner may verify the adjusters licensing status through the database maintained by the NAIC, its affiliates, or subsidiaries.  (c) As a condition to continuation of an adjuster license issued under this section, the licensee shall maintain a resident adjuster license in his or her home state. The nonresident adjuster license issued under this section shall terminate and be surrendered immediately if the home state adjuster license terminates for any reason, unless the adjuster has been issued a license as a resident adjuster in his or her new home state. Notification to any state where a nonresident license is issued must be made as soon as possible, yet no later than thirty (30) days of change in new state resident license. The licensee shall include new and old addresses in the notification to the department. A new state resident license is required for nonresident licenses to remain valid. The new state resident license must have reciprocity with the licensing nonresident state(s) for the nonresident license not to terminate.  History of Section.P.L. 2014, ch. 107,  2; P.L. 2014, ch. 195,  2.   27-10-7.1. Nonresident license reciprocity. [Effective January 1, 2023.] (a) Unless denied licensure, a nonresident person shall receive a nonresident adjuster license if:  (1) The person is currently licensed as a resident adjuster and is in good standing in his or her home state;  (2) The person has submitted the proper request for licensure and has paid the fees required by  27-10-3(a)(6);  (3) The person has submitted or transmitted to the department the appropriate, completed application for licensure for the equivalent type of license and lines of authority; and  (4) The persons home state awards nonresident adjuster licenses to residents of this state on the same basis.  (b) The insurance commissioner may verify the adjusters licensing status through the database maintained by the NAIC, its affiliates, or subsidiaries.  (c) As a condition to continuation of an adjuster license issued under this section, the licensee shall maintain a resident adjuster license in his or her home state. The nonresident adjuster license issued under this section shall terminate and be surrendered immediately if the home state adjuster license terminates for any reason, unless the adjuster has been issued a license as a resident adjuster in his or her new home state. Notification to any state where a nonresident license is issued must be made as soon as possible, yet no later than thirty (30) days of change in new state resident license. The licensee shall include new and old addresses in the notification to the department. A new state resident license is required for nonresident licenses to remain valid. The new state resident license must have reciprocity with the licensing nonresident state(s) for the nonresident license not to terminate.  (d) The department may grant a nonresident license to an adjuster who holds a current certificate issued by a national or state based claims association with a program, approved by the department, that includes at a minimum, 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.  History of Section.P.L. 2014, ch. 107,  2; P.L. 2014, ch. 195,  2; P.L. 2022, ch. 119,  1, effective January 1, 2023; P.L. 2022, ch. 120,  1, effective January 1, 2023. 
 27-10-7. Exemptions from examination. (a) An individual who applies for an adjuster license in this state who was previously licensed as an adjuster in another state based on an adjuster examination shall not be required to complete the examination. This exemption is only available if the person is currently licensed in that state, or if the application is received within twelve (12) months of the cancellation of the applicants previous license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state or the states database records or records maintained by the NAIC, its affiliates, or subsidiaries, indicate that the adjuster is or was licensed in good standing.  (b) A person licensed as an adjuster in another state based on an adjuster examination who moves to this state shall make application within ninety (90) days of establishing legal residence to become a resident licensee. No examination shall be required of that person to obtain an adjuster license.  History of Section.P.L. 1956, ch. 3790,  3; G.L. 1956,  27-10-7; P.L. 1983, ch. 65,  1; P.L. 1987, ch. 166,  14; P.L. 2009, ch. 68, art. 12,  6; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1. 
 27-10-8. Emergency licenses. (a) In the event of a declared catastrophe, an insurer shall notify the department, via an application for temporary emergency licensure, of each individual, not already licensed in the state where the catastrophe has been declared, who will act as an emergency company or independent adjuster on behalf of the insurer.  (b) A person who is otherwise qualified to adjust claims, but not already licensed in this state where the catastrophe has been declared, may act as an emergency company or independent adjuster and adjust claims, if, within five (5) days of deployment to adjust claims arising from the declared catastrophe, the insurer notifies the department by providing the following information in a format prescribed by the insurance commissioner:  (1) Name of the individual;  (2) Social security number of individual;  (3) Name of insurer the company or independent adjuster will represent;  (4) Effective date of the contract between the insurer and company or independent adjuster, if applicable;  (5) Catastrophe or loss control number;  (6) Catastrophe event name; and  (7) Other information the department deems necessary.  (c) An emergency company or independent adjusters license shall remain in force for a period not to exceed ninety (90) days, unless extended by the department.  (d) Any person licensed as an emergency company or independent adjuster must comply with all laws of this state in the same manner as if he or she had been issued a company or independent adjuster and both he or she and the insurer for whom the adjuster is working are responsible in the same manner as they would be if the adjuster was a fully licensed adjuster.  (e) There is no fee payable to the state for the licensing of the emergency adjuster. However, in order to assist in the performance of the departments duties, the department may contract with non-governmental entities, including the NAIC, its affiliates, or subsidiaries, to perform any ministerial functions related to licensing that the department may deem appropriate and the applicant is responsible for the fee associated with these services as determined by the department.  (f) Public adjusters are not eligible for licensing under this section.  History of Section.P.L. 1956, ch. 3790,  3; G.L. 1956,  27-10-8; P.L. 1978, ch. 123,  1; P.L. 2005, ch. 140,  1; P.L. 2005, ch. 191,  1; P.L. 2009, ch. 303,  4; P.L. 2009, ch. 304,  4; P.L. 2014, ch. 107,  1; P.L. 2014, ch. 195,  1. 
 27-10-9. Investigative and subpoena powers. (a) The insurance commissioner shall have the power to examine and investigate into the affairs of every person engaged in the business of negotiating adjustments of insurance claims and claims under fidelity and surety bonds.  (b) The insurance commissioner, upon a hearing, may administer oaths, examine and cross examine witnesses, and receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence, or other documents which the commissioner deems relevant to the inquiry.  History of Section.P.L. 1956, ch. 3790,  4; G.L. 1956,  27-10-9. 
 27-11.1-1. Maximum investments in real property. No domestic insurance company shall purchase, lease, hold, or improve any real property 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 that date of all real property held by the company, exceeds twenty percent (20%) of its admitted assets.  History of Section.P.L. 1984, ch. 170,  1. 
 27-11.1-2. Maximum investments in mortgage loans. A domestic insurance company may invest in mortgage loans; provided, that any mortgage loan or loans made or acquired by the domestic insurer on any one or all properties shall not exceed in the aggregate ten percent (10%) of its admitted assets.  History of Section.P.L. 1984, ch. 170,  1. 
 27-11.1-3. Maximum investments in investments currently reported in Schedule BA of the annual statement blank. A domestic insurance company may invest in those assets, which are currently reported in Schedule BA of its annual statement; provided, that those investments do not exceed in the aggregate ten percent (10%) of the companys admitted assets. Those investments may include, but are not limited to, the following types of investments:  (1) All loans on or investments in oil and gas production payments;  (2) All transportation equipment;  (3) Timber deeds;  (4) Mineral rights carried as admitted assets;  (5) Motor vehicle trust certificates; and  (6) Any other class of admitted investment not clearly includible in other statement schedules.  History of Section.P.L. 1984, ch. 170,  1. 
 27-11.1-4. Maximum investments in affiliated or subsidiary companies. A domestic insurance company may invest in securities of affiliated insurance companies or subsidiary insurance companies; provided, that any investment in securities of affiliated insurance companies or subsidiary insurance companies shall not exceed in the aggregate fifty percent (50%) of the domestic insurance companys surplus. A domestic insurance company may invest in securities of affiliated noninsurance companies or subsidiary noninsurance companies in amounts which do not exceed the lesser of ten percent (10%) of the insurers assets or fifty percent (50%) of the insurers surplus as regards policyholders; provided, that after the investments, the insurers surplus as regards policyholders will be reasonable in relation to the insurers outstanding liabilities and adequate to its financial needs. In no event may the aggregate investment in securities of insurance or noninsurance affiliates or subsidiary companies exceed fifty percent (50%) of the domestic insurance companys surplus.  History of Section.P.L. 1984, ch. 170,  1; P.L. 1993, ch. 180,  32; P.L. 1994, ch. 404,  9. 
 27-11.1-5. Investment in collateral loans. A domestic insurance company may invest in collateral loans, provided, that the collateral loans invested in by the company shall not exceed in the aggregate ten percent (10%) of the domestic insurance companys admitted assets.  History of Section.P.L. 1984, ch. 170,  1; P.L. 1991, ch. 348,  6. 
 27-11.1-6. Applicability. This chapter shall apply to all domestic companies issued a certificate of compliance subsequent to May 8, 1984.  History of Section.P.L. 1984, ch. 170,  1; P.L. 2002, ch. 292,  27. 
 27-11.1-7. Rules and regulations. The insurance commissioner may promulgate reasonable rules and regulations to carry out the purposes of this chapter.  History of Section.P.L. 1991, ch. 348,  3. 
 27-11.1-8. Investment standards. (a) All domestic insurance companies and United States branches of alien insurers entered through this state shall protect the interests of insured by promoting insurer 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 insurers to allocate investments in a manner consistent with principles of prudent investment management to achieve an adequate return so that obligations to insured 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) 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.  History of Section.P.L. 1999, ch. 147,  4. 
 27-11.2-1. Valuation of bonds. (a) All bonds or other evidences of debt having a fixed term and rate of interest held by an insurer may, if amply secured and not in default as to principal or interest, be valued as follows:  (1) If purchased at par, at the par value;  (2) If purchased above or below par, on the basis of the purchase price adjusted so as to bring the value to par at maturity and so as to yield in the meantime the effective rate of interest at which the purchase was made, or in lieu of that method, according to an accepted method of valuation as is approved by the department; and  (3) Purchase price shall in no case be taken at a higher figure than the actual market value at the time of purchase, plus actual brokerage, transfer, postage or express charges paid in the acquisition of the securities.  (b) The department shall have full discretion in determining the method of calculating values according to the rules set forth in this section, but no method or valuation shall be inconsistent with any applicable valuation or method used by insurers in general, or any method then currently formulated or approved by the National Association of Insurance Commissioners or its successor organization.  History of Section.P.L. 1992, ch. 445,  1. 
 27-11.2-2. Valuation of other securities. (a) Securities, other than those referred to in  27-11.2-1, held by an insurer shall be valued, in the discretion of the department, at their market value, or at their appraised value, or at prices determined by it as representing their fair market value.  (b) Preferred or guaranteed stocks or shares while paying full dividends may be carried at a fixed value in lieu of market value, at the discretion of the department and in accordance with any method of valuation as it may approve.  (c) Stock of a subsidiary corporation of an insurer shall not be valued at an amount in excess of its net value as based upon those assets only of the subsidiary which would be eligible under any provision of the general laws for investment of the funds of the insurer directly.  (d) No valuations under this section shall be inconsistent with any applicable valuation or method then currently formulated or approved by the National Association of Insurance Commissioners or its successor organization.  History of Section.P.L. 1992, ch. 445,  1. 
 27-11-1. Power of life insurance company to acquire and hold property. Any life insurance company incorporated under a charter granted by the general assembly of this state and any life insurance company incorporated under a charter or the laws of any other state in the United States of America which is empowered to engage in the business of making insurance upon lives, and which has complied with or shall comply with the requirements of chapter 2 of this title to engage in the life insurance business in this state, may and is authorized to invest in, purchase, lease, or acquire by gift or otherwise, and hold without any limitation of time, any real property or any interest in the property, in this state, and may use that property, and any other real property owned, held, or leased by it, for a housing project or projects designed to provide accommodations for ten (10) or more families or for any other investment or income producing purposes.  History of Section.P.L. 1947, ch. 1866,  1; G.L. 1956,  27-11-1. 
 27-11-2. Power to erect, maintain, improve, and rent structures. A life insurance company may use existing structures, may erect or cause to be erected new structures, may use any combination of existing structures and new structures, and may maintain, repair, alter, demolish, and reconstruct those structures. Structures as used in this section includes apartment or tenement buildings, dwelling houses, and buildings or accommodations for retail stores, shops, offices, and other community services as the company may deem proper and suitable for the convenience of the tenants and occupants of those structures. The company may collect and receive rents or income from, and may manage, lease, mortgage, sell, and convey, the whole or any part of the property.  History of Section.P.L. 1947, ch. 1866,  1; G.L. 1956,  27-11-2. 
 27-11-3. Maximum investment in real property. 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.  History of Section.P.L. 1947, ch. 1866,  1; G.L. 1956,  27-11-3. 
 27-12.1-1. Applicability. The provisions of this chapter shall apply to all domestic, foreign, and alien insurers who are authorized to transact business in this state. Insurer means any legal entity subject to state insurance regulation.  History of Section.P.L. 1991, ch. 257,  2; P.L. 1994, ch. 404,  14. 
 27-12.1-2. Filing requirements. (a) Each domestic, foreign, and alien insurer authorized to transact insurance in this state shall annually, on or before March 1 of each year, file with the National Association of Insurance Commissioners a hard copy of its annual statement convention blank, including diskette, along with any additional filings prescribed by the commissioner for the preceding year. The information filed with the National Association of Insurance Commissioners shall be in the same format and scope as that required by the commissioner and shall include the signed jurat page and the actuarial certification. Quarterly statements on hard copy and on diskette must also be filed with the National Association of Insurance Commissioners due on or before forty-five (45) days after the quarter ending. Any amendments and addendum to the annual or quarterly statement filing subsequently filed with the commissioner shall also be filed with the National Association of Insurance Commissioners.  (b) Foreign insurers domiciled in a state which has a law substantially similar to subsection (a) of this section shall be deemed in compliance with this section.  (c) Provisions of this chapter shall apply to corporations organized under chapters 19, 20, 20.1, 20.2 and 20.3 of this title.  History of Section.P.L. 1991, ch. 257,  2; P.L. 1994, ch. 404,  14; P.L. 1996, ch. 188,  6. 
 27-12.1-3. Immunity. In the absence of actual malice, members of the National Association of Insurance Commissioners, their duly authorized committees, subcommittees, and task forces, their delegates, National Association of Insurance Commissioners employees, and all others charged with the responsibility of collecting, reviewing, analyzing, and disseminating the information developed from the filing of the annual and quarterly statement convention blanks shall be acting as agents of the commissioner under the authority of this chapter and shall not be subject to civil liability for libel, slander, or any other cause of action by virtue of their collection, review, and analysis or dissemination of the data and information collected from the filings required pursuant to this chapter.  History of Section.P.L. 1991, ch. 257,  2; P.L. 1994, ch. 404,  14. 
 27-12.1-4. Confidentiality. All financial analysis ratios and examination synopses concerning insurance companies that are submitted to the department of business regulations by the National Association of Insurance Commissioners insurance regulatory information system are confidential and may not be disclosed by the department.  History of Section.P.L. 1991, ch. 257,  2. 
 27-12.1-5. Revocation of certificate of authority. The commissioner may suspend, revoke, or refuse to renew the certificate of authority of any insurer failing to file its annual or quarterly statement when due or within any extension of time which the commissioner, for good cause, may have granted. The commissioner may exempt diskette filings from domestic insurers that operate only in Rhode Island.  History of Section.P.L. 1991, ch. 257,  2; P.L. 1994, ch. 404,  14. 
 27-12.2-1. Repealed. History of Section.P.L. 1991, ch. 257,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.2-10. Repealed. History of Section.P.L. 1991, ch. 257,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.2-2. Repealed. History of Section.P.L. 1991, ch. 257,  3; P.L. 1999, ch. 22,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.2-3. Repealed. History of Section.P.L. 1991, ch. 257,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.2-4. Repealed. History of Section.P.L. 1991, ch. 257,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.2-5. Repealed. History of Section.P.L. 1991, ch. 257,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.2-6. Repealed. History of Section.P.L. 1991, ch. 257,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.2-7. Repealed. History of Section.P.L. 1991, ch. 257,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.2-8. Repealed. History of Section.P.L. 1991, ch. 257,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.2-9. Repealed. History of Section.P.L. 1991, ch. 257,  3; Repealed by P.L. 2011, ch. 157,  4, effective June 30, 2011; P.L. 2011, ch. 275,  4, effective July 12, 2011. 
 27-12.3-1. Title. This act shall be known as the Property and Casualty Actuarial Opinion Law. History of Section.P.L. 2008, ch. 28,  1; P.L. 2008, ch. 31,  1. 
 27-12.3-2. Actuarial opinion of reserves and supporting documentation. (a) Statement of actuarial opinion. Every property and casualty insurance company doing business in this state, unless otherwise exempted by the domiciliary commissioner, shall annually submit the opinion of an appointed actuary entitled Statement of Actuarial Opinion. This opinion shall be filed in accordance with the appropriate national association of insurance commissioners property and casualty annual statement instructions.  (b) Actuarial opinion summary.(1) Every property and casualty insurance company domiciled in this state that is required to submit a statement of actuarial opinion shall annually submit an actuarial opinion summary, written by the companys appointed actuary. This actuarial opinion summary shall be filed in accordance with the appropriate national association of insurance commissioners property and casualty annual statement instructions and shall be considered as a document supporting the actuarial opinion required in subsection (a).  (2) A company licensed but not domiciled in this state shall provide the actuarial opinion summary upon request.   (c) Actuarial report and work papers.(1) An actuarial report and underlying work papers as required by the appropriate national association of insurance commissioners property and casualty annual statement instructions shall be prepared to support each actuarial opinion.  (2) If the insurance company fails to provide a supporting actuarial report and/or work papers at the request of the commissioner or the commissioner determines that the supporting actuarial report or work papers provided by the insurance company is otherwise unacceptable to the commissioner, the commissioner may engage a qualified actuary at the expense of the company to review the opinion and the basis for the opinion and prepare the supporting actuarial report or work papers.   (d) The appointed actuary shall not be liable for damages to any person (other than the insurance company and the commissioner) for any act, error, omission, decision or conduct with respect to the actuarys opinion, except in cases of fraud or willful misconduct on the part of the appointed actuary.  History of Section.P.L. 2008, ch. 28,  1; P.L. 2008, ch. 31,  1. 
 27-12.3-3. Confidentiality. (a) The statement of actuarial opinion shall be provided with the annual statement in accordance with the appropriate national association of insurance commissioners property and casualty annual statement instructions and shall be treated as a public document.  (b)(1) Documents, materials or other information in the possession or control of the department of insurance that are considered an actuarial report, work papers or actuarial opinion summary provided in support of the opinion, and any other material provided by the company to the commissioner in connection with the actuarial report, work papers or actuarial opinion summary, shall be confidential by law and privileged, shall not be subject to the access to public records act Rhode Island general laws  38-2-1 et seq., shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action.  (2) This provision shall not be construed to limit the commissioners authority to release the documents to the actuarial board for counseling and discipline (ABCD) so long as the material is required for the purpose of professional disciplinary proceedings and that the ABCD establishes procedures satisfactory to the commissioner for preserving the confidentiality of the documents, nor shall this section be construed to limit the commissioners authority to use the documents, materials or other information in furtherance of any regulatory or legal action brought as part of the commissioners official duties.  (c) Neither the commissioner nor any person who received documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials or information subject to subsection (b).  (d) In order to assist in the performance of the commissioners duties, the commissioner:  (1) May share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subsection (b) with other state, federal and international regulatory agencies, with the national association of insurance commissioners and its affiliates and subsidiaries, and with state, federal and international law enforcement authorities, provided that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information and has the legal authority to maintain confidentiality:  (e) No waiver of any applicable privilege or claim of confidentiality in the documents, materials or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subsection (d).  History of Section.P.L. 2008, ch. 28,  1; P.L. 2008, ch. 31,  1. 
 27-12-1. Time of filing  Contents of report. (a) Every insurance company of any name or kind doing business in this state shall annually on the first day of January, or within two (2) months after that date, file with the insurance commissioner an annual National Association of Insurance Commissioners statement convention blank, prepared in accordance with the National Association of Insurance Commissioners annual statement instructions and accounting practices and procedures manuals, examiners handbook, securities valuation manual, and any other manuals published by the National Association of Insurance Commissioners that may be amended, signed and sworn to by its president and secretary, of its exact condition specifying that the company is a fire, marine, fire and marine, life, health, accident, or other insurance company; stating the amount of its capital and the manner of its investment; designating the amount invested in mortgages, in what companies, particularizing each item of investment; the amount of marine risks not terminated, and the premium paid on those risks; the amount of fire risks not terminated, and the premium paid on those risks; the amount of liabilities, specifying the amount of outstanding claims, adjusted or unadjusted, due or not due; and in case the company is incorporated on the mutual principle, the statement shall set forth, in addition to this information, the amount of risks insured by the company, the amount of premium on the risks, what portion of it has been paid in cash, what security has been taken for the remainder, and what is the largest sum insured in any one risk; and, except in the case of a company writing less than one million dollars ($1,000,000) of total direct plus assumed written premiums during a calendar year or which has fewer than one thousand (1,000) policyholders or certificate holders at the end of a calendar year, a statement of actuarial opinion relating to loss and loss adjustment expense reserves; and, except in the case of a company having direct premiums written of less than one million dollars ($1,000,000) in any calendar year and fewer than one thousand (1,000) policyholders or certificate holders at the end of a calendar year, an audited financial report prepared by an independent certified public accountant; and the statement required to be made in this section, so far as applicable, shall be made of each class in companies authorized to take risks in classes, and in all cases the returns may be varied by the commissioner to obtain more definite information of the company; and shall pay a filing fee of one hundred dollars ($100).  (b) Companies may be required to file quarterly statements upon request by the insurance commissioner, in accordance with the National Association of Insurance Commissioners guidelines and procedures, due on or before forty-five (45) days after the quarter ending. Annual and quarterly statements shall be available for inspection by the public.  (c) The commissioner may assess a late fee of one hundred dollars ($100) per day for each day the insurer is late in filing its annual or quarterly statement, except that the insurer may request and receive a reasonable extension of the filing date without penalty.  (d) Provisions of this chapter shall apply to corporations organized under chapters 19, 20, 20.1, 20.2, 20.3, and 41 of this title.  (e) With respect to individual and group health benefit contracts, including managed care contracts, written by an insurance company or health organization subject to the requirements of this chapter, when the expected claim payments or incurred costs, claims adjustment expenses, and administration costs exceed the premiums to be collected for the remainder of a contract period, the insurer or health organization shall recognize a premium deficiency reserve by recording an additional liability for the deficiency, with a corresponding charge to operations. The reserve shall be calculated in accordance with regulations promulgated pursuant to this chapter.  (f) In addition to the powers which the commissioner has under other sections of this title relating to the financial statements of health organizations, the commissioner also has the power to require any health organizations subject to this title to file the annual audited financial statements of its controlling affiliate or person whether or not the controlling affiliate or person is licensed or authorized pursuant to this title. Additionally, if the controlling affiliate or person is an insurer or health organization that prepares statutory financial statements for submission to its state of domicile, the annual and/or quarterly statutory financial statements shall be filed with the commissioner. In the event the health organization fails to comply with a request of the commissioner pursuant to this section, the commissioner shall have the power to suspend or revoke the license of the health organization and/or to examine the controlling affiliate or person.  (g) As used in this section, control including controlling and affiliate and person have the meanings ascribed to them in  27-35-1. The term health organization has the meaning ascribed to it in  27-4.7-2.  History of Section.G.L. 1896, ch. 181,  24, 25; G.L. 1896, ch. 182,  15; G.L. 1909, ch. 219,  24, 25; G.L. 1909, ch. 220,  15; P.L. 1919, ch. 1754,  1, 2; G.L. 1923, ch. 255,  24, 25; G.L. 1923, ch. 256,  15; G.L. 1938, ch. 150,  23, 24; G.L. 1938, ch. 151,  15; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-12-1; P.L. 1960, ch. 71, art. 1,  6; P.L. 1991, ch. 348,  7; P.L. 1992, ch. 445,  5; P.L. 1993, ch. 138, art. 62,  11; P.L. 1994, ch. 404,  6; P.L. 1996, ch. 188,  5; P.L. 2000, ch. 178,  2; P.L. 2000, ch. 200,  12; P.L. 2000, ch. 229,  12. 
 27-12-2. Publication of abstracts of reports. The insurance commissioner shall annually publish for distribution an abstract of the statements filed in the commissioners 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.  History of Section.G.L. 1896, ch. 182,  16; G.L. 1909, ch. 220,  16; P.L. 1919, ch. 1754,  3; G.L. 1923, ch. 256,  16; G.L. 1938, ch. 151,  16; P.L. 1947, ch. 1822,  1; G.L. 1956,  27-12-2. 
 27-12-3. Examination of reports  Requiring additional statements. (a) The insurance commissioner shall annually examine the statements and returns required to be made by the companies and insurance producers, and if, in the commissioners opinion, any return is obscure, defective, or unsatisfactory he or she shall immediately require answers under oath, from the insurance producer or company by whom that obscure, defective, or unsatisfactory return has been made, to any interrogatories as he or she may deem necessary or proper to be answered in order to explain that return, and exhibit a full and accurate view of the business and resources of the company represented by the insurance producer.  (b) In the event that the insurance commissioner for any reason does not examine the statements and returns required to be made by insurance companies as stated in subsection (a), the examination shall be deemed to have been made for all purposes upon the following conditions:  (1) The examination has not been conducted for a period of two (2) consecutive calendar years;  (2) The company has filed its financial statements for each of the two (2) years which financial statements have been examined by an independent certified public accountant and shall have been prepared in accordance with generally accepted accounting principles applicable to insurance companies for complete financial statements, including balance sheets and related statements of income, changes in surplus, and changes in financial position for each of the previous three (3) years;  (3) The chief executive officer or the chief financial officer of the company shall affirm that the filed financial statements are complete and accurate; and  (4) The insurance commissioner shall not reject any filing within sixty (60) days of the date of the filing as being incomplete, inaccurate, or requiring further information in order to provide a full and accurate review of the business and resources of the company.  History of Section.G.L. 1896, ch. 182,  19; G.L. 1909, ch. 220,  19; G.L. 1923, ch. 256,  19; G.L. 1938, ch. 151,  19; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-12-3; P.L. 1988, ch. 70  1. 
 27-12-4. Penalty for refusal to answer interrogatories. Every insurance producer who shall refuse or neglect to answer any interrogatories required under  27-12-3 for the space of thirty (30) days, and continues to act as an insurance producer, shall be liable to the penalty prescribed in  27-2.4-14.  History of Section.G.L. 1896, ch. 182,  20; G.L. 1909, ch. 220,  20; G.L. 1923, ch. 256,  20; G.L. 1938, ch. 151,  20; G.L. 1956,  27-12-4; P.L. 1989, ch. 542,  78; P.L. 2002, ch. 292,  28. 
 27-12-5. Abstracts printed for general assembly. The insurance commissioner shall make available, by electronic means, the annual reports filed by all insurance companies licensed in the state and provide these reports to members of the general assembly upon request.  History of Section.G.L. 1896, ch. 182,  21; G.L. 1909, ch. 220,  21; G.L. 1923, ch. 256,  21; G.L. 1938, ch. 150,  23; G.L. 1938, ch. 151,  21; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-12-5; P.L. 2015, ch. 82,  12; P.L. 2015, ch. 105,  12. 
 27-12-6. Rules and regulations. The insurance commissioner shall have the authority to promulgate rules and regulations necessary to carry out the purposes of this chapter.  History of Section.P.L. 1991, ch. 348,  4. 
 27-13.1-1. Purpose. The purpose of this chapter is to provide an effective and efficient system for examining the activities, operations, financial condition, and affairs of all persons transacting the business of insurance in this state and all persons otherwise subject to the jurisdiction of the director. The provisions of this chapter are intended to enable the director to adopt a flexible system of examinations that directs resources as may be deemed appropriate and necessary for the administration of the insurance and insurance related laws of this state.  History of Section.P.L. 1992, ch. 445,  1; P.L. 2009, ch. 301,  1; P.L. 2009, ch. 302,  1. 
 27-13.1-2. Definitions. The following terms, as used in this chapter, shall have the respective meanings hereinafter set forth:  (1) Company means a person engaging in or proposing or attempting to engage in any transaction or kind of insurance or surety business and any person or group of persons who may otherwise be subject to the administrative, regulatory or taxing authority of the director;  (2) Department means the department of business regulation;  (3) Director means the director of the department of business regulation of this state or his or her designee;  (4) Examiner means an individual or firm having been authorized by the director to conduct an examination or financial analysis under this chapter;  (5) Insurer means any insurance company doing business in this state; and  (6) Person means an individual, aggregation of individuals, trust, association, partnership or corporation, or any affiliate thereof.  History of Section.P.L. 1992, ch. 445,  1; P.L. 2009, ch. 301,  1; P.L. 2009, ch. 302,  1. 
 27-13.1-3.1. Authority, scope and scheduling of financial analysis. (a) The director and any of his or her examiners may conduct annual and quarterly financial analysis under this chapter of each company licensed in this state. All authority granted in conducting an examination under this chapter shall apply to the conduct of a financial analysis of a company except that a warrant is not required and the financial analysis will be conducted based on guidelines and procedures set forth in the Financial Analysis Handbook as adopted by the National Association of Insurance Commissioners. The director may also employ any other guidelines or procedures as the director may deem appropriate.  (b) The financial analysis of a company is a continuous process utilized primarily for monitoring the financial strength of a company and therefore a final report is not required, however, where there are significant financial concerns a financial examination under this chapter will be conducted and an examination report will be issued in accordance with  27-13.1-5.  (c) All correspondence, emails, memorandums and other documentation used in the financial analysis process are considered to be confidential financial analysis workpapers in accordance with  27-13.1-5(f).  (d) The total cost of the financial analysis shall be borne by the company as set forth in  27-13.1-7.  History of Section.P.L. 2009, ch. 301,  2; P.L. 2009, ch. 302,  2. 
 27-13.1-3. Authority, scope, and scheduling of examinations. (a) The director or any of his or her examiners may conduct an examination under this chapter of any company as often as the director in his or her sole discretion deems appropriate, but shall, at a minimum, conduct an examination of every insurer licensed in this state not less frequently than once every five (5) years. In scheduling and determining the nature, scope, and frequency of the examinations, the director shall consider such matters as the results of financial statement analyses and ratios, changes in management or ownership, actuarial opinions, reports of independent certified public accountants, and other criteria as set forth in the Financial Condition Examiners Handbook adopted by the National Association of Insurance Commissioners and in effect when the director exercises discretion under this section.  (b) For purposes of completing an examination of a company under this chapter, the director may examine or investigate any person, or the business of any person, in so far as the examination or investigation is, in the sole discretion of the director, necessary or material to the examination of the company.  (c) In lieu of an examination under this chapter of a foreign or alien insurer licensed in this state, the director may accept an examination report on the company as prepared by the insurance department for the companys state of domicile or port of entry state only if:  (1) The insurance department was at the time of the examination accredited under the National Association of Insurance Commissioners financial regulation standards and accreditation program; or  (2) The examination is performed under the supervision of an accredited insurance department or with the participation of one or more examiners who are employed by an accredited state insurance department and who, after a review of the examination work papers and report, state under oath that the examination was performed in a manner consistent with the standards and procedures required by their insurance department.  History of Section.P.L. 1992, ch. 445,  1; P.L. 2002, ch. 292,  29; P.L. 2009, ch. 301,  1; P.L. 2009, ch. 302,  1. 
 27-13.1-4. Conduct of examinations. (a) Upon determining that an examination should be conducted, the director or the directors designee shall issue an examination warrant appointing one or more examiners to perform the examination and instructing them as to the scope of the examination. In conducting the examination, the examiner shall observe those guidelines and procedures set forth in the Examiners Handbook adopted by the National Association of Insurance Commissioners. The director may also employ such other guidelines or procedures as the director may deem appropriate.  (b) Every company or person from whom information is sought, its officers, directors, and agents shall provide to the examiners appointed under subsection (a) timely, convenient and free access at all reasonable hours at its offices to all books, records, accounts, papers, documents, and any or all computer or other recordings relating to the property, assets, business, and affairs of the company being examined. The officers, directors, employees, and agents of the company or person must facilitate the examination and aid in the examination so far as it is in their power to do so. The refusal of a company, by its officers, directors, employees, or agents, to submit to examination or to comply with any reasonable written request of the examiners shall be grounds for suspension or refusal of, or nonrenewal of any license or authority held by the company to engage in an insurance or other business subject to the directors jurisdiction. Any such proceedings for suspension, revocation, or refusal of a license or authority shall be conducted pursuant to the Administrative Procedures Act, chapter 35 of title 42. Nothing in this subsection shall preclude the director from initiating action pursuant to chapters 14.1, 14.3, or any other chapter of this title.  (c) The director or any of his or her examiners shall have the power to issue subpoenas, to administer oaths, and to examine under oath any person as to any matter pertinent to the examination. Upon the failure or refusal of any person to obey a subpoena, the director 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. Failure to obey the court order shall be punishable as contempt of court. Such subpoena may also be enforced pursuant to  42-14-16.  (d) When making an examination under this chapter, the director may retain attorneys, appraisers, independent actuaries, independent certified public accountants, or other professionals and specialists as examiners, the cost of which shall be borne by the company that is the subject of the examination.  (e) Nothing contained in this chapter shall be construed to limit the directors authority to terminate or suspend an examination in order to pursue other legal or regulatory action pursuant to the insurance laws of this state. Findings of fact and conclusions made pursuant to an examination shall be prima facie evidence in any legal or regulatory action.  (f) Nothing contained in this chapter shall be construed to limit the directors authority to use and, if appropriate, to make public any final or preliminary examination report, any 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 director may, in his or her sole discretion, deem appropriate.  History of Section.P.L. 1992, ch. 445,  1; P.L. 1996, ch. 188,  7; P.L. 2009, ch. 301,  1; P.L. 2009, ch. 302,  1. 
 27-13.1-5. Examination reports. (a) General description. An examination report shall be comprised of only facts appearing upon the books, records, or other documents of the company, its agents or other persons examined, or as ascertained from the testimony of its officers or agents or other persons examined concerning its affairs, and such conclusions and recommendations as the examiners find reasonably warranted from the facts.  (b) Filing of examination report. No later than sixty (60) days following completion of the examination, the examiner in charge shall file with the department a verified written report of examination under oath. Upon receipt of the verified report, the department shall transmit the report to the company examined, together with a notice that shall require that the company examined file with the director a written response to all comments and recommendations contained in the examination report within thirty (30) days. 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.  (c) Adoption of report on examination. Within thirty (30) days of the end of the period allowed for the receipt of written responses or rebuttals, the director shall fully consider and review the report, together with any written responses or rebuttals and any relevant portions of the examiners workpapers and enter an order:  (1) Adopting the examination report as filed or with modification or corrections. If the examination report reveals that the company is operating in violation of any law, regulation, or prior order of the director, the director may order the company to take any action the director considers necessary and appropriate to cure the violation; or  (2) Rejecting the examination report with directions to the examiners to reopen the examination for the purposes of obtaining additional data, documentation, or information, and refiling pursuant to this section; and  (3) Calling for an investigatory hearing with no less than twenty (20) days notice to the company for the purposes of obtaining additional documentation, data, information, and testimony.  (d) Orders and procedures.(1) All orders entered pursuant to this section shall be accompanied by findings and conclusions resulting from the directors consideration and review of the examination report, relevant examiner workpapers, and any written responses or rebuttals. Any order shall be considered a final administrative decision and may be appealed pursuant to the Administrative Procedures Act, chapter 35 of title 42, and shall be served upon the company by certified mail, together with a copy of the adopted examination report. Within thirty (30) days of the issuance of the adopted report, the company shall file affidavits executed by each of its directors stating under oath that they have received a copy of the adopted report and related orders.  (2)(i) Any hearing conducted under this section by the director or authorized representative shall be conducted as a nonadversarial confidential investigatory proceeding as necessary for the resolution of any inconsistencies, discrepancies, or disputed issues apparent upon the face of the filed examination report or raised by or as a result of the directors review of relevant workpapers or by the written response or rebuttal of the company. Within twenty (20) days of the conclusion of any hearing, the director shall enter an order pursuant to this section.  (ii) The director shall not appoint an examiner as an authorized representative to conduct the hearing. The hearing shall proceed expeditiously with discovery by the company limited to the examiners workpapers that tend to substantiate any assertions set forth in any written response or rebuttal. The director or his or her representative may issue subpoenas for the attendance of any witnesses or the production of any documents deemed relevant to the investigation whether under the control of the department, the company, or other persons. The documents produced shall be included in the record and testimony taken by the director or his or her representative shall be under oath and preserved for the record.  (iii) Nothing contained in this section shall require the department to disclose any information or records that would indicate or show the existence or content of any investigation or activity of a criminal justice agency.  (iv) The hearing shall proceed with the director or his or her representative posing questions to the persons subpoenaed. Thereafter, the company and the department may present testimony relevant to the investigation. Cross-examination shall be conducted only by the director or his or her representatives. The company and the department shall be permitted to make closing statements and may be represented by counsel of their choice.   (e) Publication and use.(1) Upon the adoption of the examination report under this section, the director shall continue to hold the content of the examination report as private and confidential information for a period of thirty (30) days, except to the extent provided in subsection (b). After this, the commissioner may open the report for public inspection so long as no court of competent jurisdiction has stayed its publication;  (2) Nothing contained in this title shall prevent or be construed as prohibiting 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 country, or to law enforcement officials of this or any other state or agency of the federal government at any time, so long as the agency or office receiving the report or matters relating thereto agrees in writing to hold it confidential and in a manner consistent with this chapter;  (3) In the event the director determines that regulatory action is appropriate as a result of any examination, he or she may initiate any proceedings or actions as provided by law.   (f) Privilege for, and confidentiality of ancillary information.(1)(i) Except as provided in subsection (e) above and in this subsection, documents, materials, or other information, including, but not limited to, all working papers, and copies thereof, created, produced by, obtained by, or disclosed to the director or any other person in the course of an examination made under this chapter, or in the course of analysis by the director of the financial condition or market conduct of a company shall be confidential by law and privileged, shall not be subject to the Access to Public Records Act, chapter 2 of title 38, shall not be subject to subpoena, and shall not be subject to discovery or be admissible in evidence in any private civil action. The director is authorized to use the documents, materials, or other information in the furtherance of any regulatory or legal action brought as part of the directors official duties.  (ii) Documents, materials or other information, including, but not limited to, all working papers, and copies thereof, in the possession or control of the National Association of Insurance Commissioners and its affiliates and subsidiaries shall be confidential by law and privileged, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action if they are:  (A) Created, produced or obtained by or disclosed to the National Association of Insurance Commissioners and its affiliates and subsidiaries in the course of the National Association of Insurance Commissioners and its affiliates and subsidiaries assisting an examination made under this chapter, or assisting a director in the analysis of the financial condition or market conduct of a company; or  (B) Disclosed to the National Association of Insurance Commissioners and its affiliates and subsidiaries under subdivision (3) of this subsection by a director or commissioner.  (iii) For the purposes of paragraph (f)(1)(i), act includes the law of another state or jurisdiction that is substantially similar to this act.  (2) Neither the director nor any person who received the documents, material or other information while acting under the authority of the director, including the National Association of Insurance Commissioners and its affiliates and subsidiaries, shall be permitted to testify in any private civil action concerning any confidential documents, materials or information subject to subdivision (f)(1).  (3) In order to assist in the performance of the directors duties, the director:  (i) May share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subdivision (f)(1), with other state, federal and international regulatory agencies, with the National Association of Insurance Commissioners and its affiliates and subsidiaries, and with state, federal and international law enforcement authorities, provided that the recipient agrees to maintain the confidentiality and privileged status of the document, material, communication or other information;  (ii) May receive documents, materials, communications or information, including otherwise confidential and privileged documents, materials or information, from the National Association of Insurance Commissioners and its affiliates and subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and  (iii) May enter into agreements governing sharing and use of information consistent with this subsection.  (4) No waiver of any applicable privilege or claim of confidentiality in the documents, materials or information shall occur as a result of disclosure to the director under this section or as a result of sharing as authorized in subdivision (f)(3).  (5) A privilege established under the law of any state or jurisdiction that is substantially similar to the privilege established under this subsection shall be available and enforced in any proceeding in, and in any court of, this state.  (6) In this subsection, the terms department, insurance department, law enforcement agency, regulatory agency, and the National Association of Insurance Commissioners include, but are not limited to, their employees, agents, consultants and contractors.   History of Section.P.L. 1992, ch. 445,  1; P.L. 1996, ch. 188,  7; P.L. 2009, ch. 301,  1; P.L. 2009, ch. 302,  1. 
 27-13.1-6. Conflict of interest. (a) An examiner may not be appointed by the director if the examiner, either directly or indirectly, has a conflict of interest or is affiliated with the management of or owns a pecuniary interest in any person subject to examination under this chapter. This section shall not be construed to automatically preclude an examiner from being:  (1) A policyholder or claimant under an insurance policy;  (2) A grantor of a mortgage or similar instrument on the examiners residence to a regulated entity if done under customary terms and in the ordinary course of business;  (3) An investment owner in shares of regulated diversified investment companies; or  (4) A settlor or beneficiary of a blind trust into which any otherwise impermissible holdings have been placed.  (b) Notwithstanding the requirements of this section, the director may retain from time to time on an individual basis, qualified actuaries, certified public accountants, or other similar individuals who are independently practicing their professions, even though these persons may from time to time be similarly employed or retained by persons subject to examination under this chapter.  History of Section.P.L. 1992, ch. 445,  1; P.L. 2009, ch. 301,  1; P.L. 2009, ch. 302,  1. 
 27-13.1-7. Cost of examinations. (a) The total cost of the examinations shall be borne by the examined companies and shall include the following expenses:  (1) One hundred fifty percent (150%) of the total salaries and benefits paid to the examining personnel of the banking and insurance division engaged in those examinations less any salary reimbursements;  (2) All reasonable technology costs related to the examination process. Technology costs shall include the actual cost of software and hardware utilized in the examination process and the cost of training examination personnel in the proper use of the software or hardware;  (3) All necessary and reasonable education and training costs incurred by the state to maintain the proficiency and competence of the examining personnel. All these costs shall be incurred in accordance with appropriate state of Rhode Island regulations, guidelines and procedures.  (b) Expenses incurred pursuant to subsections (a)(2) and (a)(3) of this section shall be allocated equally to each company domiciled in Rhode Island no more frequently than annually and shall not exceed an annual average assessment of three thousand five hundred dollars ($3,500) per company for any given three (3) calendar year period. All revenues collected pursuant to this section shall be deposited as general revenues. That assessment shall be in addition to any taxes and fees payable to the state.  History of Section.P.L. 1992, ch. 445,  1; P.L. 1995, ch. 370, art. 40,  86; P.L. 2001, ch. 122,  8. 
 27-13.1-8. Immunity from liability. (a) No cause of action shall arise nor shall any liability be imposed against the director, the directors authorized representatives or an examiner appointed by the director for any statements made or conduct performed in good faith while carrying out the provisions of this chapter.  (b) No cause of action shall arise, nor shall any liability be imposed against any person for the act of communicating or delivering information or data to the director or the directors authorized representative or examiner pursuant to an examination made under this chapter, if the act of communication or delivery was performed in good faith and without fraudulent intent or the intent to deceive.  (c) This section does not abrogate or modify in any way any common law or statutory privilege or immunity heretofore enjoyed by any person identified in subsection (a) herein.  (d) A person identified in subsection (a) herein shall be entitled to an award of attorneys fees and costs if he or she is the prevailing party in a civil cause of action for libel, slander or any other relevant tort arising out of activities in carrying out the provisions of this chapter and the party bringing the action was not substantially justified in doing so. For purposes of this section a proceeding is substantially justified if it has a reasonable basis in law or fact at the time that it was initiated.  History of Section.P.L. 2009, ch. 301,  2; P.L. 2009, ch. 302,  2. 
 27-13-1. Examination into affairs of company. The insurance commissioner, either personally or by a committee appointed by him or her consisting of one or more persons not directors, officers, or agents of any life, fire, marine, fire and marine, or casualty insurance company, doing business in this state, may at any time examine into the affairs of any life, fire, marine, fire and marine, casualty, or other insurance company, incorporated by or doing business in this state. The officers or agents of any insurance company shall exhibit its books to the insurance commissioner or committee, and facilitate its examination, and the insurance commissioner or the committee may examine, under oath, the officers and agents of any insurance company in relation to its affairs. The insurance commissioner shall, if he or she deems it advisable, publish the result of the investigation in one or more newspapers published in the state. The total cost of those examinations shall be borne by the examined companies and shall be one hundred fifty percent (150%) of the total salaries paid to the examining personnel of the banking and insurance division engaged in those examinations less any salary reimbursements and shall be paid to the insurance commissioner to and for the use of the state. That assessment shall be in addition to any taxes and fees payable to the state.  History of Section.G.L. 1896, ch. 182,  23; G.L. 1909, ch. 220,  23; G.L. 1923, ch. 256,  23; P.L. 1936, ch. 2343,  1; G.L. 1938, ch. 151,  23; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-13-1; P.L. 1960, ch. 71, art. 1,  7; P.L. 1991, ch. 348,  8. 
 27-13-2  27-13-5. Repealed.
 27-14.1-1. Definitions. As used in this chapter: (1) Consent means agreement to administrative supervision by the insurer;  (2) Exceeded its powers means the following conditions:  (i) The insurer has refused to permit examination of its books, papers, accounts, records, or affairs by the commissioner, his or her deputies, employees or duly commissioned examiners;  (ii) A domestic insurer has unlawfully removed from this state books, papers, accounts, or records necessary for an examination of the insurer;  (iii) The insurer has failed to promptly comply with the applicable financial reporting statutes or rules and departmental requests relating thereto;  (iv) The insurer has neglected or refused to observe an order of the commissioner to make good, within the time prescribed by law, any prohibited deficiency in its capital, capital stock or surplus;  (v) The insurer is continuing to transact insurance or write business after its license has been revoked or suspended by the commissioner;  (vi) The insurer, by contract or otherwise, has unlawfully or has in violation of an order of the commissioner or has without first having obtained written approval of the commissioner if approval is required by law:  (A) Totally reinsured its entire outstanding business; or  (B) Merged or consolidated substantially its entire property or business with another insurer;  (vii) The insurer engaged in any transaction in which it is not authorized to engage under the laws of this state; or  (viii) The insurer refused to comply with a lawful order of the commissioner;  (3) Insurer means and includes every person engaged as indemnitor, surety or contractor in the business of entering into contracts of insurance or of annuities as limited to:  (i) Any insurer who is doing an insurer business, or has transacted insurance in this state, and against whom claims arising from that transaction may exist now or in the future; and  (ii) Any fraternal benefit society which is subject to the provisions of this title; and  (iii) Any insurer writing mono line business which means any insurer, which deals exclusively in surety bonding.  History of Section.P.L. 1991, ch. 348,  1; P.L. 2011, ch. 157,  1; P.L. 2011, ch. 275,  1. 
 27-14.1-10. Immunity. There shall be no liability on the part of, and no cause or action of any nature shall arise against, the insurance commissioner or the department of business regulation or its employees or agents for any action taken by them in the performance of their powers and duties under this chapter.  History of Section.P.L. 1991, ch. 348,  1. 
 27-14.1-2. Applicability. The provisions of this chapter apply to: (1) All domestic insurers, including a protected cell company organized under the Protected Cell Companies Act, chapter 64 of this title, and any of its protected cells established pursuant to that chapter, to the extent not inconsistent with the provisions of that chapter; and  (2) Any other insurer doing business in this state whose state of domicile has asked the commissioner to apply the provisions of this chapter as regards that insurer.  History of Section.P.L. 1991, ch. 348,  1; P.L. 1999, ch. 22,  4. 
 27-14.1-3. Notice to comply with written requirements of commissioner  Noncompliance  Administrative supervision. (a) An insurer may be subject to administrative supervision by the commissioner if upon examination or at any other time it appears in the commissioners discretion that:  (1) The insurers condition renders the continuance of its business hazardous to the public or to its insured;  (2) The insurer appears to have exceeded its powers granted under its certificate of authority and applicable law;  (3) The insurer has failed to comply with the applicable provisions of the insurance code;  (4) The business of the insurer is being conducted fraudulently; or  (5) The insurer gives its consent.  (b) If the commissioner determines that the conditions set forth in subsection (a) of this section exist, the commissioner shall:  (1) Notify the insurer of his or her determination;  (2) Furnish to the insurer a written list of the requirements to abate this determination; and  (3) Notify the insurer that it is under the supervision of the commissioner and that the commissioner is applying and effectuating the provisions of this chapter. The action by the commissioner shall be subject to review pursuant to the Administrative Procedures Act, chapter 35 of title 42.  (c) If placed under administrative supervision, the insurer shall have sixty (60) days, or another period of time as designated by the commissioner, to comply with the requirements of the commissioner subject to the provisions of this chapter.  (d) If it is determined after notice and hearing that the conditions giving rise to the supervision still exist at the end of the supervision period specified in subsection (c) of this section, the commissioner may extend the period.  (e) If it is determined that none of the conditions giving rise to the supervision exist, the commissioner shall release the insurer from supervision.  History of Section.P.L. 1991, ch. 348,  1; P.L. 2011, ch. 157,  1; P.L. 2011, ch. 275,  1. 
 27-14.1-4. Confidentiality of certain proceedings and records. (a) Notwithstanding any other provision of law and except as set forth in this section, proceedings, hearings, notices, correspondence, reports, records, and other information in the possession of the commissioner or the department of business regulation relating to the supervision of any insurer are confidential except as provided by this section.  (b) The personnel of the department of business regulation shall have access to these proceedings, hearings, notices, correspondence, reports, records, or information as permitted by the commissioner.  (c) The commissioner may open the proceedings or hearings or disclose the notices, correspondence, reports, records, or information to a department, agency, or instrumentality of this or another state of the United States if the commissioner determines that the disclosure is necessary or proper for the enforcement of the laws of this or another state of the United States.  (d) The commissioner may open the proceedings or hearings or make public the notices, correspondence, reports, records, or other information if the commissioner deems that it is in the best interest of the public or in the best interest of the insurer, its insureds, creditors, or the general public.  (e) This section does not apply to hearings, notices, correspondence, reports, records, or other information obtained upon the appointment of a receiver for the insurer by a court of competent jurisdiction.  History of Section.P.L. 1991, ch. 348,  1; P.L. 2011, ch. 157,  1; P.L. 2011, ch. 275,  1. 
 27-14.1-5. Prohibited acts during period of supervision. During the period of supervision, the commissioner or his or her designated appointee shall serve as the administrative supervisor. The commissioner may provide that the insurer may not do any of the following acts during the period of supervision without the prior approval of the commissioner or his or her appointed supervisor:  (1) Dispose of, convey, or encumber any of its assets or its business in force;  (2) Withdraw any of its bank accounts;  (3) Lend any of its funds;  (4) Invest any of its funds;  (5) Transfer any of its property;  (6) Incur any debt, obligation or liability;  (7) Merge or consolidate with another company;  (8) Approve new premiums or renew any policies;  (9) Enter into any new reinsurance contract or treaty;  (10) Terminate, surrender, forfeit, convert, or lapse any insurance policy, certificate, or contract, except for nonpayment of premiums due;  (11) Release, pay, or refund premium deposits, accrued cash or loan values, unearned premiums, or other reserves on any insurance policy, certificate, or contract;  (12) Make any material change in management; or  (13) Increase salaries and benefits of officers or directors or the preferential payment of bonuses, dividends, or other payments deemed preferential.  History of Section.P.L. 1991, ch. 348,  1. 
 27-14.1-6. Review and stay of action. During the period of supervision the insurer may contest an action taken or proposed to be taken by the supervisor specifying the manner in which the action being complained of would not result in improving the condition of the insurer. Denial of the insurers request upon reconsideration entitles the insurer to request a proceeding under the Administrative Procedures Act, chapter 35 of title 42.  History of Section.P.L. 1991, ch. 348,  1; P.L. 2011, ch. 157,  1; P.L. 2011, ch. 275,  1. 
 27-14.1-7. Administrative election of proceedings. Nothing contained in this chapter shall preclude the commissioner from initiating judicial proceedings to place an insurer in conservation, rehabilitation, or liquidation proceedings or other delinquency proceedings, however designated under the laws of this state, regardless of whether the commissioner has previously initiated administrative supervision proceedings under this chapter against the insurer.  History of Section.P.L. 1991, ch. 348,  1. 
 27-14.1-8. Rules. The commissioner is empowered to adopt reasonable rules necessary for the implementation of this chapter.  History of Section.P.L. 1991, ch. 348,  1. 
 27-14.1-9. Other laws  Conflicts  Meetings between the commissioner and the supervisor. Notwithstanding any other provision of law, the commissioner may meet with a supervisor appointed under this chapter and with the attorney or other representative of the supervisor, without the presence of any other person, at the time of any proceeding or during the pendency of any proceeding held under the authority of this chapter to carry out the commissioners duties under this chapter or for the supervisor to carry out his or her duties under this chapter.  History of Section.P.L. 1991, ch. 348,  1. 
 27-14.2-1. Purpose. (a) The purpose of this chapter is to set forth the standards which the director of the department of business regulation may use for identifying insurers found to be in a condition as to render the continuance of their business hazardous to the public or to holders of their policies or certificates of insurance.  (b) This chapter shall not be interpreted to limit the powers granted to the director by any laws or parts of laws of this state.  History of Section.P.L. 1992, ch. 445,  1. 
 27-14.2-2. Standards. (a) The following standards, either singly or a combination of two (2) or more, may be considered by the director to determine whether the continued operation of any insurer transacting an insurance business in this state might be deemed to be hazardous to its policyholders, creditors, or the general public. The director may consider:  (1) Adverse findings reported in financial condition and market conduct examination reports, audit reports, and actuarial opinions, reports or summaries;  (2) The National Association of Insurance Commissioners insurance regulatory information system and its other financial analysis solvency tools and reports;  (3) Whether the insurer has made adequate provisions, according to presently accepted actuarial standards of practice, for the anticipated cash flows required by the contractual obligations and related expenses of the insurer, when considered in light of the assets held by the insurer with respect to such reserves and related actuarial items, including, but not limited to, the investment earnings on such assets, and the considerations anticipated to be received and retained under such policies and contracts;  (4) The ability of an assuming reinsurer to perform and whether the insurers reinsurance program provides sufficient protection for the insurers remaining surplus after taking into account the insurers cash flow and the classes of business written and the financial condition of the assuming reinsurer;  (5) Whether the insurers operating loss in the last twelve (12) month period or any shorter period of time, including but not limited to net capital gain or loss, change in nonadmitted assets, and cash dividends paid to shareholders, is greater than fifty percent (50%) of the insurers remaining surplus as regards policyholders in excess of the minimum required;  (6) Whether the insurers operating loss in the last twelve (12) month period or any shorter period of time, excluding net capital gains, is greater than twenty percent (20%) of the insurers remaining surplus as regards policyholders in excess of the minimum required;  (7) Whether a reinsurer, obligor or any entity within the insurers insurance holding company system, is insolvent, threatened with insolvency, or delinquent in payment of its monetary or other obligation, and which in the opinion of the director may affect the solvency of the insurer;  (8) Contingent liabilities, pledges, or guaranties that either individually or collectively involve a total amount which in the opinion of the director may affect the solvency of the insurer;  (9) Whether any controlling person of an insurer is delinquent in the transmitting to, or payment of, net premiums to the insurer;  (10) The age and collectibility of receivables;  (11) Whether the management of an insurer, including officers, directors, or any other person who directly or indirectly controls the operation of the insurer, fails to possess and demonstrate the competence, fitness, and reputation deemed necessary to serve the insurer in the position;  (12) Whether the management of an insurer has failed to respond to inquiries relative to the condition of the insurer or has furnished false and misleading information concerning an inquiry;  (13) Whether the insurer has failed to meet financial and holding company filing requirements in the absence of a reason satisfactory to the director;  (14) Whether the management of an insurer either has filed any false or misleading sworn financial statement, or has released a false or misleading financial statement to lending institutions or to the general public, or has made a false or misleading entry, or has omitted an entry of material amount in the books of the insurer;  (15) Whether the insurer has grown so rapidly and to such an extent that it lacks adequate financial and administrative capacity to meet its obligations in a timely manner; or  (16) Whether the insurer has experienced or will experience in the foreseeable future cash flow and/or liquidity problems.  (17) Whether management has established reserves that do not comply with minimum standards established by state insurance laws, regulations statutory accounting standards, sound actuarial principles and standards of practice;  (18) Whether management persistently engages in material under reserving that results in adverse development;  (19) Whether transactions among affiliates, subsidiaries or controlling persons for which the insurer receives assets or capital gains, or both, do not provide sufficient value, liquidity or diversity to assure the insurers ability to meet its outstanding obligations as they mature;  (20) Any other finding determined by the director to be hazardous to the insurers policyholders, creditors or general public.  (b) The standards enumerated in subsection (a) of this section shall not be construed as limiting the director from making a finding that other conditions not specifically enumerated also constitute hazardous conditions.  History of Section.P.L. 1992, ch. 445,  1; P.L. 2010, ch. 57,  1; P.L. 2010, ch. 68,  1. 
 27-14.2-3. Directors authority. (a) For the purposes of making a determination of an insurers financial condition under this chapter, the director may:  (1) Disregard any credit or amount receivable resulting from transactions with a reinsurer which is insolvent, impaired, or otherwise subject to a delinquency proceeding;  (2) Make appropriate adjustments, including disallowances to asset values attributable to investments in or transactions with parents, subsidiaries, or affiliates consistent with the NAIC Accounting Practices and Procedures Manual, state laws and regulations;  (3) Refuse to recognize the stated value of accounts receivable if the ability to collect receivables is highly speculative in view of the age of the account or the financial condition of the debtor;  (4) Increase the insurers liability in an amount equal to any contingent liability, pledge, or guarantee not otherwise included if there is a substantial risk that the insurer will be called upon to meet the obligation undertaken within the next twelve (12) month period.  (b) If the director determines that the continued operation of the insurer licensed to transact business in this state may be hazardous to its policyholders, creditors or the general public, then the director may, upon his or her determination, issue an order requiring the insurer to:  (1) Reduce the total amount of present and potential liability for policy benefits by reinsurance;  (2) Reduce, suspend, or limit the volume of business being accepted or renewed;  (3) Reduce general insurance and commission expenses by specified methods;  (4) Increase the insurers capital and surplus;  (5) Suspend or limit the declaration and payment of a dividend by an insurer to its stockholders or to its policyholders;  (6) File reports in a form acceptable to the director concerning the market value of an insurers assets;  (7) Limit or withdraw from certain investments or discontinue certain investment practices to the extent the director deems necessary;  (8) Document the adequacy of premium rates in relation to the risks insured; or  (9) File, in addition to regular annual statements, interim financial reports on the form adopted by the national association of insurance commissioners or on a format as promulgated by the director;  (10) Correct corporate governance practice deficiencies, and adopt and utilize governance practices acceptable to the director;  (11) Provide a business plan to the director in order to continue to transact business in the state; or  (12) Notwithstanding any other provision of law limiting the frequency or amount of premium rate adjustments, adjust rates for any non-life insurance product written by the insurer that the director considers necessary to improve the financial condition of the insurer.  (c) If the insurer is a foreign insurer, the directors order under subsection (b) of this section may be limited to the extent provided by statute.  (d) Any insurer subject to an order under subsection (b) of this section may request a hearing to review that order. The notice of hearing shall be served upon the insurer pursuant to the Administrative Procedures Act, chapter 35 of title 42. The notice of hearing shall state the time and place of the hearing, and the conduct, condition, or ground upon which the director based the order. Unless mutually agreed between the director and the insurer, the hearing shall occur not less than ten (10) days nor more than thirty (30) days after notice is served and shall be either in Providence County or in some other place of convenience to the parties to be designated by the director. The director shall hold all hearings under this subsection privately, unless the insurer requests a public hearing, in which case the hearing shall be public.  History of Section.P.L. 1992, ch. 445,  1; P.L. 2010, ch. 57,  1; P.L. 2010, ch. 68,  1. 
 27-14.2-4. Judicial review. Any order or decision of the director shall be subject to review in accordance with the Administrative Procedures Act, chapter 35 of title 42, at the instance of any party to the proceedings whose interests are substantially affected.  History of Section.P.L. 1992, ch. 445,  1. 
 27-14.3-1. Short title  Construction  Purpose. (a) This chapter shall be cited as the Insurers Rehabilitation and Liquidation Act.  (b) This chapter shall not be interpreted to limit the powers granted the commissioner by other provisions of the law.  (c) This chapter shall be liberally construed to effect the purpose stated in subsection (d) of this section.  (d) The purpose of this chapter is the protection of the interests of insured, claimants, creditors, and the public generally with minimum interference with the normal prerogatives of the owners and managers of insurers, through:  (1) Early detection of any potentially dangerous condition in an insurer, and prompt application of appropriate corrective measures;  (2) Improved methods for rehabilitating insurers, involving the cooperation and management expertise of the insurance industry;  (3) Enhanced efficiency and economy of liquidation, through clarification of the law, to minimize legal uncertainty and litigation;  (4) Equitable apportionment of any unavoidable loss;  (5) Lessening the problems of interstate rehabilitation and liquidation by facilitating cooperation between states in the liquidation process, and by extending the scope of personal jurisdiction over debtors of the insurer outside of this state;  (6) Regulation of the insurance business by the impact of the law relating to delinquency procedures and substantive rules on the entire insurance business; and  (7) Providing for a comprehensive scheme for the rehabilitation and liquidation of insurance companies and those subject to this chapter as part of the regulation of the business of insurance, insurance industry, and insurers in this state. Proceedings in cases of insurer insolvency and delinquency are deemed an integral aspect of the business of insurance and are of vital public interest and concern.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-10. Courts seizure order. (a) The commissioner may file in the superior court for the county of Providence a petition alleging, with respect to a domestic insurer:  (1) That there exists any grounds that would justify a court order for a formal delinquency proceeding against an insurer under this chapter;  (2) That the interests of policyholders, creditors, or the public will be endangered by delay; and  (3) The contents of an order deemed necessary by the commissioner.  (b) Upon a filing under subsection (a) of this section, the court may issue ex parte and without a hearing the requested order which shall direct the commissioner to take possession and control of all or a part of the property, books, accounts, documents, and other records of an insurer, and of the premises occupied by it for transaction of its business, and until further order of the court enjoin the insurer and its officers, managers, agents and employees from disposition of its property and from the transaction of its business except with the written consent of the commissioner.  (c) The court shall specify in the order what its duration shall be, which shall be that time as the court deems necessary for the commissioner to ascertain the condition of the insurer. On the motion of either party or on its own motion, the court may hold hearings as it deems desirable after providing notice as it deems appropriate, and may extend, shorten, or modify the terms of the seizure order. The court shall vacate the seizure order if the commissioner fails to commence a formal proceeding under this chapter after having had a reasonable opportunity to do so. An order of the court pursuant to a formal proceeding under this chapter shall by itself vacate the seizure order.  (d) Entry of a seizure order under this section shall not constitute an anticipatory breach of any contract of the insurer.  (e) An insurer subject to an ex parte order under this section may petition the court at any time after the issuance of the order for a hearing and review of the order. The court shall hold a hearing and review not more than fifteen (15) days after the request. A hearing under this subsection may be held privately in chambers and it shall be held if the insurer proceeded against requests this.  (f) If, at any time after the issuance of an order, it appears to the court that any person whose interest is or will be substantially affected by the order did not appear at the hearing and has not been served, the court may order that notice be given. An order that notice be given shall not stay the effect of any order previously issued by the court.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-11. Commencement of formal delinquency proceeding. (a) Any formal delinquency proceeding against a person shall be commenced by filing a petition in the name of the commissioner.  (b) The petition shall state the grounds upon which the proceeding is based and the relief requested, and may include a prayer for restraining orders and injunctive relief as described in  27-14.3-5.  (c) Any petition that prays for a temporary restraining order must be verified by the commissioner or his or her designee, but need not plead or prove irreparable harm or inadequate remedy by law. The commissioner shall provide only that notice as the court may require.  (d) If any temporary restraining order is prayed for:  (1) The court may issue an initial order containing the relief requested;  (2) The order shall state the time and date of its issuance;  (3) The court shall set a time and date for the return of summons, not more than ten (10) days from the time and date of the issuance of the initial order, at which time the person proceeded against may appear before the court for a summary hearing;  (4) The order shall not continue in effect beyond the time and date set for the return of summons, unless the court shall expressly enter one or more orders extending the restraining order; and  (5) The verified petition and the initial order shall be filed with the clerk of the court and maintained as confidential, except for good cause shown, until personal service is made.  (e) If no temporary restraining order is requested, the court shall cause summons to be issued. The summons shall specify a return date not more than thirty (30) days after issuance and that an answer must be filed at or before the return date.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-12. Return of summons and summary hearing. (a) The court shall hold a summary hearing at the time and date for the return of summons.  (b) If a person is not served with summons and fails to appear for the summary hearing, the court shall:  (1) Continue the summary hearing not more than ten (10) days;  (2) Provide for alternative service of summons upon the person; and  (3) Extend any restraining order.  (c) Upon a showing of good faith efforts to effect personal service upon a person who has failed to appear for a continued summary hearing, the court shall order notice of the petition to be published. The order and notice shall specify a return date not less than ten (10) nor more than twenty (20) days after the publication and that the restraining order has been extended to the continued hearing date.  (d) If a person fails to appear for a summary hearing after service of summons, the court shall enter a judgment in favor of the commissioner against that person.  (e) A person who appears for the summary hearing shall file its answer at the hearing and the court shall:  (1) Determine whether to extend any temporary restraining orders pending final judgment; and  (2) Set the case for trial on a date not more than ten (10) days from the summary hearing.  (f) The court shall grant no continuance for filing an answer.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-13. Proceedings for expedited trial  Continuances, discovery, and evidence. (a) The court shall proceed to hear the case at the time and date set forth for trial without a jury and without unnecessary delays. To the extent not inconsistent with other law, the court shall give precedence to the matter over all other matters. To the extent authorized by law, the court may assign the matter to other judges if necessary to comply with the need for expedited proceedings under this chapter.  (b) Continuances for trial shall be granted only in extreme circumstances.  (c) The court shall receive as self-authenticated any of the following when offered by the commissioner:  (1) Certified copies of the financial statements made by the person; and  (2) Certified copies of examination reports of the person made by or on behalf of the commissioner.  (d) The facts contained in any examination report shall be presumed to be true as of the date of the hearing if the examination was made as of a date not more than two hundred seventy (270) days before the petition was filed. The presumption shall be rebuttable and shall shift the burden of production and persuasion.  (e) Discovery shall be limited to grounds alleged in the petition, and shall be concluded on an expedited basis.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-14. Decision and appeals. (a) The court shall enter judgment within fifteen (15) days after the conclusion of the evidence.  (b) The judgment shall be final when entered. Any appeal shall be prosecuted on an expedited basis and must be taken within five (5) days of entry. No request for reconsideration, review, or appeal, and no posting of a bond, shall dissolve or stay the judgment.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-15. Confidentiality of hearings. In all proceedings and judicial reviews under  27-14.3-10, all records of the insurer, other documents, and all insurance department files and court records and papers, so far as they pertain to or are a part of the record of the proceedings, shall be and remain confidential except as is necessary to obtain compliance with the proceedings, unless and until the superior court for the county of Providence, after hearing arguments from the parties in chambers, shall order otherwise or unless the insurer requests that the matter be made public. Until that court order, all papers filed with the clerk of the superior court for the county of Providence shall be held by him or her in a confidential file.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-16. Grounds for rehabilitation. The commissioner may apply by petition to the superior court for the county of Providence for an order authorizing him or her to rehabilitate a domestic insurer or an alien insurer domiciled in this state on any one or more of the following grounds:  (1) The insurer is in a condition that the further transaction of business would be hazardous financially to its policyholders, creditors, or the public;  (2) There is reasonable cause to believe that there has been embezzlement from the insurer, wrongful sequestration or diversion of the insurers assets, forgery or fraud affecting the insurer, or other illegal conduct in, by, or with respect to the insurer that if established would endanger assets in an amount threatening the solvency of the insurer;  (3) The insurer has failed to remove any person who in fact has executive authority in the insurer, whether an officer, manager, general agent, employee, or other person if the person has been found after notice and opportunity for a hearing by the commissioner to be dishonest or untrustworthy in a way affecting the insurers business;  (4) Control of the insurer, whether by stock ownership or otherwise, and whether direct or indirect, is in a person or persons found after notice and opportunity for a hearing to be untrustworthy;  (5) Any person who in fact has executive authority in the insurer, whether an officer, manager, general agent, director or trustee, employee, or other person, has refused to be examined under oath by the commissioner concerning its affairs, whether in this state or in another place, and after reasonable notice of the fact, the insurer has failed promptly and effectively to terminate the employment and status of the person and all of his or her influence on management;  (6) After demand by the commissioner under  27-1-11 and chapter 13.1 of this title or under this chapter, the insurer has failed to promptly make available for examination any of its own property, books, accounts, documents, or other records, or those of any subsidiary or related company within the control of the insurer, or those of any person having executive authority in the insurer so far as they pertain to the insurer;  (7) Without first obtaining the written consent of the commissioner, the insurer has transferred, or attempted to transfer, in a manner contrary to chapter 35 or chapter 53 of this title, a material amount of its entire property or business, or has entered into any transaction the effect of which is to merge, consolidate, or reinsure a material amount of its entire property or business in or with the property or businesses of any other person;  (8) The insurer or its property has been or is the subject of an application for the appointment of a receiver, trustee, custodian, conservator, or sequestrator or similar fiduciary of the insurer or its property as authorized under the insurance laws of this state, and that appointment has been made or is imminent, and that appointment might oust the courts of this state of jurisdiction or might prejudice orderly delinquency proceedings under this chapter;  (9) Within the previous four (4) years the insurer has willfully violated its charter or articles of incorporation, its bylaws, any insurance law of this state, or any valid order of the commissioner;  (10) The insurer has failed to pay within sixty (60) days after due date any obligation to any state or any subdivision of the state or any judgment entered in any state, if the court in which the judgment was entered had jurisdiction over the subject matter, except that the nonpayment shall not be a ground until sixty (60) days after any good faith effort by the insurer to contest the obligation has been terminated, whether it is before the commissioner or in the courts, or the insurer has systematically attempted to compromise or renegotiate previously agreed settlements with its creditors on the ground that it is financially unable to pay its obligations in full;  (11) The insurer has failed to file its annual report or other financial report required by statute within the time allowed by law and, after written demand by the commissioner, has failed to give an adequate explanation immediately; and/or  (12) The board of directors or the holders of a majority of the shares entitled to vote, or a majority of those individuals entitled to the control of those entities specified in  27-35-1, request or consent to rehabilitation under this chapter.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-17. Rehabilitation order. (a) An order to rehabilitate the business of a domestic insurer, or an alien insurer domiciled in this state, shall appoint the commissioner and his or her successors in office the rehabilitator, and shall direct the rehabilitator to take possession of the assets of the insurer, and to administer them under the general supervision of the court. The filing or recording of the order with the clerk of the superior court for the county of Providence or recorder of deeds of the city or town in which the principal business of the company is conducted, or the city or town in which its principal office or place of business is located, shall impart the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds would have imparted. The order to rehabilitate the insurer shall by operation of law vest title to all assets of the insurer in the rehabilitator.  (b) Any order issued under this section shall require accountings to the court by the rehabilitator. Accountings shall be at those intervals as the court specifies in its order, but no less frequently than semiannually. Each accounting shall include a report concerning the rehabilitators opinion as to the likelihood that a plan under  27-14.3-18(f) will be prepared by the rehabilitator and the timetable for doing so.  (c) Entry of an order of rehabilitation shall not constitute an anticipatory breach of any contracts of the insurer nor shall it be grounds for retroactive revocation or retroactive cancellation of any contracts of the insurer, unless the revocation or cancellation is done by the rehabilitator pursuant to  27-14.3-18.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-18. Powers and duties of rehabilitator. (a) The commissioner as rehabilitator may appoint one or more special deputies who shall have all of the powers and responsibilities of the rehabilitator granted under this section, and the commissioner may employ counsel, clerks and assistants as necessary. The compensation of the special deputy, counsel, clerks, and assistants and all of the expenses of taking possession of the insurer and of conducting the proceedings shall be fixed by the commissioner, with the approval of the court, and shall be paid out of the funds or assets of the insurer. The persons appointed under this section shall serve at the pleasure of the commissioner. The commissioner, as rehabilitator, may, with the approval of the court, appoint an advisory committee of policyholders, claimants, or other creditors including guaranty associations should an advisory committee be deemed necessary; provided, that if a nonprofit hospital service corporation, nonprofit medical service corporation, or nonprofit dental service corporation is subject to an order of rehabilitation, the commissioner shall appoint an advisory committee of creditors to include Rhode Island nonprofit hospitals. The committee shall serve at the pleasure of the commissioner and shall serve without compensation other than reimbursement for reasonable travel and per diem living expenses. No other committee of any nature shall be appointed by the commissioner or the court in rehabilitation proceedings conducted under this chapter.  (b) In the event that the property of the insurer does not contain sufficient cash or liquid assets to defray the costs incurred, the commissioner may advance the incurred costs out of any appropriation for the maintenance of the division of insurance. Any advanced amounts for expenses of administration shall be repaid to the commissioner for the use of the insurance department out of the first available money of the insurer.  (c) The commissioner may reimburse the division of insurance and its agents and consultants at its statutory examination rate and/or reasonable consultants rate for reasonable costs incurred in the examination and the investigation in anticipation of the rehabilitation of the insurer and in the rehabilitation of the insurer, from the funds or assets of the insurer, those fees to be class one expenses of administration pursuant to  27-14.3-46.  (d) The rehabilitator may take any action that he or she deems necessary or appropriate to reform and revitalize the insurer. He or she shall have all of the powers of the directors, officers, and managers, whose authority shall be suspended, except as they are delegated by the rehabilitator. He or she shall have full power to direct and manage, to hire and discharge employees subject to any contract rights they may have, and to deal with the property and business of the insurer.  (e) If it appears to the rehabilitator that there has been criminal or tortious conduct, or breach of any contractual or fiduciary obligation detrimental to the insurer by any officer, manager, agent, insurance producer, broker, employee, or other person, he or she may pursue all appropriate legal remedies on behalf of the insurer.  (f) If the rehabilitator determines that reorganization, consolidation, conversion, reinsurance, merger, or other transformation of the insurer is appropriate, he or she shall prepare a plan to effect those changes. Upon application of the rehabilitator for approval of the plan, and after any notice and hearings as the court may prescribe, the court may either approve or disapprove the proposed plan, or may modify it and approve it as modified. Any plan approved under this section shall be, in the judgment of the court, fair and equitable to all parties concerned. If the plan is approved, the rehabilitator shall carry out the plan. In the case of a life insurer, the proposed plan may include the imposition of liens upon the policies of the company, if all of the rights of the shareholders are first relinquished. A plan for a life insurer may also propose imposition of a moratorium upon loan and cash surrender rights under policies for a period and to an extent as may be necessary.  (g) The rehabilitator shall have the power under  27-14.3-30 and 27-14.3-31 to avoid fraudulent transfers.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-19. Actions by and against rehabilitator. (a) Any court in this state before which any action or proceeding in which the insurer is a party, or is obligated to defend a party, is pending when a rehabilitative order against the insurer is entered shall stay the action or proceeding for ninety (90) days and any additional time as is necessary for the rehabilitator to obtain proper representation and prepare for further proceedings. The rehabilitator shall take any action respecting the pending litigation as he or she deems necessary in the interests of justice and for the protection of creditors, policyholders, and the public. The rehabilitator shall immediately consider all litigation pending outside of this state and shall petition the courts having jurisdiction over that litigation for injunctions and stays whenever necessary to protect the estate of the insurer.  (b) No statute of limitations or defense of laches shall run with respect to any action by or against an insurer between the filing of a petition for appointment of a rehabilitator for that insurer and the order granting or denying that petition. Any action against the insurer that might have been commenced when the petition was filed may be commenced for at least sixty (60) days after the order of rehabilitation is entered or the petition is denied. The rehabilitator may, upon an order for rehabilitation, within one year or other longer time as applicable law may permit, institute an action or proceeding on behalf of the insurer upon any cause of action against which the period of limitation fixed by applicable law has not expired at the time of the filing of the petition upon which the order is entered.  (c) Any guaranty association or foreign guaranty association covering life or health insurance or annuities shall have standing to appear in any court proceeding concerning the rehabilitation of a life or health insurer if the association is or may become liable to act as a result of the rehabilitation.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-2. Applicability. The proceedings authorized by this chapter may be applied to: (1) All insurers who are doing, or have done, an insurance business in this state, including a protected cell company organized under the Protected Cell Companies Act, chapter 64 of this title, and any of its protected cells established pursuant to that chapter, to the extent not inconsistent with the provisions of that chapter, and against whom claims arising from that business may exist now or in the future;  (2) All insurers who purport to do an insurance business in this state, including a protected cell company organized under the Protected Cell Companies Act, chapter 64 of this title, and any of its protected cells established pursuant to that chapter, to the extent not inconsistent with the provisions of that chapter;  (3) All insurers who have insured resident in this state;  (4) All other persons organized or in the process of organizing with the intent to do an insurance business in this state, including a protected cell company organized under the Protected Cell Companies Act, chapter 64 of this title, and any of its protected cells established pursuant to that chapter, to the extent not inconsistent with the provisions of that chapter;  (5) All nonprofit service plans and all fraternal benefit societies and beneficial societies;  (6) All title insurance companies;  (7) All prepaid health care delivery plans; and  (8) All nonprofit health service corporations, nonprofit hospital service corporations, nonprofit medical service corporations, nonprofit dental service corporations, nonprofit optometric service corporations, nonprofit legal service corporations, health maintenance organizations, and risk retention groups pursuant to chapters 19, 20, 20.1, 20.2, 20.3, 41, and 46 of this title.  History of Section.P.L. 1993, ch. 248,  1; P.L. 1999, ch. 22,  5. 
 27-14.3-20. Termination of rehabilitation. (a) Whenever the commissioner believes further attempts to rehabilitate an insurer would substantially increase the risk of loss to creditors, policyholders, or the public, or would be futile, the commissioner may petition the superior court for the county of Providence for an order of liquidation. A petition under this subsection shall have the same effect as a petition under  27-14.3-21. The superior court for the county of Providence shall permit the directors of the insurer to take any actions as are reasonably necessary to defend against the petition and may order payment from the estate of the insurer of any costs and other expenses of defense as justice may require.  (b) The protection of the interests of the insured, claimants, and the public requires the timely performance of all insurance policy obligations. If the payment of policy obligations is suspended in substantial part for a period of six (6) months at any time after the appointment of the rehabilitator and the rehabilitator has not filed an application for approval of a plan under  27-14.3-18(f), the rehabilitator shall petition the court for an order of liquidation on the grounds of insolvency.  (c) The rehabilitator may at any time petition the superior court for the county of Providence for an order terminating rehabilitation of an insurer. The court shall also permit the directors of the insurer to petition the court for an order terminating rehabilitation of the insurer and may order payment from the estate of the insurer of any costs and other expenses of the petition as justice may require. If the superior court for the county of Providence finds that rehabilitation has been accomplished and that grounds for rehabilitation under  27-14.3-16 no longer exist, it shall order that the insurer be restored to possession of its property and the control of the business. The superior court for the county of Providence may also make that finding and issue that order at any time upon its own motion.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-21. Grounds for liquidation. The commissioner may petition the superior court for the county of Providence for an order directing him or her to liquidate a domestic insurer or an alien insurer domiciled in this state on the basis:  (1) Of any ground for an order of rehabilitation as specified in  27-14.3-16, whether or not there has been a prior order directing the rehabilitation of the insurer;  (2) That the insurer is insolvent; or  (3) That the insurer is in a condition that would make the further transaction of business hazardous, financially or otherwise, to its policyholders, its creditors, or the public.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-22.1. Grounds for rehabilitation or liquidation of a domestic company that is a covered financial company under Dodd-Frank Wall Street Reform and Consumer Protection Act. (a) The provisions of this section apply in accordance with title II of the federal Dodd-Frank Wall Street reform and consumer protection act, Pub. L. No. 111-203 with respect to an insurance company that is a covered financial company, as that term is defined under 12 U.S.C.  5381.  (b) The commissioner may file a complaint for an order of rehabilitation or liquidation pursuant to subdivision (4) of this chapter on any of the following grounds:  (1) Upon a determination and notification given by the secretary of the treasury of the United States (in consultation with the President of the United States) that the insurance company is a financial company satisfying the requirements of 12 U.S.C.  5383(b), and the board of directors (or body performing similar functions) of the insurance company acquiesces or consents to the appointment of a receiver pursuant to 12 U.S.C.  5382(a)(1)(A)(i) with such consent to be considered as consent to an order of rehabilitation or liquidation;  (2) Upon an order of the United States district court for the District of Columbia under 12 U.S.C.  5382(a)(1)(A)(iv)(I) granting the petition of the secretary of the treasury of the United States concerning the insurance company under 12 U.S.C.  5382(a)(1)(A)(i); or  (3) A petition by the secretary of the treasury of the United States concerning the insurance company is granted by operation of law under 12 U.S.C.  5382(a)(1)(A)(v).  (c) Notwithstanding any other provision of law, after notice to the insurance company, the receivership court may grant an order on the complaint for rehabilitation or liquidation within twenty-(24) hours after the filing of a complaint pursuant to this section.  (d) If the receivership court does not make a determination on a complaint for rehabilitation or liquidation filed by the commissioner pursuant to this section within twenty-four (24) hours after its filing, then it shall be deemed granted by operation of law upon the expiration of the twenty-four (24) hour period. At the time that an order is deemed granted under this section, the provisions of chapter 14.3 of title 27 of this title shall be deemed to be in effect, and the director shall be deemed to be affirmed as receiver and have all of the applicable powers provided by this code, regardless of whether an order has been entered. The receivership court shall expeditiously enter an order of rehabilitation or liquidation that:  (1) Is effective as of the date that it is deemed granted by operation of law; and  (2) Conforms to the provisions for rehabilitation or liquidation contained in this chapter, as applicable.  (e) Any order of rehabilitation or liquidation made pursuant to this section shall not be subject to any stay or injunction pending appeal.  (f) Nothing in this section shall be construed to supersede or impair any other power or authority of the commissioner or the court under this chapter or title 27.  History of Section.P.L. 2012, ch. 308,  2; P.L. 2012, ch. 335,  2. 
 27-14.3-22. Liquidation orders. (a) An order to liquidate the business of a domestic insurer shall appoint the commissioner and his or her successors in office liquidator, and shall direct the liquidator to take possession of the assets of the insurer and to administer them under the general supervision of the court. The liquidator shall be vested by operation of law with the title to all of the property, contracts, and rights of action, and all of the books and records of the insurer ordered liquidated, wherever located, as of the entry of the final order of liquidation. The filing or recording of the order with the clerk of the superior court for the county of Providence and the recorder of deeds of the city or town in which its principal office or place of business is located or, in the case of real estate, with the recorder of deeds of the city or town where the property is located, shall impart the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds would have imparted.  (b) Upon issuance of the order, the rights and liabilities of any insurer and of its creditors, policyholders, shareholders, members, and all other persons interested in its estate shall become fixed as of the date of entry of the order of liquidation, except as provided in  27-14.3-23 and 27-14.3-41.  (c) An order to liquidate the business of an alien insurer domiciled in this state shall be on the same terms and have the same legal effect as an order to liquidate a domestic insurer, except that the assets and the business in the United States shall be the only assets and business included in the order.  (d) At the time of petitioning for an order of liquidation, or at any time after this, the commissioner, after making appropriate findings of an insurers insolvency, may petition the court for a judicial declaration of insolvency. After providing any notice and hearing that it deems proper, the court may make the declaration.  (e) Any order issued under this section shall require financial reports to the court by the liquidator. Financial reports shall include at a minimum the assets and liabilities of the insurer and all funds received or disbursed by the liquidator during the current period. Financial reports shall be filed within one year of the liquidation order and at least annually after this.  (f) Within five (5) days after the initiation of an appeal of an order of liquidation, which order has been stayed, the commissioner shall present for the courts approval a plan for the continued performance of the defendant companys policy claims obligations, including the duty to defend insured under liability insurance policies, during the pendency of an appeal. The plan shall provide for the continued performance and payment of policy claims obligations in the normal course of events, notwithstanding the grounds alleged in support of the order of liquidation, including the ground of insolvency. In the event the defendant companys financial condition will not, in the judgment of the commissioner, support the full performance of all policy claims obligations during the appeal pendency period, the plan may prefer the claims of certain policyholders and claimants over creditors and interested parties and other policyholders and claimants, as the commissioner finds to be fair and equitable considering the relative circumstances of the policyholders and claimants. The court shall examine the plan submitted by the commissioner and if it finds the plan to be in the best interests of the parties, the court shall approve the plan. No action shall lie against the commissioner or any of his or her deputies, agents, clerks, assistants, or attorneys by any party based on preference in an appeal pendency plan approved by the court.  (g) The appeal pendency plan shall not supersede or affect the obligations of any insurance guaranty association.  (h) Any appeal pendency plan shall provide for equitable adjustments to be made by the liquidator to any distributions of assets to guaranty associations, in the event that the liquidator pays claims from the assets of the estate, which would be the obligations of any particular guaranty association but for the appeal of the order of liquidation, so that all guaranty associations equally benefit on a pro rata basis from the assets of the estate. In the event an order of liquidation is set aside upon any appeal, the company shall not be released from delinquency proceedings unless and until all funds advanced by any guaranty association, including reasonable administrative expenses in connection with the proceedings relating to obligations of the company, shall be repaid in full, together with interest at the judgment rate of interest or unless an arrangement for repayment has been made with the consent of all applicable guaranty associations.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-23. Continuance of coverage. (a) All policies, including bonds and other noncancellable business, other than life or health insurance or annuities, in effect at the time of the issuance of an order of liquidation shall continue in force only for the lesser of:  (1) The greater of a period of thirty (30) days from the date of entry of the liquidation order or a time as coverage is provided for by a responsible guaranty association, if any is applicable;  (2) The expiration of the policy coverage;  (3) The date when the insured has replaced the insurance coverage with equivalent insurance in another insurer or terminated the policy;  (4) The liquidator has effected a transfer of the policy obligation pursuant to  27-14.3-25(a)(10); or  (5) The date proposed by the liquidator and approved by the court to cancel coverage.  (b) An order or liquidation under  27-14.3-22 shall terminate coverage at the time specified in subsection (a) of this section for the purposes of any other statute.  (c) Policies of life or health insurance or annuities shall continue in force for any period and under any terms as is provided for by any applicable guaranty association or foreign guaranty association.  (d) Policies of life or health insurance or annuities or any period or coverage of those policies not covered by a guaranty association or foreign guaranty association shall terminate under subsections (a) and (b) of this section.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-24. Dissolution of insurer. The commissioner may petition for an order dissolving the corporate existence of a domestic insurer or the United States branch of an alien insurer domiciled in this state at the time he or she applies for a liquidation order. The court shall order the dissolution of the corporation upon petition by the commissioner upon or after the granting of a liquidation order. If the dissolution has not previously been ordered, it shall be effected by operation of law upon the discharge of the liquidator if the insurer is insolvent, but may be ordered by the court upon the discharge of the liquidator if the insurer is under a liquidation order for some other reason.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-25. Powers of liquidator. (a) The liquidator shall have the power:  (1) To appoint a special deputy or deputies to act for him or her under this chapter, and to determine his or her reasonable compensation. The special deputy shall have all of the powers of the liquidator granted by this section. The special deputy shall serve at the pleasure of the liquidator;  (2) To employ employees and agents, legal counsel, actuaries, accountants, appraisers, consultants, and any other personnel as he or she may deem necessary to assist in the liquidation;  (3) To appoint, with the approval of the court, an advisory committee of policyholders, claimants, or other creditors including guaranty associations should a committee be deemed necessary; provided, that if a nonprofit hospital service corporation, nonprofit medical service corporation, or nonprofit dental service corporation is subject to an order of liquidation, the commissioner shall appoint an advisory committee of creditors to include Rhode Island nonprofit hospitals. The committee shall serve at the pleasure of the commissioner and shall serve without compensation other than reimbursement for reasonable travel and per diem living expenses. No other committee of any nature shall be appointed by the commissioner or the court in liquidation proceedings conducted under this chapter;  (4) To fix the reasonable compensation of employees and agents, legal counsel, actuaries, accountants, appraisers, and consultants with the approval of the court and may reimburse from the assets of the insurer the division of insurance and its agents and consultants at the statutory examination rate and/or reasonable agents or consultants rates for reasonable costs incurred in the examination and investigation in anticipation of liquidation, and in the liquidation of the insurer, those fees are to be Class 1 expenses of administration pursuant to  27-14.3-46;  (5) To pay reasonable compensation to persons appointed and to defray from the funds or assets of the insurer all of the expenses of taking possession of, conserving, conducting, liquidating, disposing of, or dealing with the business and property of the insurer. In the event that the property of the insurer does not contain sufficient cash or liquid assets to defray the incurred costs, the commissioner may advance the incurred costs out of any appropriation for the maintenance of the insurance department. Any advanced amounts for the expenses of administration shall be repaid to the commissioner for the use of the insurance department out of the first available moneys of the insurer;  (6) To hold hearings, to subpoena witnesses to compel their attendance, to administer oaths, to examine any person under oath, and to compel any person to subscribe to his or her testimony after it has been correctly reduced to writing, and in connection with this to require the production of any books, papers, records or other documents which he or she deems relevant to the inquiry;  (7) To audit the books and records of all agents or insurance producers of the insurer insofar as those records relate to the business activities of the insurer;  (8) To collect all debts and moneys due and claims belonging to the insurer, wherever located, and for this purpose:  (i) To institute timely action in other jurisdictions in order to forestall garnishment and attachment proceedings against the debts;  (ii) To do any other acts as are necessary or expedient to collect, conserve, or protect its assets or property, including the power to sell, compound, compromise, or assign debts for the purposes of collection upon any terms and conditions as he or she deems best; and  (iii) To pursue any creditors remedies available to enforce his or her claims;  (9) To conduct public and private sales of the property of the insurer;  (10) To use assets of the estate of an insurer under a liquidation order to transfer policy obligations to a solvent assuming insurer, if the transfer can be arranged without prejudice to applicable priorities under  27-14.3-46;  (11) To acquire, hypothecate, encumber, lease, improve, sell, transfer, abandon, or dispose of or deal with any property of the insurer at its market value or upon terms and conditions as are fair and reasonable. He or she shall also have the power to execute, acknowledge, and deliver any and all deeds, assignments, releases, and other instruments necessary or proper to effectuate any sale of property or other transaction in connection with the liquidation;  (12) To borrow money on the security of the insurers assets or without security and to execute and deliver all documents necessary to that transaction for the purpose of facilitating the liquidation. Any funds borrowed may be repaid as an administrative expense and have priority over any other claims in  27-14.3-46(a)(1), Class 1, under the priority of distribution;  (13) To enter into any contracts as are necessary to carry out the order to liquidate, and to affirm or disavow any contracts to which the insurer is a party;  (14) To continue to prosecute and to institute in the name of the insurer or in his or her own name any and all suits and other legal proceedings, in this state or another place, and to abandon the prosecution of claims he or she deems unprofitable to pursue further. If the insurer is dissolved under  27-14.3-24, he or she shall have the power to apply to any court in this state or another place for leave to substitute himself for the insurer as plaintiff;  (15) To prosecute any action which may exist in behalf of the creditors, members, policyholders, or shareholders of the insurer against any officer or director of the insurer, or any other person;  (16) To remove any or all records and property of the insurer to the offices of the commissioner or to any other place as may be convenient for the purposes of efficient and orderly execution of the liquidation. Guaranty associations and foreign guaranty associations shall have reasonable access to the records of the insurer as is necessary for them to carry out their statutory obligations;  (17) To deposit in one or more banks in this state those sums as are required for meeting current administration expenses and dividend distributions;  (18) To invest all sums not currently needed, unless the court orders otherwise;  (19) To file any necessary documents for record in the office of any recorder of deeds or record office in this state or another place where property of the insurer is located;  (20) To assert all defenses available to the insurer as against third persons, including statutes of limitations, statutes of frauds, and the defense of usury. A waiver of any defense by the insurer after a petition in liquidation has been filed shall not bind the liquidator. Whenever a guaranty association or foreign guaranty association has an obligation to defend any suit, the liquidator shall give precedence to that obligation and may defend only in the absence of a defense by the guaranty associations;  (21) To exercise and enforce all of the rights, remedies, and powers of any creditor, shareholder, policyholder, or member including any power to avoid any transfer or lien that may be given by the general laws and that is not included with  27-14.3-30  27-14.3-32;  (22) To intervene in any proceeding wherever instituted that might lead to the appointment of a receiver or trustee, and to act as the receiver or trustee whenever the appointment is offered;  (23) To enter into agreements with any receiver or commissioner of any other state relating to the rehabilitation, liquidation, conservation, or dissolution of an insurer doing business in both states; and  (24) To exercise all of the powers now held or after this conferred upon receivers by the laws of this state not inconsistent with the provisions of this chapter.  (b) The enumeration in this section of the powers and authority of the liquidator shall not be construed as a limitation upon him or her, nor shall it exclude in any manner his or her right to do any other acts not specifically enumerated or provided for in this section as may be necessary or appropriate for the accomplishment of or in aid of the purpose of liquidation.  (c) Notwithstanding the powers of the liquidator as stated in subsections (a) and (b) of this section, the liquidator shall have no obligation to defend claims or to continue to defend claims subsequent to the entry of a liquidation order.  History of Section.P.L. 1993, ch. 248,  1; P.L. 2008, ch. 475,  80. 
 27-14.3-26. Notice to creditors and others. (a) Unless the court otherwise directs, the liquidator shall give or cause to be given notice of the liquidation order as soon as possible:  (1) By first class mail and either by facsimile or telegraph to the insurance commissioner of each jurisdiction in which the insurer is doing business;  (2) By first class mail to any guaranty association or foreign guaranty association which is or may become obligated as a result of the liquidation;  (3) By first class mail to all insurance agents or insurance producers of the insurer;  (4) By first class mail to all persons known or reasonably expected to have claims against the insurer including all policyholders, at their last known address as indicated by the records of the insurer;  (5) By first class mail to federal, state, and local governmental agencies and instrumentalities as their interests may arise; and  (6) By publication in a newspaper of general circulation in the state in which the insurer has its principal place of business and in those other locations that the liquidator deems appropriate.  (b) Except as established by the liquidator with the approval of the court, notice to potential claimants under subsection (a) of this section shall require claimants to file with the liquidator their claims together with proper proofs of their claims under  27-14.3-40, on or before a date the liquidator shall specify in the notice. The liquidator need not require persons claiming cash surrender values or other investment values in life insurance and annuities to file a claim. All claimants shall have a duty to keep the liquidator informed of any changes of address.  (c)(1) Notice under subsection (a) of this section to agents or insurance producers of the insurer and to potential claimants who are policyholders shall include, where applicable, notice that coverage by state guaranty associations may be available for all or part of policy benefits in accordance with applicable state guaranty laws.  (2) The liquidator shall promptly provide to the guaranty associations any information concerning the identities and addresses of the policyholders and their policy coverages as may be within the liquidators possession or control, and cooperate with guaranty associations to assist them in providing to the policyholders timely notice of the guaranty associations coverage of policy benefits, including, as applicable, coverage of claims and continuation termination of coverage.  (d) If notice is given in accordance with this section, the distribution of assets of the insurer under this chapter shall be conclusive with respect to all claimants, whether or not they received notice.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-27. Duties of agents or insurance producers. (a) Every person who receives notice in the form prescribed in  27-14.3-26 that an insurer which he or she represents as an agent or insurance producer is the subject of a liquidation order, shall within thirty (30) days of the notice provide to the liquidator in addition to the information he or she may be required to provide pursuant to  27-14.3-6, the information in the agents or insurance producers records related to any policy issued by the insurer through the agent or insurance producer, and, if the agent or insurance producer is a general agent, the information in the general agents records related to any policy issued by the insurer through an agent or insurance producer under contract to him or her, including the name and address of the subagent or subproducer. A policy shall be deemed issued through an agent or insurance producer if the agent or insurance producer has a property interest in the expiration of the policy, or if the agent or insurance producer has had in his or her possession a copy of the declarations of the policy at any time during the life of the policy, except where the ownership of the expiration of the policy has been transferred to another.  (b) Any agent or insurance producer failing to provide information to the liquidator as required in subsection (a) of this section may be subject to the payment of a penalty of not more than one thousand dollars ($1,000) and may have his or her licenses suspended, after a hearing held by the commissioner.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-28. Actions by and against liquidator. (a) Upon issuance of an order appointing a liquidator of a domestic insurer or of an alien insurer domiciled in this state, no action at law or equity or in arbitration shall be brought against the insurer or liquidator, whether in this state or another place, nor shall any existing actions be maintained or further presented after the issuance of the order. The courts of this state shall give full faith and credit to injunctions against new actions against the liquidator or the company or the continuation of existing actions against the liquidator or the company, when the injunctions are included in an order to liquidate an insurer issued pursuant to corresponding provisions in other states. Whenever, in the liquidators judgment, protection of the estate of the insurer necessitates intervention in an action against the insurer that is pending outside of this state, he or she may intervene in the action. The liquidator may defend any action in which he or she intervenes under this section at the expense of the estate of the insurer.  (b) The liquidator may, upon or after an order for liquidation, within two (2) years or a longer time as applicable law may permit, institute an action or proceeding on behalf of the estate of the insurer upon any cause of action against which the period of limitation fixed by applicable law has not expired at the time of the filing of the petition upon which the order is entered. When, by any agreement, a period of limitation is fixed for instituting a suit or proceeding upon any claim, or for filing any claim, proof of claim, proof of loss, demand, notice, or the like, or when in any proceeding, judicial or otherwise, a period of limitation is fixed, either in the proceeding or by applicable law, for taking any action, filing any claim or pleading, or doing any act, and when in this case the period had not expired at the date of the filing of the petition the liquidator may, for the benefit of the estate, take any action or do any act, required of or permitted to the insurer, within a period of one hundred eighty (180) days subsequent to the entry of an order for liquidation, or within a further period that is shown to the satisfaction of the court not to be unfairly prejudicial to the other party.  (c) No statute of limitations or defense of laches shall run with respect to any action against an insurer between the filing of a petition for liquidation against an insurer and the denial of the petition. Any action against the insurer that might have been commenced when the petition was filed may be commenced for at least sixty (60) days after the petition is denied.  (d) Any guaranty association or foreign guaranty association shall have standing to appear in any court proceeding concerning the liquidation of an insurer if the association is or may become liable to act as a result of the liquidation.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-29. Collection and list of assets. (a) As soon as practicable after the liquidation order but not later than one hundred twenty (120) days after this, the liquidator shall prepare in duplicate a list of the insurers assets. The list shall be amended or supplemented as the liquidator may determine. One copy shall be filed in the office of the clerk of the superior court for the county of Providence and one copy shall be retained for the liquidators files. All amendments and supplements shall be similarly filed.  (b) The liquidator shall reduce the assets to a degree of liquidity that is consistent with the effective execution of the liquidation.  (c) A submission to the court for disbursement of assets in accordance with  27-14.3-38 fulfills the requirements of subsection (a) of this section.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-3. Definitions. For the purposes of this chapter: (1) Ancillary state means any state other than a domiciliary state;  (2) Commissioner means the director of the department of business regulation;  (3) Creditor is a person having any claim, whether matured or unmatured, liquidated or unliquidated, secured or unsecured, absolute, fixed, or contingent;  (4) Delinquency proceeding means any proceeding instituted against an insurer for the purpose of liquidating, rehabilitating, reorganizing, or conserving that insurer, and any summary proceeding under  27-14.3-10. Formal delinquency proceeding means any liquidation or rehabilitation proceeding;  (5) Doing business includes any of the following acts, whether effected by mail or otherwise:  (i) The issuance or delivery of contracts of insurance to persons resident in this state;  (ii) The solicitation of applications for those contracts, or other negotiations preliminary to the execution of those contracts;  (iii) The collection of premiums, membership fees, assessments, or other consideration for those contracts;  (iv) The transaction of matters subsequent to the execution of those contracts and arising out of them;  (v) Operating under a license, approval, or certificate of authority, as an insurer, issued by the insurance department; or  (vi) Those other acts defined in  27-16-1.2(b);  (6) Domiciliary state means the state in which an insurer is incorporated or organized; or, in the case of an alien insurer, its state of entry;  (7) Fair consideration is given for property or obligation:  (i) When in exchange for the property or obligation, as a fair equivalent for these, and in good faith, property is conveyed or services are rendered or an obligation is incurred or an antecedent debt is satisfied; or  (ii) When the property or obligation is received in good faith to secure a present advance or antecedent debt in an amount not disproportionately small as compared to the value of the property or obligation obtained;  (8) Foreign country means any other jurisdiction not in any state of the United States;  (9) General assets means all property, real, personal, or otherwise, not specifically mortgaged, pledged, deposited, or encumbered for the security or benefit of specified persons or classes of persons. As to specifically encumbered property, general assets includes all property or its proceeds in excess of the amount necessary to discharge the sum or sums secured by those assets. Assets held in trust and on deposit for the security or benefit of all policyholders or all policyholders and creditors in more than a single state, shall be treated as general assets;  (10) Guaranty association means the Rhode Island insurers insolvency fund created by the Rhode Island Insurers Insolvency Fund Act, chapter 34 of this title, and the Rhode Island life and health insurance guaranty association, created by the Rhode Island Life and Health Insurance Guaranty Association Act, chapter 34.1 of this title, and any other similar entity now or after this created by the legislature of this state for the payment of claims of insolvent insurers. Foreign guaranty association means any similar entities now in existence in or after this created by the legislature of any other state;  (11) Insolvency or insolvent means:  (i) For an insurer issuing only assessable fire insurance policies:  (A) The inability to pay any obligation within thirty (30) days after it becomes payable; or  (B) If an assessment is made within thirty (30) days after that date, the inability to pay the obligation thirty (30) days following the date specified in the first assessment notice issued after the date of loss;  (ii) For any other insurer, including those referenced in  27-14.3-2(8), that it is unable to pay its obligations when they are due, or when its admitted assets do not exceed its liabilities plus the greater of:  (A) Any capital and surplus required by law for its organization and continued operation; or  (B) The total par or stated value of its authorized and issued capital stock;  (iii) For the purposes of this subdivision, liabilities includes, but is not limited to, reserves required by statute or by insurance department general regulations or specific requirements imposed by the commissioner upon a subject company at the time of admission or subsequent to admission;  (12) Insurer means any person who has done, purports to do, is doing, or is licensed or approved to do an insurance business, and is or has been subject to the authority of, or to liquidation, rehabilitation, reorganization, supervision, or conservation by, any insurance commissioner. For the purposes of this chapter, any other persons included under  27-14.3-2 shall be deemed to be insurers and for the purposes of this chapter, guaranty associations shall not be deemed to be doing the business of insurance or the insurer;  (13) Person includes any natural person, corporation, association, partnership, trust, or other legal entity;  (14) Preferred claim means any claim with respect to which the terms of this chapter accord priority of payment from the general assets of the insurer;  (15) Receiver means receiver, liquidator, rehabilitator, or conservator, as the context requires;  (16) Reciprocal state means any state other than this state in which in substance and effect  27-14.3-22(a), 27-14.3-56, 27-14.3-57 and 27-14.3-59  27-14.3-61 are in force, and in which provisions are in force requiring that the commissioner or equivalent official is the receiver of a delinquent insurer, and in which some provision exists for the avoidance of fraudulent conveyances and preferential transfers;  (17) Secured claim means any claim secured by mortgage, trust deed, pledge, deposit as security, escrow, or otherwise, but not including special deposit claims or claims against general assets. The term also includes claims, which have become liens upon specific assets by reason of judicial process;  (18) Special deposit claim means any claim secured by a deposit made pursuant to statute for the security or benefit of a limited class or classes of persons, but not including any claim secured by general assets;  (19) State means any state, district, or territory of the United States and the Panama canal zone; and  (20) Transfer includes the sale and every other and different mode, direct or indirect, or disposing of or of parting with property or with an interest in property, or with the possession of property or of fixing a lien upon property or upon an interest in it absolutely or conditionally, voluntarily, by or without judicial proceedings. The retention of a security title to property delivered to a debtor shall be deemed a transfer suffered by the debtor.  History of Section.P.L. 1993, ch. 248,  1; P.L. 2001, ch. 122,  10. 
 27-14.3-30. Fraudulent transfers prior to petition. (a) Every transfer made or suffered and every obligation incurred by an insurer within one year prior to the filing of a successful petition for rehabilitation or liquidation under this chapter is fraudulent as to then existing and future creditors if made or incurred without fair consideration, or with actual intent to hinder, delay, or defraud either existing or future creditors. A transfer made or an obligation incurred by an insurer ordered to be rehabilitated or liquidated under this chapter, which is fraudulent under this section, may be avoided by the receiver, except as to a person who in good faith is a purchaser, lienor, or obligee for a present fair equivalent value, and except that any purchaser, lienor, or obligee, who in good faith has given a consideration less than fair for the transfer, lien, or obligation, may retain the property, lien, or obligation as security for repayment. The court may, on due notice, order any transfer or obligation to be preserved for the benefit of the estate, and in that event, the receiver shall succeed to and may enforce the rights of the purchaser, lienor, or obligee.  (b)(1) A transfer of property other than real property shall be deemed made or suffered when it becomes so far perfected that no subsequent lien obtainable by legal or equitable proceedings on a simple contract could become superior to the rights of the transferee under  27-14.3-32(c);  (2) A transfer of real property shall be deemed made or suffered when it becomes so far perfected that no subsequent bona fide purchaser from the insurer could obtain rights superior to the rights of the transferee;  (3) A transfer that creates an equitable lien shall not be deemed perfected if there are available means by which a legal lien could be created;  (4) Any transfer not perfected prior to the filing of a petition for liquidation shall be deemed made immediately before the filing of the successful petition;  (5) The provisions of this subsection apply whether or not there are or were creditors who might have obtained any liens or persons who might have become bona fide purchasers.  (c) Any transaction of the insurer with a reinsurer shall be deemed fraudulent and may be avoided by the receiver under subsection (a) of this section if:  (1) The transaction consists of the termination, adjustment, or settlement of a reinsurance contract in which the reinsurer is released from any part of its duty to pay the originally specified share of losses that had occurred prior to the time of the transactions, unless the reinsurer gives a present fair equivalent value for the release; and  (2) Any part of the transaction took place within one year prior to the date of filing of the petition through which the receivership was commenced.  (d) Every person receiving any property from the insurer or any benefit of this which is a fraudulent transfer under subsection (a) of this section shall be personally liable for it and shall be bound to account to the liquidator.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-31. Fraudulent transfer after petition. (a) After a petition for rehabilitation or liquidation has been filed, a transfer of any of the real property of the insurer made to a person acting in good faith shall be valid against the receiver if made for a present fair equivalent value or, if not made for a present fair equivalent value, then to the extent of the present consideration actually paid for it, for the amount the transferee shall have a lien on the transferred property. The commencement of a proceeding in rehabilitation or liquidation shall be constructive notice upon the recording of a copy of the petition for or order of rehabilitation or liquidation with the recorder of deeds in the city or town where any real property in question is located. The exercise by a court of the United States or any state or jurisdiction to authorize or effect a judicial sale of real property of the insurer within any county in any state shall not be impaired by the pendency of a proceeding unless the copy is recorded in the county prior to the consummation of the judicial sale.  (b) After a petition for rehabilitation or liquidation has been filed and before either the receiver takes possession of the property of the insurer or an order of rehabilitation or liquidation is granted:  (1) A transfer of any of the property of the insurer, other than real property, made to a person acting in good faith shall be valid against the receiver if made for a present fair equivalent value or, if not made for a present fair equivalent value, then valid to the extent of the present consideration actually paid for it, for the amount the transferee shall have a lien on the transferred property;  (2) A person indebted to the insurer or holding property of the insurer may, if acting in good faith, pay the indebtedness or deliver the property, or any part of the property, to the insurer or upon his or her order, with the same effect as if the petition were not pending;  (3) A person having actual knowledge of the pending rehabilitation or liquidation shall be deemed not to act in good faith; and  (4) A person asserting the validity of a transfer under this section shall have the burden of proof. Except as provided in this section, no transfer by or on behalf of the insurer after the date of the petition for liquidation by any person other than the liquidator shall be valid against the liquidator.  (c) Every person receiving any property from the insurer or any benefit of the property which is a fraudulent transfer under subsection (a) of this section shall be personally liable for it and shall be bound to account to the liquidator.  (d) Nothing in this chapter shall impair the negotiability of currency or negotiable instruments.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-32. Voidable preferences and liens. (a)(1) A preference is a transfer of any of the property of an insurer to or for the benefit of a creditor, for or on account of an antecedent debt, made or suffered by the insurer within one year before the filing of a successful petition for liquidation under this chapter, the effect of which transfer may be to enable the creditor to obtain a greater percentage of this debt than another creditor of the same class would receive. If a liquidation order is entered while the insurer is already subject to a rehabilitation order, then the transfers shall be deemed preferences if made or suffered within one year before the filing of the successful petition for rehabilitation, or within two (2) years before the filing of the successful petition for liquidation, whichever time is shorter;  (2) Any preference may be avoided by the liquidator if:  (i) The insurer was insolvent at the time of the transfer;  (ii) The transfer was made within four (4) months before the filing of the petition;  (iii) The creditor receiving it or to be benefited by it or his or her agent acting with reference to it had, at the time when the transfer was made, reasonable cause to believe that the insurer was insolvent or was about to become insolvent; or  (iv) The creditor receiving it was an officer, or any employee or attorney or other person who was in fact in a position of comparable influence in the insurer to an officer whether or not he or she held the petition, or any shareholder holding directly or indirectly more than five percent (5%) of any class of any equity security issued by the insurer, or any other person, firm, corporation, association, or aggregation of persons with whom the insurer did not deal at arms length;  (3) Where the preference is voidable, the liquidator may recover the property or, if it has been converted, its value from any person who has received or converted the property; provided, that where a bona fide purchaser or lienor has given less than fair equivalent value, he or she shall have a lien upon the property to the extent of the consideration actually given by him or her. Where a preference by way of lien or security title is voidable, the court may on due notice order the lien or title preserved for the benefit of the estate, in the event the lien or title shall pass to the liquidator.  (b)(1) A transfer of property other than real property shall be deemed made or suffered when it becomes so far perfected that no subsequent lien obtainable by legal or equitable proceedings on a simple contract could become superior to the rights of the transferee;  (2) A transfer of real property shall be deemed made or suffered when it becomes so far perfected that no subsequent bona fide purchaser from the insurer could obtain rights superior to the rights of the transferee;  (3) A transfer which creates an equitable lien shall not be deemed perfected if there are available means by which a legal lien could be created;  (4) A transfer not perfected prior to the filing of a petition for liquidation shall be deemed made immediately before the filing of the successful petition;  (5) The provisions of this subsection apply whether or not there are or were creditors who might have obtained liens or persons who might have become bona fide purchasers.  (c)(1) A lien obtainable by legal or equitable proceedings upon a simple contract is one arising in the ordinary course of the proceedings upon the entry or docketing of a judgment or decree, or upon attachment, garnishment, execution, or a similar process, whether before, upon, or after judgment or decree and whether before or upon levy. It does not include liens that under applicable law are given a special priority over other liens which are prior in time;  (2) A lien obtainable by legal or equitable proceedings could become superior to the rights of a transferee or a purchaser could obtain rights superior to the rights of a transferee, within the meaning of subsection (b) of this section, if the consequences would follow only from the lien or purchase itself, or from the lien or purchase followed by any step wholly within the control of the lienholder or purchaser, with or without the aid of ministerial action by public officials. That lien could not become superior and that purchase could not create superior rights for the purpose of subsection (b) of this section through any acts subsequent to the obtaining of the lien or subsequent to the purchase which require the agreement or concurrence of any third party or which require any further judicial action or ruling.  (d) A transfer of property for or on account of a new and contemporaneous consideration which is deemed under subsection (b) of this section made or suffered after the transfer because of delay in perfecting it does not by this become a transfer for or on account of an antecedent debt if any acts required by the applicable law to be performed in order to perfect the transfer as against liens or bona fide purchasers rights are performed within twenty-one (21) days or any period expressly allowed by the law, whichever is less. A transfer to secure a future loan, if the loan is actually made, or a transfer, which becomes security for a future loan, shall have the same effect as a transfer for or on account of a new and contemporaneous consideration.  (e) If any lien deemed voidable under subdivision (a)(2) of this section has been dissolved by the furnishing of a bond or other obligation, the surety on which has been indemnified directly or indirectly by the transfer of or the creation of a lien upon any property of an insurer before the filing of a petition under this chapter which results in a liquidation order, the indemnifying transfer or lien shall also be deemed voidable.  (f) The property affected by any lien deemed voidable under subsections (a) and (e) of this section shall be discharged from the lien, and that property and any of the indemnifying property transferred to or for the benefit of a surety shall pass to the liquidator, except that the court may on due notice order any lien preserved for the benefit of the estate and the court may direct that conveyance executed as may be proper or adequate to evidence the title of the liquidator.  (g) The superior court for the county of Providence shall have summary jurisdiction of any proceeding by the liquidator to hear and determine the rights of any parties under this section. Reasonable notice of any hearing in the proceeding shall be given to all parties in interest, including the obligee of a releasing bond or other similar obligation. Where an order is entered for the recovery of indemnifying property in kind or for the avoidance of an indemnifying lien the court, upon application of any party in interest, shall in the same proceeding ascertain the value of the property or lien, and if the value is less than the amount for which the property is indemnity or than the amount of the lien, the transferee or lienholder may elect to retain the property or lien upon payment of its value, as ascertained by the court, to the liquidator, within any reasonable times as the court shall fix.  (h) The liability of the surety under a releasing bond or other similar obligation shall be discharged to the extent of the value of the indemnifying property recovered or the indemnifying lien nullified and avoided by the liquidator, or where the property is retained under subsection (g) of this section to the extent of the amount paid to the liquidator.  (i) If a creditor has been preferred, and afterward in good faith gives the insurer further credit without security of any kind for property which becomes a part of the insurers estate, the amount of the new credit remaining unpaid at the time of the petition may be set off against the preference which would be recoverable from him or her.  (j) If an insurer, directly or indirectly, within one year before the filing of a successful petition for liquidation under this chapter, or at any time in contemplation of a proceeding to liquidate it, pays money or transfers property to an attorney at law for services rendered or to be rendered, the transactions may be examined by the court on its own motion or shall be examined by the court on petition of the liquidator and shall be held valid only to the extent of a reasonable amount to be determined by the court, and the excess may be recovered by the liquidator for the benefits of the estate; provided, that where the attorney is in a position of influence in the insurer or an affiliate of the insurer, payment of any money or the transfer of any property to the attorney at law for services rendered or to be rendered shall be governed by the provision of subdivision (a)(2)(iv) of this section.  (k)(1) Every officer, manager, employee, shareholder, member, subscriber, attorney, or any other person acting on behalf of the insurer who knowingly participates in giving any preference when he or she has reasonable cause to believe the insurer is or is about to become insolvent at the time of the preference shall be personally liable to the liquidator for the amount of the preference. It is permissible to infer that there is a reasonable cause to believe this if the transfer was made within four (4) months before the date of filing of this successful petition for liquidation;  (2) Every person receiving any property from the insurer or the benefit of the property as a preference voidable under subsection (a) of this section shall be personally liable for it and shall be bound to account to the liquidator;  (3) Nothing in this subsection shall prejudice any other claim by the liquidator against any person.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-33. Claims of holders of void or voidable rights. (a) No claims of a creditor who has received or acquired a preference, lien, conveyance, transfer, assignment, or encumbrance voidable under this chapter shall be allowed unless he or she surrenders the preference, lien, conveyance, transfer, assignment, or encumbrance. If the avoidance is effected by a proceeding in which a final judgment has been entered, the claim shall not be allowed unless the money is paid or the property is delivered to the liquidator within thirty (30) days from the date of the entering of the final judgment, except that the court having jurisdiction over the liquidation may allow further time if there is an appeal or other continuation of the proceeding.  (b) A claim allowable under  27-14.3-32(a) by reason of the avoidance, whether voluntary or involuntary, or a preference, lien, conveyance, transfer, assignment, or encumbrance, may be filed as an excused last filing under  27-14.3-39 if filed within thirty (30) days from the date of the avoidance, or within the further time allowed by the court under  27-14.3-32(a).  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-34. Setoffs. (a) Mutual debts or mutual credits, whether arising out of one or more contracts between the insurer and another person in connection with any action or proceeding under this chapter, shall be set off and the balance only shall be allowed or paid, except as provided in subsection (b) of this section and  27-14.3-37.  (b) No setoff shall be allowed in favor of any person where:  (1) The obligation of the insurer to the person would not at the date of the filing of a petition for liquidation entitle the person to share as a claimant in the assets of the insurer;  (2) The obligation of the insurer to the person was purchased by or transferred to the person with a view to its being used as a setoff;  (3) The obligation of the insurer is owed to an affiliate of the person, or any other entity or association other than the person;  (4) The obligation of the person is owed to an affiliate of the insurer, or any other entity or association other than the insurer;  (5) The obligation of the person is to pay an assessment levied against the members or subscribers of the insurer, or is to pay a balance upon a subscription to the capital stock of the insurer, or is in any other way in the nature of a capital contribution; or  (6) The obligations between the person and the insurer arise from business where either the person or the insurer has assumed risks and obligations from the other party and then has ceded back to that party substantially the same risks and obligations.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-35. Assessments. (a) As soon as practicable but not more than two (2) years from the date of an order of liquidation under  27-14.3-22 of an insurer issuing assessable policies, the liquidator shall make a report to the court setting forth:  (1) The reasonable value of the assets of the insurer;  (2) The insurers probable total liabilities;  (3) The probable aggregate amount of the assessment necessary to pay all claims of creditors and expenses in full, including expenses of administration and costs of collecting the assessment; and  (4) A recommendation as to whether or not an assessment should be made and in what amount.  (b)(1) Upon the basis of the report provided in subsection (a) of this section, including any supplements and amendments to the report, the superior court for the county of Providence may levy one or more assessments against all members of the insurer who are subject to assessment;  (2) Subject to any applicable legal limits on assessability, the aggregate assessment shall be for the amount that the sum of the probable liabilities, the expenses of administration, and the estimated cost of collection of the assessment exceeds the value of existing assets, with due regard being given to assessments that cannot be collected economically.  (c) After levy of assessment under subsection (b) of this section, the liquidator shall issue an order directing each member who has not paid the assessment pursuant to the order to show cause why the liquidator should not pursue a judgment for payment.  (d) The liquidator shall give notice of the order to show cause by publication and by first class mail to each member liable pursuant to the order mailed to his or her last known address as it appears on the insurers records, at least twenty (20) days before the return day of the order to show cause.  (e)(1) If a member does not appear and serve duly verified objections upon the liquidator on or before the return day of the order to show cause under subsection (c) of this section, the court shall make an order adjudging the member liable for the amount of the assessment against him or her pursuant to subsection (c) of this section together with costs, and the liquidator shall have a judgment against the member for the amount;  (2) If on or before the return day, the member appears and serves duly verified objection upon the liquidator, the commissioner may hear and determine the matter or may appoint a referee to hear it and make an order as the facts warrant. In the event that the commissioner determines that the objections do not warrant relief from assessment, the member may request the court to review the matter and vacate the order to show cause.  (f) The liquidator may enforce any order or collect any judgment under subsection (e) of this section by any lawful means.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-36. Reinsurers liability. The amount recoverable by the liquidator from reinsurance shall not be reduced as a result of the delinquency proceedings, regardless of any provision in the reinsurance contract or other agreement. Payment made directly to an insured or other creditor shall not diminish the reinsurers obligation to the insurers estate except when the reinsurance contract provided for direct coverage of a named insured and the payment was made in discharge of that obligation.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-37. Recovery of premiums owed. (a)(1) An agent or insurance producer, broker, premium finance company, or any other person, other than the insured, responsible for the payment of a premium shall be obligated to pay any collected earned premiums and any unearned commissions due the insurer at the time of the declaration of insolvency as shown on the records of the insurer. The agent or insurance producer, broker, solicitor or other person responsible for the payment of a premium shall remit unearned premiums in his or her possession to the insured who paid them, or with the written approval of the insured, purchase new coverage for the insured with a different insurer. Credits or setoffs or both shall not be allowed to an agent or insurance producer, broker or premium finance company for any amounts advanced to the insurer by the agent or insurance producer, broker, or premium finance company on behalf of, but in the absence of a payment by, the insured;  (2) An insured shall be obligated to pay any unpaid earned premium due the insurer at the time of the declaration of insolvency, as shown on the records of the insurer.  (b) Upon satisfactory evidence of a violation of this section, the commissioner may pursue either one or both of the following courses of action:  (1) Suspend or revoke or refuse to renew the licenses of the offending party or parties; and/or  (2) Impose a penalty of not more than one thousand dollars ($1,000) for each and every act in violation of this section by the party or parties.  (c) Before the commissioner shall take any action as set forth in subsection (b) of this section, he or she shall give written notice to the person, company, association, or exchange accused of violating the law, stating specifically the nature of the alleged violation and fixing a time and place, at least ten (10) days after this, when a hearing on the matter shall be held. After the hearing, or upon the failure of the accused to appear at the hearing, the commissioner, if he or she shall find a violation, shall impose any of the penalties under subsection (b) of this section as he or she deems advisable.  (d) When the commissioner shall take action in any or all of the ways set out in subsection (b) of this section, the party aggrieved may appeal from the action to the superior court for the county of Providence.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-38. Domiciliary liquidators proposal to distribute assets. (a) Within one hundred twenty (120) days of a final determination of insolvency of an insurer by a court of competent jurisdiction of this state, the liquidator shall make application to the court for approval of a proposal to disburse assets out of marshaled assets as those assets become available, to a guaranty association or foreign guaranty association having obligations because of the insolvency. If the liquidator determines that there are insufficient assets to disburse, the application required by this section shall be considered satisfied by a filing by the liquidator stating the reasons for this determination.  (b) The proposal shall at least include provisions for:  (1) Reserving amounts for the payment of the expenses of administration and the payment of claims of secured creditors, to the extent of the value of the security held, and claims falling within the priorities established in  27-14.3-46, Classes 1 and 2;  (2) Disbursement of the assets marshaled to date and subsequent disbursement of assets as they become available;  (3) Equitable allocation of disbursements to each of the guaranty associations and foreign guaranty associations entitled to disbursements;  (4) The securing by the liquidator from each of the associations entitled to disbursements pursuant to this section of an agreement to return to the liquidator any assets, together with income earned on assets previously disbursed, as may be required to pay the claims of secured creditors and claims falling within the priorities established in  27-14.3-46 in accordance with those priorities. No bond shall be required of the guaranty association; and  (5) A full report to be made by each guaranty association to the liquidator accounting for all assets disbursed in this manner to the guaranty association, all disbursements made from them, any interest earned by the association on the assets, and any other matter as the court may direct.  (c) The liquidators proposal shall provide for disbursements to the guaranty associations in amounts estimated at least equal to the claim payments made or to be made by them for which the guaranty associations could assert a claim against the liquidator, and shall provide that if the assets available for disbursement do not equal or exceed the amount of the claim payments made or to be made by the guaranty associations then disbursements shall be in the amount of available assets.  (d) The liquidators proposal shall, with respect to an insolvent insurer writing life or health insurance or annuities, provide for the disbursements of assets to any guaranty association or any foreign guaranty association covering life or health insurance or annuities or to any other entity or organization reinsuring, assuming, or guaranteeing policies or contracts of insurance under the acts creating the associations.  (e) Notice of the application shall be given to the guaranty association in and to the commissioners of insurance of each of the states. Any notice shall be deemed to have been given when deposited in the United States certified mail, first class postage prepaid, at least thirty (30) days prior to submission of the application to the court. Action on the application may be taken by the court provided this required notice has been given and provided that the liquidators proposal complies with subdivisions (b)(1) and (b)(2) of this section.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-39. Filing of claims. (a) Proof of all claims shall be filed with the liquidator in the form required by  27-14.3-40 on or before the last day for filing specified in the notice required under  27-14.3-26, except that proof of claims for cash surrender values or other investment values in life insurance and annuities need not be filed unless the liquidator expressly so requires this. Provided, however, only upon the application of the liquidator, the court may allow alternative procedures and requirements for the filing of proofs of claim or for allowing or proving claims. Upon application, if the court dispenses with the requirements of filing a proof of claim by a person, class, or group of persons, a proof of claim for such persons shall be deemed as having been filed for all purposes, including the application of guaranty association or foreign guaranty association laws.  (b) The liquidator may permit a claimant making a late filing to share in distributions, whether past or future, as if the claimant were not late, to the extent that the payment will not prejudice the orderly administration of the liquidation, under the following circumstances:  (1) The existence of the claim was not known to the claimant and that the claimant filed the claim as promptly thereafter as reasonably possible after learning of it;  (2) A transfer to a creditor was avoided under  27-14.3-30  27-14.3-32, or was voluntarily surrendered under  27-14.3-33, and that the filing satisfies the conditions of  27-14.3-33; and  (3) The valuation under  27-14.3-45 of security held by a secured creditor shows a deficiency, which is filed within thirty (30) days after the valuation.  (c) The liquidator may consider any claim filed late which is not covered by subsection (b) and permit it to receive distributions which are subsequently declared on any claims of the same or lower priority if the payment does not prejudice the orderly administration of the liquidation. The late filing claimant shall receive, at each distribution, the same percentage of the amount allowed on the claim as is then being paid to claimants of any lower priority. This shall continue until the claim has been paid in full.  History of Section.P.L. 1993, ch. 248,  1; P.L. 2003, ch. 396,  1. 
 27-14.3-4. Jurisdiction and venue. (a) A delinquency proceeding shall be commenced under this chapter by the commissioner and no court shall have jurisdiction to entertain, hear or determine any proceeding commenced by any other person; provided, that a Rhode Island trade association or another similar entity or entities representing nonprofit hospitals in Rhode Island acting by and through its members shall be consulted prior to the commencement of and included as a party to a delinquency proceeding brought against nonprofit hospital service corporations, nonprofit medical service corporations, or nonprofit dental service corporations; and provided, that a trade association or similar entity or entities may request a hearing before the commissioner in order to require the commissioner to commence a delinquency proceeding under this chapter against nonprofit hospital service corporations, nonprofit medical service corporations, or nonprofit dental service corporations, and if the commissioner does not hold the hearing within ten (10) business days of the request or if the request is denied after the hearing, the requesting party may petition the superior court for Providence County for an order directing the commissioner to commence a delinquency proceeding pursuant to this chapter and the court shall hear the petition on an expedited basis. The administrative proceeding before the commissioner and the judicial review of those proceedings, and all records and other documents or papers relating to the proceedings so far as they pertain to or are a part of the record of the proceedings, shall be and remain confidential except as is necessary to obtain compliance with the proceedings, unless and until the superior court for the county of Providence, after hearing arguments from the parties in chambers, shall order otherwise or unless the nonprofit hospital corporation, nonprofit medical corporation, or nonprofit dental service corporation request that the matter be made public. All papers shall be held in confidential files.  (b) No court of this state shall have jurisdiction to entertain, hear, or determine any complaint praying for the dissolution, liquidation, rehabilitation, sequestration, conservation, or receivership of any insurer or praying for an injunction or restraining order or other relief preliminary to, incidental to, or relating to those proceedings other than in accordance with this chapter.  (c) In addition to other grounds for jurisdiction provided by the law of this state, a court of this state having jurisdiction of the subject matter has jurisdiction over a person served pursuant to Rule 4 of the Superior Court Rules of Civil Procedure or other applicable provisions of law in an action brought by the receiver of a domestic insurer or an alien insurer domiciled in this state:  (1) If the person served is an agent, broker, insurance producer, or other person who has at any time written policies of insurance for or has acted in any manner on behalf of an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to this relationship with the insurer;  (2) If the person served is a reinsurer who has at any time entered into a contract of reinsurance with an insurer against which a delinquency proceeding has been instituted, or is an agent, insurance producer, or broker of or for the reinsurer, in any action on or incident to the reinsurance contract;  (3) If the person served is or has been an officer, director, manager, trustee, organizer, promoter, or other person in a position of comparable authority or influence over an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to this relationship with the insurer;  (4) If the person served is or was at the time of the institution of the delinquency proceeding against the insurer holding assets in which the receiver claims an interest on behalf of the insurer, in any action concerning the assets; or  (5) If the person served is obligated to the insurer in any way, in any action on or incident to the obligation.  (d) If the court on motion of the liquidator finds any action should as a matter of substantial justice be tried in a forum outside of this state, the court may enter an appropriate order to stay further proceedings on the action in this state.  (e) All action authorized pursuant to this section shall be brought in the superior court for the county of Providence.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-40. Proof of claim. (a) Proof of claim shall consist of a statement signed by the claimant that includes all of the following that are applicable:  (1) The particulars of the claim including the consideration given for it;  (2) The identity and amount of the security on the claim;  (3) The payments made on the debt, if any;  (4) That the sum claimed is justly owing and that there is no setoff, counterclaim, or defense to the claim;  (5) Any right of priority of payment or other specific right asserted by the claimants;  (6) A copy of the written instrument which is the foundation of the claim;  (7) The name and address of the claimant and the attorney who represents the claimant, if any; and  (8) The social security or federal employer identification number of the claimant.  (b) No claim need be considered or allowed if it does not contain all the information in subsection (a) which may be applicable. The liquidator may require that a prescribed form be used, and may require that other information and documents be included.  (c) At any time the liquidator may request the claimant to present information or evidence supplementary to that required under subsection (a) and may take testimony under oath, require production of affidavits or depositions, or otherwise obtain additional information or evidence.  (d) No judgment or order against an insured or the insurer entered after the date of filing of a successful petition for liquidation, and no judgment or order against an insured or the insurer entered at any time by default or by collusion need be considered as evidence of liability or of quantum of damages. No judgment or order against an insured or the insurer entered within four (4) months before the filing of the petition needs to be considered as evidence of liability or of the quantum of damages.  (e) A guaranty association shall be permitted to file a single omnibus proof of claim for all claims of the association in connection with payment of claims of the insolvent insurer. The omnibus proof of claim may be periodically updated by the association, and the association may be required to submit a reasonable amount of documentation in support of the claim.  History of Section.P.L. 1993, ch. 248,  1; P.L. 2003, ch. 396,  1. 
 27-14.3-41. Special claims. (a) The claim of a third party which is contingent only on his or her first obtaining a judgment against the insured shall be considered and allowed as if there were no contingency.  (b) A claim may be allowed even if contingent if it is filed in accordance with  27-14.3-39. It may be allowed and may participate in all distributions declared after it is filed to the extent that it does not prejudice the orderly administration of the liquidation.  (c) Claims that are due except for the passage of time shall be treated as absolute claims are treated, except that the claims may be discounted at the legal rate of interest.  (d) Claims made under employment contracts by directors, principal officers, or persons in fact performing similar functions or having similar powers are limited to payment for services rendered prior to the issuance of any order of rehabilitation or liquidation under  27-14.3-17 or 27-14.3-22.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-42. Special provisions for third party claims. (a) Whenever any third party asserts a cause of action against an insured of an insurer in liquidation, the third party may file a claim with the liquidator.  (b) Whether or not the third party files a claim, the insured may file a claim on his or her own behalf in the liquidation. If the insured fails to file a claim by the date for filing claims specified in the order of liquidation or within sixty (60) days after the mailing of the notice required by  27-14.3-26, whichever is later, he or she is an unexcused late filer.  (c) The liquidator shall make his or her recommendations to the court under  27-14.3-46 for the allowance of an insureds claim under subsection (b) of this section after consideration of the probable outcome of any pending action against the insured on which the claim is based, the probable damages recoverable in the action, and the probable costs and expenses of defense. After allowance by the court, the liquidator shall withhold any dividends payable on the claim, pending the outcome of litigation and negotiation with the insured. Whenever it seems appropriate, he or she shall reconsider the claim on the basis of additional information and amend his or her recommendations to the court. The insured shall be afforded the same notice and opportunity to be heard on all changes in the recommendation as in its initial determination. The court may amend its allowance as it thinks appropriate. As claims against the insured are settled or barred, the insured shall be paid from the amount withheld the same percentage dividend as was paid on other claims of similar property, based on the lesser of: (1) the amount actually recovered from the insured by action or paid by agreement plus the reasonable costs and expense of defense, or (2) the amount allowed on the claims by the court. After all claims are settled or barred, any sum remaining from the amount withheld shall revert to the undistributed assets of the insurer. Delay in final payment under this subsection shall not be a reason for unreasonable delay of the final distribution and discharge of the liquidator.  (d) If several claims founded upon one policy are filed, whether by third parties or as claims by the insured under this section, and the aggregate allowed amount of the claims to which the same limit of liability in the policy is applicable exceeds that limit, each claim as allowed shall be reduced in the same proportion so that the total equals the policy limit. Claims by the insured shall be evaluated as in subsection (c) of this section. If any insureds claim is subsequently reduced under subsection (c) of this section, the freed amount shall be apportioned ratably among the claims which have been reduced under this subsection.  (e) No claim may be presented under this section if it is or may be covered by any guaranty association or foreign guaranty association.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-43. Disputed claims. (a) When a claim is denied in whole or in part by the liquidator, written notice of the determination shall be given to the claimant or his or her attorney by first class mail at the address shown in the proof of claim. Within sixty (60) days from the mailing of the notice, the claimant may file his or her objection with the liquidator. If no filing is made, the claimant may not further object to the determination.  (b) Whenever objections are filed with the liquidator and the liquidator does not alter his or her denial of the claim as a result of the objections, the claimant shall petition for relief from any injunction in effect against the insurer and ask the court for a hearing as soon as practicable and give notice of the hearing by first class mail to the liquidator or his or her attorney and to any other persons directly affected, not less than ten (10) nor more than thirty (30) days before the date of the hearing. The matter may be heard by the court or by a court-appointed referee who shall submit findings of fact along with his or her recommendation.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-44. Claims of surety. Whenever a creditor, whose claim against an insurer is secured, in whole or in part, by the undertaking of another person, fails to prove and file that claim the other person may do so in the creditors name, and shall be subrogated to the rights of the creditor, whether the claim has been filed by the creditor or by the other person in the creditors name, to the extent that he or she discharges the undertaking. In the absence of an agreement with the creditor to the contrary, the other person shall not be entitled to any distribution until the amount paid to the creditor on the undertaking plus the distributions paid on the claim from the insurers estate to the creditor equals the amount of the entire claim of the creditor. Any excess received by the creditor shall be held by him or her in trust for the other person. The term other person as used in this section is not intended to apply to a guaranty association or foreign guaranty association.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-45. Secured creditors claims. (a) The value of any security held by a secured creditor shall be determined in one of the following ways, as the court may direct:  (1) By converting the security into money according to the terms of the agreement pursuant to which the security was delivered to the creditors; or  (2) By agreement, arbitration, compromise, or litigation between the creditor and the liquidator.  (b) The determination shall be under the supervision and control of the court with due regard for the recommendation of the liquidator. The determined amount shall be credited upon the secured claim, and any deficiency shall be treated as an unsecured claim. If the claimant shall surrender his or her security to the liquidator, the entire claim shall be allowed as if unsecured.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-46.1. Insurer assessments. Notwithstanding language to the contrary in this or any other title of the general laws, an insurer that is subject to an order of liquidation pursuant to this chapter shall not be subject to any assessment or fee imposed pursuant to any section of the general laws. Notwithstanding this provision, the amount of any assessment or fee may be assumed and redistributed among all other insurers subject to the assessment or fee. This section shall only apply to those assessments and/or fees, which are first billed on or subsequent to the date of any order of liquidation. For purposes of this section the terms assessment and fee shall not include taxes defined in any title of the general laws.  History of Section.P.L. 2001, ch. 122,  9. 
 27-14.3-46. Priority of distribution. (a) The priority of distribution of claims from the insurers estate shall be in accordance with the order in which each class of claims is set forth in this section. Every claim in each class shall be paid in full or adequate funds retained for such payment before the members of the next class receive any payment. Once such funds are retained by the liquidator and approved by the court, the insurers estate shall have no further liability to members of that class except to the extent of the retained funds and any other undistributed funds. No subclasses shall be established within any class except as provided in  27-14.3-25(a)(12). No claim by a shareholder, policyholder, or other creditor shall be permitted to circumvent the priority classes through the use of equitable remedies. The order of distribution of claims shall be:  (1) Class 1. The costs and expenses of administration expressly approved by the receiver, including, but not limited to, the following:  (i) The actual and necessary costs of preserving or recovering the assets of the insurer;  (ii) Compensation for all authorized services rendered in the conservation, rehabilitation or liquidation;  (iii) Any necessary filing fees;  (iv) The fees and mileage payable to witnesses; and  (v) Authorized reasonable attorneys fees and other professional services rendered in the conservation, rehabilitation or liquidation.  (2) Class 2. The administrative expenses of guaranty associations. For purposes of this section these expenses shall be the reasonable expenses incurred by guaranty associations where the expenses are not payments or expenses which are required to be incurred as direct policy benefits in fulfillment of the terms of the insurance contract or policy, and that are of the type and nature that, but for the activities of the guaranty association otherwise would have been incurred by the receiver, including, but not limited to, evaluations of policy coverage, activities involved in the adjustment and settlement of claims under policies, including those of in-house or outside adjusters, and the reasonable expenses incurred in connection with the arrangements for ongoing coverage through transfer to other insurers, policy exchanges or maintaining policies in force. The receiver may in his or her sole discretion approve as an administrative expense under this section any other reasonable expenses of the guaranty association if the receiver finds:  (i) The expenses are not expenses required to be paid or incurred as direct policy benefits by the terms of the policy; and  (ii) The expenses were incurred in furtherance of activities that provided a material economic benefit to the estate as a whole, irrespective of whether the activities resulted in additional benefits to covered claimants. The court shall approve such expenses unless it finds the receiver abused his or her discretion in approving the expenses.  If the receiver determines that the assets of the estate will be sufficient to pay all Class 1 claims in full, Class 2 claims shall be paid currently, provided that the liquidator shall secure from each of the associations receiving disbursements pursuant to this section and agreement to return to the liquidator such disbursements, together with investment income actually earned on such disbursements, as may be required to pay Class 1 claims. No bond shall be required of any such association.  (3) Class 3.(i) All claims under policies including claims of the federal or any state or local government for losses incurred, (loss claims) including third party claims, claims for unearned premiums, and all claims of guaranty association for reasonable expenses other than those included in Class 2. All claims under life and health insurance and annuity policies, whether for death proceeds, health benefits, annuity proceeds, or investment values shall be treated as loss claims. That portion of any loss, indemnification for which is provided by other benefits or advantages recovered by the claimant, shall not be included in this class, other than benefits or advantages recovered or recoverable in discharge of familial obligation of support or by way of succession at death or as proceeds of life insurance, or as gratuities. No payment by an employer to his or her employee shall be treated as a gratuity;  (ii) Notwithstanding the foregoing, the following claims shall be excluded from Class 3 priority:  (A) Obligations of the insolvent insurer arising out of reinsurance contracts;  (B) Obligations incurred after the expiration date of the insurance policy or after the policy has been replaced by the insured or canceled at the insureds request or after the policy has been canceled as provided in this chapter;  (C) Obligations to insurers, insurance pools or underwriting associations and their claims for contribution, indemnity or subrogation, equitable or otherwise;  (D) Any claim which is in excess of any applicable limits provided in the insurance policy issued by the insolvent insurer;  (E) Any amount accrued as punitive or exemplary damages unless expressly covered under the terms of the policy; and  (F) Tort claims of any kind against the insurer, and claims against the insurer for bad faith or wrongful settlement practices.  (4) Class 4. Claims of the federal government other than those claims included in Class 3.  (5) Class 5. Debts due to employees for services, benefits, contractual or otherwise due arising out of such reasonable compensation to employees for services performed to the extent that they do not exceed two (2) months of monetary compensation and represent payment for services performed within six (6) months before the filing of the petition for liquidation or, if rehabilitation preceded liquidation within one year before the filing of the petition for rehabilitation. Principal officers and directors shall not be entitled to the benefit of this priority except as otherwise approved by the liquidator and the court. This priority shall be in lieu of any other similar priority which may be authorized by law as to wages or compensation of employees.  (6) Class 6. Claims of any person, including claims of state or local governments, except those specifically classified elsewhere in this section. Claims of attorneys for fees and expenses owed them by a person for services rendered in opposing a formal delinquency proceeding. In order to prove the claim, the claimant must show that the insurer which is the subject of the delinquency proceeding incurred such fees and expenses based on its best knowledge, information and belief, formed after reasonable inquiry indicating opposition was in the best interests of the person, was well grounded in fact and was warranted by existing law or a good faith argument for the extension, modification or reversal of existing law, and that opposition was not pursued for any improper purpose, such as to harass or to cause unnecessary delay or needless increase in the cost of the litigation.  (7) Class 7. Surplus claims of any state or local government for a penalty or forfeiture, but only to the extent of the pecuniary loss sustained from the act, transaction or proceeding out of which the penalty or forfeiture arose with reasonable and actual costs occasioned thereby. The remainder of such claims shall be postponed to the class of claims under subdivision 8.  (8) Class 8. Surplus or contribution notes or similar obligations, premium refunds on assessable policies, interest on claims of Classes 1 through 7 and any other claims specifically subordinated to this class.  (9) Class 9. Claims of shareholders or other owners arising out of their capacity as shareholders or other owners, or any other capacity except as they may be qualified in Class 3 or 6 above.  (b) If any claimant of this state, another state or foreign country shall be entitled to or shall receive a dividend upon his or her claim out of a statutory deposit or the proceeds of any bond or other asset located in another state or foreign country, unless such deposit or proceeds shall have been delivered to the domiciliary liquidator, then the claimants shall not be entitled to any further dividend from the receiver until and unless all other claimants of the same class, irrespective of residence or place of the acts or contracts upon which their claims are based, shall have received an equal dividend upon their claims, and after such equalization, such claimants shall be entitled to share in the distribution of further dividends by the receiver, along with and like all other creditors of the same class, wheresoever residing.  (c) Upon the declaration of a dividend, the receiver shall apply the amount of the dividend against any indebtedness owed to the insurer by the person entitled to the dividend. There shall be no claim allowed for any deductible charged by a guaranty association or entity performing a similar function.  History of Section.P.L. 1993, ch. 248,  1; P.L. 2001, ch. 247,  2; P.L. 2001, ch. 367,  2; P.L. 2003, ch. 396,  1; P.L. 2008, ch. 475,  80. 
 27-14.3-47. Liquidators recommendations to the court. (a) The liquidator shall review all claims duly filed in the liquidation and shall make any further investigation as he or she shall deem necessary. He or she may compound, compromise, or in any other manner negotiate the amount for which claims will be recommended to the court except where the liquidator is required by law to accept claims as settled by any person or organization, including any guaranty association or foreign guaranty association. Unresolved disputes shall be determined under  27-14.3-43. As soon as practicable, he or she shall present to the court a report of the claims against the insurer with his or her recommendations. The report shall include the name and address of each claimant and the amount of the claim finally recommended, if any. If the insurer has issued annuities or life insurance policies, the liquidator shall report the persons to whom, according to the records of the insurer, amounts are owed as cash surrender values or other investment value and the amounts owed.  (b) The court may approve, disapprove, or modify the report on claims by the liquidator. Those reports not modified by the court within a period of sixty (60) days following submission by the liquidator shall be treated by the liquidator as allowed claims, subject after this to later modification or to rulings made by the court pursuant to  27-14.3-43. No claim under a policy of insurance shall be allowed for an amount in excess of the applicable policy limits.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-48. Distribution of assets. Under the direction of the court, the liquidator shall pay distributions in a manner that will assure the proper recognition of priorities and a reasonable balance between the expeditious completion of the liquidation and the protection of unliquidated and undetermined claims, including third party claims. Distribution of assets in kind may be made at valuations set by agreement between the liquidator and the creditor and approved by the court.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-49. Unclaimed and withheld funds. (a) All unclaimed funds subject to distribution in accordance with  27-14.3-46 remaining in the liquidators hands when he or she is ready to apply to the court for discharge, including the amount distributable to any creditor, shareholder, member, or other person who is unknown or cannot be found, shall be deposited with the general treasurer, and shall be paid without interest except in accordance with  27-14.3-46 to the person entitled to the funds or his or her legal representative upon satisfactory proof to the general treasurer of his or her right to the funds. Any amount on deposit not claimed within one year from the discharge of the liquidator shall be deemed to have been abandoned and shall be escheated without formal escheat proceedings and be deposited with the general treasurer.  (b) All funds withheld under  27-14.3-41 and not distributed shall upon discharge of the liquidator be deposited with the general treasurer and paid by him or her in accordance with  27-14.3-46. Any sums remaining which under  27-14.3-46 would revert to the undistributed assets of the insurer shall be transferred to the general treasurer and become the property of the state under subsection (a) of this section, unless the commissioner, in his or her discretion, petitions the court to reopen the liquidation under  27-14.3-51.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-5. Injunctions and orders. (a) Any receiver appointed in a proceeding under this chapter may at any time apply for, and any court of general jurisdiction may grant, restraining orders, preliminary and permanent injunctions, and other orders as may be deemed necessary and proper to prevent:  (1) The transaction of further business;  (2) The transfer of property;  (3) Interference with the receiver or with a proceeding under this chapter;  (4) Waste of the insurers assets;  (5) Dissipation and transfer of bank accounts;  (6) The institution or further prosecution of any actions or proceedings;  (7) The obtaining of preferences, judgments, attachments, garnishments, or liens against the insurer, its assets, or its policyholders;  (8) The levying of execution against the insurer, its assets, or its policyholders;  (9) The making of any sale or deed for nonpayment of taxes or assessments that would lessen the value of the assets of the insurer;  (10) The withholding from the receiver of books, accounts, documents, or other records relating to the business of the insurer; or  (11) Any other threatened or contemplated action that might lessen the value of the insurers assets or prejudice the rights of policyholders, creditors, or shareholders, or the administration of any proceeding under this chapter.  (b) The receiver may apply to any court outside of the state for the relief described in  27-14.3-4(a).  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-50. Termination of proceedings. (a) When all assets justifying the expense of collection and distribution have been collected and distributed under this chapter, the liquidator shall apply to the court for discharge. The court may grant the discharge and make any other orders, including an order to transfer any remaining funds that are uneconomic to distribute, as may be deemed appropriate.  (b) Any other person may apply to the court at any time for an order under subsection (a) of this section. If the application is denied, the applicant shall pay the costs and expenses of the liquidator in resisting the application, including a reasonable attorneys fee.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-51. Reopening liquidation. After the liquidation proceeding has been terminated and the liquidator discharged, the commissioner or other interested party may at any time petition the superior court for the county of Providence to reopen the proceedings for good cause, including the discovery of additional assets. If the court is satisfied that there is justification for reopening, it shall order this.  History of Section.P.L. 1993, ch. 248,  1; P.L. 2009, ch. 310,  6. 
 27-14.3-52. Disposition of records during and after termination of liquidation. Whenever it shall appear to the commissioner that the records of any insurer in the process of liquidation or completely liquidated are no longer useful, he or she may recommend to the court and the court shall direct what records should be retained for future reference and what should be destroyed.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-53. External audit of receivers books. The superior court for the county of Providence may, as it deems desirable, cause audits to be made of the books of the commissioner relating to any receivership established under this chapter, and a report of each audit shall be filed with the commissioner and with the court. The books, records, and other documents of the receivership shall be made available to the auditor at any time without notice. The expense of each audit shall be considered a cost of administration of the receivership.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-54. Conservation of property of foreign or alien insurers found in this state. (a) If a domiciliary liquidator has not been appointed, the commissioner may apply to the superior court for the county of Providence by verified petition for an order directing him or her to act as conservator to conserve the property of an alien insurer not domiciled in this state or a foreign insurer on any one or more of the following grounds:  (1) Any of the grounds in  27-14.3-16;  (2) That any of its property has been sequestered by official action in its domiciliary state, or in any other state;  (3) That enough of its property has been sequestered in a foreign country to give reasonable cause to fear that the insurer is or may become insolvent; and/or  (4)(i) That its certificate of authority to do business in this state has been revoked or that none was ever issued, and  (ii) That there are residents of this state with outstanding claims or outstanding policies.  (b) When an order is sought under subsection (a) of this section the court shall cause the insurer to be given notice and time to respond to it as is reasonable under the circumstances.  (c) The court may issue the order in whatever terms it shall deem appropriate. The filing or recording of the order with the clerk of superior court for the county of Providence or the recorder of deeds of the city or town in which the principal business of the company is located shall impart the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds would have imparted.  (d) The conservator may at any time petition for, and the court may grant, an order under  27-14.3-55 to liquidate the assets of a foreign or alien insurer under conservation, or, if appropriate, for an order under  27-14.3-57, to be appointed ancillary receiver.  (e) The conservator may at any time petition the court for an order terminating the conservation of an insurer. If the court finds that the conservation is no longer necessary, it shall order that the insurer be restored to possession of its property and the control of its business. The court may also make the finding and issue the order at any time upon the motion of any interested party, but if the motion is denied, all costs shall be assessed against the party.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-55. Liquidation of property of foreign or alien insurers found in this state. (a) If no domiciliary receiver has been appointed, the commissioner may apply to the superior court for the county of Providence by verified petition for an order directing him or her to liquidate the assets found in this state of a foreign insurer or an alien insurer not domiciled in this state, on any of the following grounds:  (1) Any of the grounds in  27-14.3-16 or 27-14.3-21; or  (2) Any of the grounds specified in  27-14.3-54(a)(2) through (4).  (b) When an order is sought under subsection (a) of this section, the court shall cause the insurer to be given notice and time to respond to it as is reasonable under the circumstances.  (c) If it shall appear to the court that the best interests of creditors, policyholders, and the public require, the court may issue an order to liquidate in whatever terms it shall deem appropriate. The filing or recording of the order with the clerk of the superior court for the county of Providence, or the recorder of deeds of the city or town in which the principal business of the company is located or the city or town in which its principal office or place of business is located, shall impart the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds would have imparted.  (d) If a domiciliary liquidator is appointed in a reciprocal state while a liquidation is proceeding under this section, the liquidator under this section shall after this act as ancillary receiver under  27-14.3-57. If a domiciliary liquidator is appointed in a nonreciprocal state while a liquidation is proceeding under this section, the liquidator under this section may petition the court for permission to act as ancillary receiver under  27-14.3-57.  (e) On the same grounds as are specified in subsection (a) of this section, the commissioner may petition any appropriate federal district court to be appointed receiver to liquidate that portion of the insurers assets and business over which the court will exercise jurisdiction, or any lesser of the assets and business that the commissioner deems desirable for the protection of the policyholders and creditors in this state.  (f) The court may order the commissioner, when he or she has liquidated the assets of a foreign or alien insurer under this section, to pay the claims of residents of this state against the insurer under any rules as to the liquidation of insurers under this chapter as are compatible with the provisions of this section.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-56. Domiciliary liquidators in other states. (a) The domiciliary liquidator of an insurer domiciled in a reciprocal state shall, except as to special deposits and security on secured claims under  27-14.3-57(c), be vested by operation of law with the title to all of the assets, property, contracts, and rights of action, agents or insurance producers balances, and all of the books, accounts and other records of the insurer located in this state. The date of vesting shall be the date of the filing of the petition, if that date is specified by the domiciliary law for the vesting of property in the domiciliary state. The date of vesting shall be the date of entry of the order directing possession to be taken. The domiciliary liquidator shall have the immediate right to recover balances due from agents or insurance producers and to obtain possession of the books, accounts, and other records of the insurer located in this state. He or she also shall have the right to recover all of the other assets of the insurer located in this state, subject to  27-14.3-57.  (b) If a domiciliary liquidator is appointed for an insurer not domiciled in a reciprocal state, the commissioner of this state shall be vested by operation of law with the title to all of the property, contracts, and right of action, and all of the books, accounts, and other records of the insurer located in this state, at the same time that the domiciliary liquidator is vested with the title in the domicile. The commissioner of this state may petition for a conservation or liquidation order under  27-14.3-54 or 27-14.3-55, or for an ancillary receivership under  27-14.3-57, or after approval by the superior court for the county of Providence may transfer the title to the domiciliary liquidator, as the interests of justice and the equitable distribution of the assets require.  (c) Claimants residing in this state may file claims with the liquidator or ancillary receiver, if any, in this state or with the domiciliary liquidator, if the domiciliary law permits. The claims must be filed on or before the last date fixed for the filing of claims in the domiciliary liquidation proceedings.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-57. Ancillary formal proceedings. (a) If a domiciliary liquidator has been appointed for an insurer not domiciled in this state, the commissioner may file a petition with the superior court for the county of Providence requesting appointment as ancillary receiver in this state:  (1) If he or she finds that there are sufficient assets of the insurer located in this state to justify the appointment of an ancillary receiver; and  (2) If the protection of creditors or policyholders in this state requires this.  (b) The court may issue an order appointing an ancillary receiver in whatever terms it shall deem appropriate. The filing or recording of the order with the recorders of deeds in this state imparts the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds.  (c) When a domiciliary liquidator has been appointed in a reciprocal state, then the ancillary receiver appointed in this state may, whenever necessary, aid and assist the domiciliary liquidator in recovering assets of the insurer located in this state. The ancillary receiver shall, as soon as practicable, liquidate from their respective securities those special deposit claims and secured claims which are proved and allowed in the ancillary proceedings in this state, and shall pay the necessary expenses of the proceedings. He or she shall promptly transfer all remaining assets, books, accounts, and records to the domiciliary liquidator. Subject to this section, the ancillary receiver and his or her deputies shall have the same powers and be subject to the same duties with respect to the administration of assets as a liquidator of an insurer domiciled in this state.  (d) When a domiciliary liquidator has been appointed in this state, ancillary receivers appointed in reciprocal states shall have, as to assets and books, accounts, and other records in their respective states, corresponding rights, duties, and powers to those provided in subsection (c) of this section for ancillary receivers appointed in this state.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-58. Ancillary summary proceedings. The commissioner in his or her sole discretion may institute proceedings under  27-14.3-10 at the request of the commissioner or other appropriate insurance official of the domiciliary state of any foreign or alien insurer having property located in this state.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-59. Claims of nonresidents against insurers domiciled in this state. (a) In a liquidation proceeding begun in this state against an insurer domiciled in this state, claimants residing in foreign countries or in states not reciprocal states must file claims in this state, and claimants residing in reciprocal states may file claims either with the ancillary receivers, if any, in their respective states, provided a claim filing procedure is established in the ancillary proceeding, or with the domiciliary liquidator. Claims must be filed on or before the last date fixed for the filing of claims in the domiciliary liquidation proceeding.  (b) Claims belonging to claimants residing in reciprocal states may be proved either in the liquidation proceeding in this state as provided in this chapter, or in ancillary proceedings, if any, in the reciprocal states, provided a claim filing procedure is established in the ancillary proceeding. If notice of the claims and opportunity to appear and be heard is afforded the domiciliary liquidator of this state as provided in  27-14.3-60(b) with respect to ancillary proceedings, the final allowance of claims by the courts in ancillary proceedings in reciprocal states shall be conclusive as to amount and as to priority against special deposits or other security located in the ancillary states, but shall not be conclusive with respect to priorities against general assets under  27-14.3-46.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-6. Cooperation of officers, owners, and employees. (a) Any officer, manager, director, trustee, owner, employee, insurance producer, or agent of any insurer, or any other persons with authority over or in charge of any segment of the insurers affairs, shall cooperate with the commissioner in any proceeding under this chapter or any investigation preliminary to the proceeding. The term person as used in this section includes any person who exercises control directly or indirectly over activities of the insurer through any holding company or other affiliate of the insurer. The term cooperate includes, but shall not be limited to, the following:  (1) To reply promptly in writing to any inquiry from the commissioner requesting a reply; and  (2) To make available to the commissioner any books, accounts, documents, or other records or information or property of or pertaining to the insurer and in his or her possession, custody or control.  (b) No person shall obstruct or interfere with the commissioner in the conduct of any delinquency proceeding or any investigation preliminary or incidental to that proceeding.  (c) This section shall not be construed to abridge existing legal rights, including the right to resist a petition for liquidation or other delinquency proceedings, or other orders.  (d) Any person included within subsection (a) of this section who fails to cooperate with the commissioner, or any person who obstructs or interferes with the commissioner in the conduct of any delinquency proceedings or any investigation preliminary or incidental to that proceeding, or who violates any order the commissioner issued validly under this chapter may:  (1) Be sentenced to pay a fine not exceeding ten thousand dollars ($10,000) or to undergo imprisonment for a term of not more than one year, or both; or  (2) After a hearing, be subject to the imposition by the commissioner of a civil penalty not to exceed ten thousand dollars ($10,000) and shall also be subject to the revocation or suspension of any insurance licenses issued by the commissioner.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-60. Claims of residents against insurers domiciled in reciprocal states. (a) Promptly after the appointment of the commissioner as ancillary receiver for an insurer not domiciled in this state, the commissioner shall determine whether there are claimants residing in this state who are not protected by guaranty funds, and if so, whether the protection of those claimants requires the establishing of a claim filing procedure in the ancillary proceeding. If a claim filing procedure is established, claimants against the insurer who reside within this state may file claims with either the ancillary receiver, if any, in this state, or with the domiciliary liquidator. Claims must be filed on or before the last dates fixed for the filing of claims in the domiciliary liquidation proceeding.  (b) Claims belonging to claimants residing in this state may be proved either in the domiciliary state under the law of that state, or in ancillary proceedings, if any, in this state, provided a claim filing procedure is established in the ancillary proceeding. If a claimant elects to prove his or her claim in this state, he or she shall file his or her claim with the liquidator in the manner provided in  27-14.3- 39 and 27-14.3-40. The ancillary receiver shall make his or her recommendation to the court as under  27-14.3-47. He or she shall also arrange a date for a hearing if necessary under  27-14.3-43 and shall give notice to the liquidator in the domiciliary state, either by certified mail or by personal service, at least forty (40) days prior to the date set for the hearing. If the domiciliary liquidator, within thirty (30) days after the giving of the notice, gives notice in writing to the ancillary receiver and to the claimant, either by certified mail or by personal service, of his or her intention to contest the claim, he or she shall be entitled to appear or to be represented in any proceeding in this state involving the adjudication of the claim.  (c) The final allowance of the claim by the courts of this state shall be accepted as conclusive as to amount and as to priority against special deposits or other security located in this state.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-61. Attachment, garnishment and levy of execution. During the pendency in this or any other state of liquidation proceeding, whether called by that name or not, no action or proceeding in the nature of an attachment, garnishment, or levy of execution shall be commenced or maintained in this state against the delinquent insurer or its assets.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-62. Interstate priorities. (a) In a liquidation proceeding in this state involving one or more reciprocal states, the order of distribution of the domiciliary state shall control as to all claims of residents of this and reciprocal states. All claims of residents of reciprocal states shall be given equal priority of payment from general assets regardless of where those assets are located.  (b) The owners of special deposit claims against an insurer for which a liquidator is appointed in this or any other state shall be given priority against the special deposits in accordance with the statutes governing the creation and maintenance of the deposits. If there is a deficiency in any deposit, so that the claims secured by it are not fully discharged from it, the claimants may share in the general assets, but the sharing shall be deferred until general creditors, and also claimants against other special deposits who have received smaller percentages from their respective special deposits, have been paid a percentage of their claims equal to the percentage paid from the special deposit.  (c) The owner of a secured claim against an insurer for which a liquidator has been appointed in this or any other state may surrender his or her security and file his or her claim as a general creditor, or the claim may be discharged by resort to the security in accordance with  27-14.3-45, in which case the deficiency, if any, shall be treated as a claim against the general assets of the insurer of the same basis as claims of unsecured creditors.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-63. Subordination of claims for noncooperation. If an ancillary receiver in another state or foreign country, whether called by that name or not, fails to transfer to the domiciliary liquidator in this state any assets within his or her control other than special deposits, diminished only by the expenses of the ancillary receivership, if any, the claims filed in the ancillary receivership other than special deposit claims or secured claims shall be placed in the class of claims under  27-14.3-46(a)(8).  History of Section.P.L. 1993, ch. 248,  1; P.L. 2008, ch. 475,  80. 
 27-14.3-64. Severability. If any provision of this chapter or the application of any provision to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of the provision to other persons or circumstances shall not be affected by that invalidity.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-65. Rules and regulations. The commissioner is empowered to adopt reasonable rules and regulations for the implementation and administration of this chapter.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-7. Repealed.
 27-14.3-8. Condition on release from delinquency proceedings. No insurer that is subject to any delinquency proceedings, whether formal or informal, administrative or judicial, shall:  (1) Be released from the proceeding, unless the proceeding is converted into a judicial rehabilitation or liquidation proceeding;  (2) Be permitted to solicit or accept new business or request or accept the restoration of any suspended or revoked license or certificate of authority;  (3) Be returned to the control of its shareholders or private management; or  (4) Have any of its assets returned to the control of its shareholders or private management until all payments of or on account of the insurers contractual obligations by all guaranty associations, along with all expenses thereof and interest on all the payments and expenses, shall have been repaid to the guaranty associations or a plan of repayment by the insurer shall have been approved by the guaranty association.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.3-9. Immunity and indemnification of the receiver and employees. (a) For the purposes of this section, the persons entitled to protection under this section are:  (1) All receivers responsible for the conduct of a delinquency proceeding under this chapter including present and former receivers; and  (2) Their employees, meaning all present and former special deputies and assistant special deputies appointed by the commissioner, and all persons whom the commissioner, special deputies, or assistant special deputies have employed to assist in a delinquency proceeding under this chapter. Attorneys, accountants, auditors, and other professional persons or firms who are retained by the receiver as independent contractors and their employees shall not be considered employees of the receiver for the purposes of this section.  (b) The receiver and his or her employees shall have official immunity and shall be immune from suit and liability, both personally and in their official capacities, for any claim for damage to or loss of property or personal injury or other civil liability caused by or resulting from any alleged act, error, or omission of the receiver or any employee arising out of or by reason of their duties or employment; provided, that nothing in this provision shall be construed to hold the receiver or any employee immune from suit and/or liability for any damage, loss, injury, or liability caused by the intentional or willful and wanton misconduct of the receiver or any employee.  (c)(1) If any legal action is commenced against the receiver or any employee, whether against him or her personally or in his or her official capacity, alleging property damage, property loss, personal injury, or other civil liability caused by or resulting from any alleged act, error, or omission of the receiver or any employee arising out of or by reason of their duties or employment, the receiver and any employee shall be indemnified from the assets of the insurer for all expenses, attorneys fees, judgments, settlements, decrees, or amounts due and owing or paid in satisfaction of or incurred in the defense of the legal action unless it is determined upon a final adjudication on the merits that the alleged act, error, or omission of the receiver or employee giving rise to the claim did not arise out of or by reason of his or her duties or employment, or was caused by intentional or willful and wanton misconduct.  (2) Attorneys fees and any and all related expenses incurred in defending a legal action for which immunity or indemnity is available under this section shall be paid from the assets of the insurer, as they are incurred, in advance of the final disposition of the action upon receipt of an undertaking by or on behalf of the receiver or employee to repay the attorneys fees and expenses if it shall ultimately be determined upon a final adjudication on the merits that the receiver or employee is not entitled to immunity or indemnity under this section;  (3) Any indemnification for expense payments, judgments, settlements, decrees, attorneys fees, surety bond premiums, or other amounts paid or to be paid from the insurers assets pursuant to this section shall be an administrative expense of the insurer;  (4) In the event of any actual or threatened litigation against a receiver or any employee for which immunity or indemnity may be available under this section, a reasonable amount of funds which in the judgment of the commissioner may be needed to provide immunity or indemnity shall be segregated and reserved from the assets of the insurer as security for the payment of indemnity until that time as all applicable statutes of limitation shall have run and all actual or threatened actions against the receiver or any employee have been completely and finally resolved, and all obligations of the insurer and the commissioner under this section shall have been satisfied;  (5) In lieu of segregation and reserving of funds, the commissioner may, in his or her discretion, obtain a surety bond or make other arrangements, which will enable the commissioner to fully secure the payment of all obligations under this section.  (d) If any legal action against an employee for which indemnity may be available under this section is settled prior to final adjudication on the merits, the insurer must pay the settlement amount on behalf of the employee, or indemnify the employee for the settlement amount, unless the commissioner determines:  (1) That the claim did not arise out of or by reason of the employees duties or employment; or  (2) That the claim was caused by the intentional or willful and wanton misconduct of the employee.  (e) In any legal action in which the receiver is a defendant, that portion of any settlement relating to the alleged act, error, or omission of the receiver shall be subject to the approval of the court before which the delinquency proceeding is pending. The court shall not approve that portion of the settlement if it determines:  (1) That the claim did not arise out of or by reason of the receivers duties or employment; or  (2) That the claim was caused by the intentional or willful and wanton misconduct of the receiver.  (f) Nothing contained or implied in this section shall operate, or be construed or applied, to deprive the receiver or any employee of any immunity, indemnity, benefits of law, rights, or any available defense.  (g)(1) Subsection (b) of this section shall apply to any suit based in whole or in part on any alleged act, error, or omission which takes place on or after July 23, 1993;  (2) Subsections (c), (d), and (e) of this section shall apply to any suit which is pending on or filed after July 23, 1993 without regard to when the alleged act, error, or omission took place.  History of Section.P.L. 1993, ch. 248,  1. 
 27-14.4-1. Short title. This chapter may be cited as the Uniform Insurers Liquidation Act. History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-10. Filing by claimants in this state against foreign insurer. In a delinquency proceeding in a reciprocal state against an insurer domiciled in that state, claimants against that insurer who reside within this state may file claims either with the ancillary receiver, if any, appointed in this state, or with the domiciliary receiver. All of those claims must be filed on or before the last date fixed for the filing of claims in the domiciliary delinquency proceeding.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-11. Proof of controverted claims of residents. Controverted claims belonging to claimants residing in this state may either: (1) be proved in the domiciliary state as provided by the law of that state, or (2) if ancillary proceedings have been commenced in this state, be proved in those proceedings. In the event that any claimant elects to prove his or her claim in this state, the claimant shall file his or her claim with the ancillary receiver in the manner provided by the law of this state for the proving of claims against insurers domiciled in this state, and the claimant shall give notice in writing to the receiver in the domiciliary state, either by registered or certified mail or by personal service at least forty (40) days prior to the date set for the hearing. The notice shall contain a concise statement of the amount of the claim, the facts on which the claim is based, and the priorities asserted, if any. If the domiciliary receiver, within thirty (30) days after the giving of notice, shall give notice in writing to the ancillary receiver and to the claimant, either by registered or certified mail or by personal service, of his or her intention to contest the claim, the domiciliary receiver shall be entitled to appear or to be represented in any proceeding in this state involving the adjudication of the claim. The final allowance of the claim by the courts of this state shall be accepted as conclusive as to its amount, and shall also be accepted as conclusive as to its priority, if any, against special deposits or other security located within this state.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-12. Preferred ancillary claims against domestic insurers. In a delinquency proceeding against an insurer domiciled in this state, claims owing to residents of ancillary states shall be preferred claims if like claims are preferred under the laws of this state. All claims whether owing to residents or nonresidents shall be given equal priority of payment from general assets regardless of where those assets are located.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-13. Preferred claims in this state against foreign insurers. In a delinquency proceeding against an insurer domiciled in a reciprocal state, claims owing to residents of this state shall be preferred if similar claims are preferred by the laws of that state.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-14. Special deposit claims. The owners of special deposit claims against an insurer for which a receiver is appointed in this or any other state shall be given priority against their several special deposits in accordance with the provisions of the statutes governing the creation and maintenance of special deposits. If there is a deficiency in any special deposit so that the claims secured by the special deposit are not fully discharged, the claimants may share in the general assets, but any sharing shall be deferred until general creditors, and also claimants against other special deposits who have received smaller percentages from their respective special deposits, have been paid percentages of their claims equal to the percentage paid from the special deposit.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-15. Secured claims. The owner of a secured claim against an insurer for which a receiver has been appointed in this or any other state may surrender his or her security and file his or her claim as a general creditor, or the claim may be discharged by resort to the security, in which case the deficiency, if any, shall be treated as a claim against the general assets of the insurer on the same basis as the claims of unsecured creditors. If the amount of the deficiency has been adjudicated in ancillary proceedings as provided in this chapter, or if it has been adjudicated by a court of competent jurisdiction in proceedings in which the domiciliary receiver has had notice and opportunity to be heard, that amount shall be conclusive; otherwise the amount shall be determined in the delinquency proceeding in the domiciliary state.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-16. Attachment, garnishment, and execution. During the pendency of delinquency proceedings in this or any reciprocal state no action or proceeding in the nature of an attachment, garnishment, or execution shall be commenced or maintained in the courts of this state against the delinquent insurer or its assets. Any lien obtained by any action or proceeding in the nature of an attachment, garnishment, or execution within four (4) months prior to the commencement of any delinquency proceeding or at any time after this shall be void as against any rights arising in the delinquency proceeding.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-17. Suit in this state by domiciliary receiver of foreign insurer. The domiciliary receiver of an insurer domiciled in a reciprocal state may sue in this state to recover any assets of that insurer to which the receiver may be entitled under the laws of this state.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-18. Right of receiver to deposits. The provisions of  27-1-8 shall not apply in any case where the director of business regulation has been appointed and is acting as a receiver, pursuant to the provisions of this chapter.  History of Section.P.L. 1994, ch. 141,  2; G.L. 1956,  27-14.4-20. 
 27-14.4-19. Immediate access to assets. (a) Within one hundred twenty (120) days of a final determination of insolvency of a company by a court of competent jurisdiction of this state, the receiver shall make an application to the court for the approval of a proposal to disburse assets out of that companys marshaled assets as those assets become available, to the Rhode Island insurers insolvency fund and to any similar organization in another state. The Rhode Island insurers insolvency fund and similar organizations in other states shall be referred to throughout this section collectively as the funds.  (b) The proposal shall at least include provision for:  (1) Reserving amounts for the payment of the expenses of administration and claims falling within the priorities established in  27-14.4-20(1), (2), and (3).  (2) The disbursement of the assets marshaled to date and subsequent disbursements of assets as they become available.  (3) The equitable allocation of disbursements to each of the funds entitled to the disbursements; and  (4) The securing by the receiver from each of the funds entitled to disbursements pursuant to this section of an agreement to return to the receiver any assets previously disbursed as may be required to pay claims of secured creditors and claims falling within the priorities established in  27-14.4-20(1), (2), (3), and (4) in accordance with those priorities. No bond shall be required of any fund.  (c) The receivers proposal shall provide for disbursements to the funds in amounts at least equal to the payments made or to be made by the funds for which the funds could assert claims against the receiver, and shall provide that if the assets available for disbursement do not equal or exceed the amount of those payments made or to be made by the funds then disbursements shall be in the amount of available assets.  (d) Notice of the application shall be given to the funds in each of the states and to the commissioners of insurance of each of the states. Any notice shall be deemed to have been given when deposited in the United States certified mails, first class postage prepaid, at least thirty (30) days prior to the submission of the application to the court. Action on the application may be taken by the court provided this required notice has been given, and provided that the receivers proposal complies with subdivisions (b)(1) and (b)(4) of this section.  History of Section.P.L. 1994, ch. 141,  2; G.L. 1956,  27-14.4-21. 
 27-14.4-2. Definitions. For the purposes of this chapter: (1) Ancillary state means any state other than a domiciliary state;  (2) Delinquency proceeding means any proceeding commenced against an insurer for the purpose of liquidating, rehabilitating, reorganizing, or conserving that insurer;  (3) Domiciliary state means the state in which an insurer is incorporated or organized, or, in the case of an insurer incorporated or organized in a foreign country, the state in which that insurer, having become authorized to do business in that state, has, at the commencement of delinquency proceedings, the largest amount of its assets held in trust and assets held on deposit for the benefit of its policyholders or policyholders and creditors in the United States; and any foreign insurer is deemed to be domiciled in that state;  (4) Foreign country means territory not in any state;  (5) General assets means all property, real, personal, or otherwise, not specifically mortgaged, pledged, deposited, or otherwise encumbered for the security or benefit of specified persons or a limited class or classes of persons, and as to specifically encumbered property the term includes all property or its proceeds in excess of the amount necessary to discharge the sum or sums secured by that property. Assets held in trust and assets held on deposit for the security or benefit of all policyholders, or all policyholders and creditors in the United States, shall be deemed general assets; provided that general assets shall not mean unearned premiums due or owed the insurer by the policyholder, agent or broker at the time an insolvency or liquidation is declared by a court of competent jurisdiction, nor shall general assets mean unearned premiums held in trust or held on deposit by the agent, broker, or insurer;  (6) Insurer means any person, firm, corporation, association, or aggregation of persons doing an insurance business and subject to the insurance supervisory authority of, or to liquidation, rehabilitation, reorganization, or conservation by, the department of business regulation of this state, or the equivalent insurance supervisory official of another state, including a protected cell company organized under the Protected Cell Companies Act, chapter 64 of this title, and any of its protected cells established to that chapter, to the extent not inconsistent with the provisions of chapter 64 of this title;  (7) Preferred claim means any claim with respect to which the law of a state or of the United States accords priority of payment from the general assets of the insurer;  (8) Receiver means receiver, liquidator, rehabilitator, or conservator as the context may require;  (9) Reciprocal state means any state other than this state in which in substance and effect the provisions of this chapter are in force, including the provisions requiring that the director of business regulation is the receiver of a delinquent insurer;  (10) Secured claim means any claim secured by mortgage, trust, deed, pledge, deposit as security, escrow, or otherwise, but not including special deposit claims or claims against general assets. The term also includes claims which more than four (4) months prior to the commencement of delinquency proceedings in the state of the insurers domicile have become liens upon specific assets by reason of judicial process;  (11) Special deposit claim means any claim secured by a deposit made pursuant to statute for the security or benefit of a limited class or classes of persons, but not including any general assets; and  (12) State means any state of the United States, and also the District of Columbia and Puerto Rico.  History of Section.P.L. 1994, ch. 141,  2; P.L. 1999, ch. 22,  6. 
 27-14.4-20. Priority of distribution. The priorities of distribution in a liquidation proceeding shall be in the following order:  (1) The cost and expenses of administration, including the claims handling the expenses of the Rhode Island insurers insolvency fund and of any similar organization in any other state.  (2) Wages actually owing to employees for services rendered within three (3) months prior to the date of the filing of the delinquency petition, not exceeding three hundred dollars ($300) to each employee.  (3) Federal, state, and local taxes.  (4) Claims by policyholders, beneficiaries, and insured arising from and within the coverage of and not in excess of the applicable limits of insurance policies and insurance contracts issued by the company, and liability claims against the insured which claims are within the coverage of, and not in excess of, the applicable limits of insurance policies and insurance contracts issued by the company, and claims of the Rhode Island insurers insolvency fund and any similar organization in another state.  (5) All other claims.  History of Section.P.L. 1994, ch. 141,  2; G.L. 1956,  27-14.4-22. 
 27-14.4-21. Agents responsibilities. In the event of the entry of a decree ordering liquidation of an insurer, the responsibility of the agent to render premiums to the receiver shall be as follows:  (1) Any agent upon receiving notice that a policy of insurance is being cancelled shall as of the date of policy termination immediately remit unearned premiums in the possession of the agent to the insured who paid them, or with the written approval of the insured, purchase new coverage for the insured with a different insurer. The agent shall not owe, or remit to the insurer or to the liquidator-receiver any premiums that are unearned as of the date of commencement of the proceedings. The insurance commissioner shall promulgate rules in accordance with the Administrative Procedures Act, chapter 35 of title 42, establishing guidelines for use by agents to calculate unearned premium.  (2) An agent who places initial insurance coverage, or renewal coverage, with an insurer admitted to do business in this state or with any insurer conducting business in Rhode Island which is an admitted carrier on the date of the coverage placement shall be deemed to have fulfilled his or her duty to the insured regarding the financial condition of the insurer and a claim for monetary damages shall not be brought or maintained against the agent for breach of duty or for any other cause of action resulting from the financial condition of the insurer.  (3) An agent who places initial insurance coverage, or renewal coverage, with an insurer that is not admitted to do business in this state or with any insurer conducting business in Rhode Island which is a non-admitted carrier on the date of the coverage placement, or if the insurer is not rated in the most recent published issue of Bests Key Rating Guide, shall be deemed to have fulfilled his or her duty to the insured regarding the financial condition of the insurer and a claim for monetary damages shall not be brought or maintained against the agent for breach of duty or for any other cause of action resulting from the financial condition of the insurer, but only if the insured voluntarily signs this statement:   (AFFIDAVIT BY INSURED) (Name of insured of (street, city or town, state), being duly sworn, deposes and says that on (date), he (she) directed his (her) insurance agent or broker to obtain insurance against certain risks covering property as described on the reverse side; that his (her) insurance agent or broker informed him (her) that (only part of) (no part of) the required insurance could be obtained from companies admitted to transact business in the state of Rhode Island, to wit: ($); and that he (she) informed me that he (she) made a diligent effort to procure the full amount of insurance from admitted insurers, but was unable to do so.  The following companies or groups and officer(s) or agent(s) of these companies or groups are among those which have declined the offering or accepted a part of it:  _________________________________________  I was further informed that the amount of insurance shown below could be obtained from certain insurers not admitted to transact business in the state of Rhode Island. I therefore directed ________ a licensed Rhode Island agent (broker) to obtain this insurance from these non-admitted companies through the office of ________ a licensed surplus line broker. This insurance was only the excess over the amounts procurable from admitted insurers. ________ personally appeared before me _______ and made oath that the above affidavit signed by him (her) is true to the best of his (her) knowledge and belief.  ________________________ (Signature of Insured) ____________  (Notary Public)  History of Section.P.L. 1994, ch. 141,  2; G.L. 1956,  27-14.4-23. 
 27-14.4-22. Severability. If any provision of this chapter or the application of any provision to any person or circumstance is held invalid, that invalidity shall not affect other provisions or applications of the chapter which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared to be severable.  History of Section.P.L. 1994, ch. 141,  2; G.L. 1956,  27-14.4-18. 
 27-14.4-23. Uniformity of construction. This chapter shall be interpreted and construed as to effectuate its general purpose to make uniform the law of those states that enact it.  History of Section.P.L. 1994, ch. 141,  2; G.L. 1956,  27-14.4-19. 
 27-14.4-3. Director as domiciliary receiver. Whenever under this title, including  27-1-14, a receiver is to be appointed upon the commencement of delinquency proceedings for an insurer domiciled in this state, the superior court shall appoint the director of business regulation as the receiver. The court shall direct the receiver to immediately take possession of the assets of the insurer and to administer them under the orders of the court. The receiver may, subject to the discretion of the court, continue to be the receiver for the duration of the receivership proceedings and shall have all of the powers and duties conferred upon the receivers by law including the powers and duties set forth in chapter 1 of this title.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-4. Title vested in domiciliary receiver  Official bond. The domiciliary receiver and his or her successors shall be vested by operation of law with the title to all of the property, contracts, and rights of action, and all of the books and records, of the insurer wherever located, as of the date of entry of the order directing possession to be taken, and the receiver shall have the right to recover that property and reduce it to possession; except that ancillary receivers in reciprocal states shall have, as to assets located in their respective states, the rights and powers which are prescribed in this chapter for ancillary receivers appointed in this state as to assets located in this state. The filing or recording of the order directing possession to be taken, or a certified copy of it, in the office where instruments affecting title to property are required to be filed or recorded shall impart the same notice as would be imparted by a deed, bill of sale, or other evidence of title duly filed or recorded. The domiciliary receiver shall be responsible on his or her official bond for the proper administration of all assets coming into his or her possession or control. The court may at any time require an additional bond from the receiver or his or her deputies if deemed desirable for the protection of the assets.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-5. Administration of assets by receiver  Employment of deputies and personnel. Upon taking possession of the assets of a delinquent insurer the domiciliary receiver shall, subject to the direction of the court, immediately proceed to conduct the business of the insurer or to take those steps authorized by the laws of this state for the purpose of liquidating, rehabilitating, reorganizing, or conserving the affairs of the insurer. In connection with delinquency proceedings the receiver may appoint one or more special deputies to act for him or her, and may employ any counsel, clerks, and assistants as he or she deems necessary. The compensation of the special deputies, counsel, clerks, or assistants and all of the expenses of taking possession of the delinquent insurer and of conducting the delinquency proceedings shall be fixed by the receiver, subject to the approval of the court, and shall be paid out of the funds or assets of the insurer. Within the limits of the duties imposed upon them, special deputies shall possess all of the powers given to, and, in the exercise of those powers, shall be subject to all of the duties imposed upon the receiver with respect to delinquency proceedings.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-6. Director as ancillary receiver. Whenever under the laws of this state an ancillary receiver is to be appointed in delinquency proceedings for an insurer not domiciled in this state, the superior court shall appoint the director of business regulation as the ancillary receiver. The ancillary receiver shall file a petition in the court requesting appointment:  (1) If he or she finds that there are sufficient assets of the insurer located in this state to justify the appointment of an ancillary receiver; or  (2) If ten (10) or more persons resident in this state having claims against the insurer file a petition with the director of business regulation requesting the appointment of an ancillary receiver.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-7. Powers and duties of receivers of foreign companies. The domiciliary receiver of an insurer domiciled in a reciprocal state shall be vested by operation of law with the title to all of the property, contracts, and rights of action, and all of the books and records, of the insurer located in this state, and the receiver shall have the immediate right to recover all balances due from local agents and to obtain possession of any books and records of the insurer found in this state. The receiver shall also be entitled to recover the other assets of the insurer located in this state except that upon the appointment of an ancillary receiver in this state, the ancillary receiver shall during the ancillary receivership proceedings have the sole right to recover those other assets. The ancillary receiver shall, as soon as practicable, liquidate from their respective securities those special deposit claims and secured claims which are proved and allowed in the ancillary proceedings in this state, and shall pay the necessary expenses of the proceedings. All remaining assets the ancillary receiver shall promptly transfer to the domiciliary receiver. Subject to these provisions the ancillary receiver and his or her deputies shall have the same powers and be subject to the same duties, with respect to the administration of the insurers assets, as a receiver of an insurer domiciled in this state.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-8. Filing by claimants in reciprocal states against insurers of this state. In a delinquency proceeding begun in this state against an insurer domiciled in this state, claimants residing in reciprocal states may file claims with either the ancillary receivers, if any, in their respective states, or with the domiciliary receiver. All of those claims must be filed on or before the last date fixed for the filing of claims in the domiciliary delinquency proceeding.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.4-9. Proof of controverted claims of nonresidents. Controverted claims belonging to claimants residing in reciprocal states may either: (1) be proved in this state as provided by law, or (2) if ancillary proceedings have been commenced in those reciprocal states, be proved in those proceedings. In the event a claimant elects to prove his or her claim in ancillary proceedings, if notice of the claim and opportunity to appear and be heard is afforded the domiciliary receiver of this state as provided in  27-14.4-11 with respect to ancillary proceedings in this state, the final allowance of that claim by the courts in the ancillary state shall be accepted in this state as conclusive as to its amount, and shall also be accepted as conclusive as to its priority, if any, against special deposits or other security located within the ancillary state.  History of Section.P.L. 1994, ch. 141,  2. 
 27-14.5-1. Definitions. As used in this chapter: (1) Applicant means a commercial run-off insurer applying under  27-14.5-4.  (2) Assessment deficit means the amount that the assessment for the previous year under  27-14.5-5 is less than, and assessment surplus is the amount that the assessment for the previous year exceeds:  (i) The run-off insurers proportionate share of regulatory expenditure for the previous year, if the run-off insurer was domiciled in Rhode Island on March 15 of the previous year; or  (ii) The redomestication expenditure for the previous year attributable to the run-off insurer, if the run-off insurer was not domiciled in Rhode Island on March 15 of the previous year.  (3) Assumption policyholder means a policyholder whose policy is reinsured under an assumption reinsurance agreement between the applicant and a reinsurer.  (4) Assumption reinsurance agreement has the meaning given in  27-53.1-3(b), subject to the following:  (i) The agreement may be conditioned upon the courts entry of an implementation order.  (ii) If any policy subject to the agreement is protected through a guarantee association, then the assuming insurer must have been and be licensed, and must have been and be a member of the guarantee association, in all states known to the applicant in which either: (A) Any property covered under the policy has a permanent situs; or (B) The policyholder resided while the policy was in force.  (5) Class of creditors means:  (i) All voting policyholders, including those without known claims;  (ii) Voting creditors, other than policyholders; or  (iii) Any separate class of creditors as the court may in its discretion determine should approve the commutation plan.  (6) Commercial run-off insurer means:  (i) A run-off insurer domiciled in Rhode Island, or the protected cell of the insurer, whose business, excluding all business subject to an assumption reinsurance agreement, includes only the reinsuring of any line(s) of business other than life and/or the insuring of any line(s) of business other than life, workers compensation, and personal lines insurance; or  (ii) A Rhode Island domestic insurance company, or the protected cell of that insurer, meeting the requirements of subsection (i) whose liabilities consist of commercial liabilities transferred to said company with the approval of the commissioner and pursuant to the regulations issued by the department under this chapter. The amount of the commercial liabilities transferred must be less than or equal to the amount of assets transferred to the newly formed or re-activated company.  (7) Commissioner means the director of the department.  (8) Commutation plan means a plan for extinguishing the outstanding liabilities of a commercial run-off insurer.  (9) Creditor means:  (i) Any person who has a claim against the applicant; or  (ii) A policyholder other than an assumption policyholder.  (10) Department means the department of business regulation.  (11) Guarantee association means a guarantee association or foreign guarantee association, as those terms are defined in  27-14.3-3(10), that is potentially obligated with respect to the applicants policies.  (12) Implementation order means an order under  27-14.5-4(c).  (13) Insurer has the meaning given in  27-14.3-3(12).  (14) Person means an individual, corporation, partnership, association, joint stock company, trust, unincorporated organization, or any similar entity or any combination of the foregoing acting in concert.  (15) Personal lines insurance means insurance issued for personal, family, or household purposes.  (16) Policy means a contract of insurance or a contract of reinsurance.  (17) Policyholder means an insured or a reinsured of the insurer.  (18) Proportionate share means, for a particular run-off insurer as of December 31 of the previous year, the ratio of:  (i) The gross assets of that run-off insurer; to  (ii) The gross assets of all run-off insurers, other than those that were not domiciled in Rhode Island on March 15 of that calendar year.  (19) Redomestication expenditure means, for any calendar year:  (i) The amount that the departments expenditures attributable to the regulation of run-off insurers increases as a result of any run-off insurer redomiciling to Rhode Island on or after March 15 of that year; less  (ii) Filing fees, examination costs, and any other fees in relation to insurance regulation in this state paid to this state by run-off insurers that redomiciled to Rhode Island on or after March 15 of that year, but excluding any premium taxes.  (20) Regulatory expenditure means, for any calendar year:  (i) The amount of the departments expenditures attributable to the regulation of run-off insurers domiciled in Rhode Island on March 15 of that year; less  (ii) Filing fees, examination costs, and any other fees in relation to insurance regulation in this state paid to this state by run-off insurers domiciled in Rhode Island on March 15 of that year, but excluding any premium taxes.  (21) Run-off insurer means an insurer that:  (i) Is domiciled in Rhode Island;  (ii) Has liabilities under policies for property and casualty lines of business;  (iii) Has ceased underwriting new business; and  (iv) Is only renewing ongoing business to the extent required by law or by contract.  (22) Voluntary restructuring means the act of reorganizing the legal ownership, operational, governance, or other structures of a solvent insurer, for the purpose of enhancing organization and maximizing efficiencies, and shall include the transfer of assets and liabilities to or from an insurer, or the protected cell of an insurer pursuant to an insurance business transfer plan. A voluntary restructuring under this chapter may be approved by the commissioner only if, in the commissioners opinion, it would have no material adverse impact on the insurers policyholders, reinsureds, or claimants of policies subject to the restructuring.  History of Section.P.L. 2002, ch. 381,  1; P.L. 2007, ch. 156,  1; P.L. 2007, ch. 269,  1; P.L. 2018, ch. 218,  1; P.L. 2018, ch. 290,  1. 
 27-14.5-2. Jurisdiction, venue, and court orders. (a) The court considering applications brought under this chapter shall have the same jurisdiction as a court under chapter 14.3 of this title.  (b) Venue for all court proceedings under this chapter shall lie in the superior court for the county of Providence.  (c) The court may issue any order, process, or judgment that is necessary or appropriate to carry out the provisions of this chapter. No provision of this chapter providing for the raising of an issue by a party in interest shall be construed to preclude the court from, on its own motion, taking any action or making any determination necessary or appropriate to enforce or implement court orders or rules, or to prevent an abuse of process.  History of Section.P.L. 2002, ch. 381,  1. 
 27-14.5-3. Notice. (a) Wherever in this chapter notice is required, the applicant shall, within ten (10) days of the event triggering the requirement, cause transmittal of the notice:  (1) To the insurance regulator in each jurisdiction in which the applicant is doing business;  (2) To the national conference of insurance guaranty funds and all guaranty associations for the states in which the applicant is doing business;  (3) To all reinsurers of the applicant pursuant to the notice provisions of reinsurance agreements or, where an agreement has no provision for notice, in a manner reasonably designed to provide actual notice to all reinsurers of the applicant;  (4) To all insurance agents or insurance producers of the applicant;  (5) To all persons known or reasonably expected to have claims against the applicant including all policyholders, at their last known address as indicated by the records of the applicant;  (6) To federal, state, and local government agencies and instrumentalities as their interests may arise; and  (7) By publication in a newspaper of general circulation in the state in which the applicant has its principal place of business and in any other locations that the court overseeing the proceeding deems appropriate.  (b) Notice under this section shall be given in a manner designed to provide actual notice to the intended recipient. Depending upon the circumstances, that notice may take the form of first-class mail, facsimile, or electronic notice.  (c) If notice is given in accordance with this section, any orders under this chapter shall be conclusive with respect to all claimants and policyholders, whether or not they received notice.  (d) Where this chapter requires that the applicant provide notice but the commissioner has been named receiver of the applicant, the commissioner shall provide the required notice.  History of Section.P.L. 2002, ch. 381,  1; P.L. 2013, ch. 31,  5; P.L. 2013, ch. 36,  5; P.L. 2018, ch. 218,  1; P.L. 2018, ch. 290,  1. 
 27-14.5-4.1. Insurance business transfer plans. The commissioner shall promulgate rules and regulations establishing standards by which liabilities may be novated to a new or existing domestic insurer pursuant to an Insurance Business Transfer Plan.  History of Section.P.L. 2018, ch. 218,  2; P.L. 2018, ch. 290,  2. 
 27-14.5-4. Commutation plans. (a) Application. Any commercial run-off insurer may apply to the court for an order implementing a commutation plan.  (b) Procedure.(1) The applicant shall give notice of the application and proposed commutation plan.  (2) All creditors shall be given the opportunity to vote on the plan.  (3) All creditors, assumption policyholders, reinsurers, and guaranty associations shall be provided with access to the same information relating to the proposed plan and shall be given the opportunity to file comments or objections with the court.  (4) Approval of a commutation plan requires consent of: (i) Fifty percent (50%) of each class of creditors; and (ii) The holders of seventy-five percent (75%) in value of the liabilities owed to each class of creditors.   (c) Implementation order.(1) The court shall enter an implementation order if: (i) The plan is approved under subsection (b)(4); and (ii) The court determines that implementation of the commutation plan would not materially adversely affect either the interests of objecting creditors or the interests of assumption policyholders.  (2) The implementation order shall:  (i) Order implementation of the commutation plan;  (ii) Subject to any limitations in the commutation plan, enjoin all litigation in all jurisdictions between the applicant and creditors other than with the leave of the court;  (iii) Require all creditors to submit information requested by the bar date specified in the plan;  (iv) Require that upon a noticed application, the applicant obtain court approval before making any payments to creditors other than, to the extent permitted under the commutation plan, payments in the ordinary course of business, this approval to be based upon a showing that the applicants assets exceed the payments required under the terms of the commutation plan as determined based upon the information submitted by creditors under subsection (c)(2)(iii);  (v) Release the applicant of all obligations to its creditors upon payment of the amounts specified in the commutation plan;  (vi) Require quarterly reports from the applicant to the court and commissioner regarding progress in implementing the plan; and  (vii) Be binding upon the applicant and upon all creditors and owners of the applicant, whether or not a particular creditor or owner is affected by the commutation plan or has accepted it or has filed any information on or before the bar date, and whether or not a creditor or owner ultimately receives any payments under the plan.  (3) The applicant shall give notice of entry of the order.   (d) Applicable law and procedure with respect to dispute resolution procedures.(1) Any dispute resolution procedure in any commutation plan brought by a ceding insurance creditor to challenge the value of its claim assessed in any commutation plan will be consistent with the provisions of title 9, United States code;  (2) The adjudicator and the court, if applicable, hearing any appeal from an adjudication proceeding where the ceding insurance creditor challenges the value of its claim assessed by the applicant in its commutation plan, shall:  (i) Not attempt to enforce a reinsurance contract on terms different than those set forth in the reinsurance contract;  (ii) Not apply the laws of Rhode Island to reinsurance agreements of ceding insurers not domiciled in Rhode Island unless the reinsurance contract provides that Rhode Island law shall apply;  (iii) Apply the law applicable to the underlying contract between the ceding insurer and the applicant or, if the underlying reinsurance contract has no choice of law provision, the law of the state of domicile of the ceding insurer shall apply.   (e) Order of dissolution or discharge.(1) Upon completion of the commutation plan, the applicant shall advise the court.  (2) The court shall then enter an order that:  (i) Is effective upon filing with the court proof that the applicant has provided notice of entry of the order;  (ii) Transfers those liabilities subject to an assumption reinsurance agreement to the assumption reinsurer, thereby novating the original policy by substituting the assumption reinsurer for the applicant and releasing the applicant of any liability relating to the transferred liabilities;  (iii) Assigns each assumption reinsurer the benefit of reinsurance on transferred liabilities, except that the assignment shall only be effective upon the consent of the reinsurer if either:  (A) The reinsurance contract requires that consent; or  (B) The consent would otherwise be required under applicable law; and  (iv) Either:  (A) The applicant be discharged from the proceeding without any liabilities; or  (B) The applicant be dissolved.  (3) The applicant shall provide notice of entry of the order.   (f) Reinsurance. Nothing in this chapter shall be construed as authorizing the applicant, or any other entity, to compel payment from a reinsurer on the basis of estimated incurred but not reported losses or loss expenses, or case reserves for unpaid losses and loss expenses.  (g) Modifications to plan. After provision of notice and an opportunity to object, and upon a showing that some material factor in approving the plan has changed, the court may modify or change a commutation plan, except that upon entry of an order under subsection (e)(2) of this section, there shall be no recourse against the applicants owners absent a showing of fraud.  (h) Role of commissioner and guaranty funds; relationship to rehabilitation/liquidation statutes.(1) The commissioner and guaranty funds shall have the right to intervene in any and all proceedings under this section; provided, that notwithstanding any provision of this title, any action taken by a commercial run-off insurer to restructure pursuant to this chapter, including the formation or re-activation of an insurance company for the sole purpose of entering into a voluntary restructuring shall not affect the guaranty fund coverage existing on the business of such commercial run-off insurer prior to the taking of such action.  (2) If, at any time, the conditions for placing an insurer in rehabilitation or liquidation specified in chapter 14.3 of this title exist, the commissioner may request and, upon a proper showing, the court shall order that the commissioner be named statutory receiver of the applicant.  (3) If no implementation order has been entered, then upon being named receiver, the commissioner may request, and if requested, the court shall order, that the proceeding under this chapter be converted to a rehabilitation or liquidation pursuant to chapter 14.3 of this title. If an implementation order has already been entered, then the court may order a conversion upon a showing that some material factor in approving the original order has changed.  (4) The commissioner, any creditor, or the court on its own motion may move to have the commissioner named as receiver. The court may enter such an order only upon finding either that one or more grounds for rehabilitation or liquidation specified in chapter 14.3 of this title exist or that the applicant has materially failed to follow the commutation plan or any other court instructions.  (5) Unless and until the commissioner is named receiver, the board of directors or other controlling body of the applicant shall remain in control of the applicant.   History of Section.P.L. 2002, ch. 381,  1; P.L. 2007, ch. 156,  1; P.L. 2007, ch. 269,  1; P.L. 2013, ch. 31,  5; P.L. 2013, ch. 36,  5; P.L. 2018, ch. 218,  1; P.L. 2018, ch. 290,  1. 
 27-14.5-5. Taxes, fees, assessments, pools, and regulatory and supervision fund. (a) Application fee. Upon application to a court pursuant to  27-14.5-4, the applicant shall pay a fee to the department in the amount of ten thousand dollars ($10,000).  (1) In connection with the departments participation in the proceedings undertaken pursuant to  27-14.5-4, the applicant shall be assessed the following expenses:  (i) One hundred fifty percent (150%) of the total salaries and benefits paid to the personnel of the department of business regulation engaged in the proceedings, including, but not limited to, examiners, actuaries, attorneys, managers, and para-professionals, less any salary reimbursements.  (ii) The department may retain independent attorneys, appraisers, actuaries, certified public accountants, or other professionals and specialists to assist department personnel in connection with the proceedings, the cost of which shall be borne by the applicant.  (b) Ongoing assessment.(1) Every March 15, the commissioner shall assess each run-off insurer an amount equal to the greater of: (i) one thousand dollars ($1,000), or (ii) the sum of that run-off insurers proportionate share of estimated regulatory expenditure for that calendar year and that run-off insurers assessment deficit, less its assessment surplus.  (2) The calculation of the assessment surplus or deficit shall reflect the total cost of any examinations, which shall be borne by the companies so examined, and shall include the following expenses:  (i) One hundred fifty percent (150%) of the total salaries and benefits paid to the examining personnel of the department of business regulation engaged in those examinations, including, but not limited to, examiners, actuaries, attorneys, managers, and para-professionals, less any salary reimbursements;  (ii) All reasonable technology costs related to the examination process. Technology costs shall include the actual cost of software and hardware utilized in the examination process and the cost of training examination personnel in the proper use of the software or hardware;  (iii) All necessary and reasonable education and training costs incurred by the state to maintain the proficiency and competence of the examining personnel. All such costs shall be incurred in accordance with appropriate state of Rhode Island regulations, guidelines and procedures.  (3) Each run-off insurer shall pay the assessment to the department on or before the following fifteenth (15th) day of April.  (4) An insurer that redomiciles to Rhode Island after March 15 of any year and that qualifies as a run-off insurer upon redomestication shall pay an assessment equal to the commissioners estimate of redomestication expenditure attributable to that run-off insurer.  (5) All revenues collected pursuant to this section shall be deposited as general revenues. That assessment shall be in addition to any taxes and fees otherwise payable to the state.   (c) Pools. Except with respect to policy renewals required by law or contract, no run-off insurer shall be subject to any assessment or assignment in connection with any residual market, fair plan, or assigned-risk plan mechanisms in this state.  (d) Scope. This section shall only apply to run-off insurers that cease underwriting new business after January 1, 2002, or that were not domiciled in Rhode Island on January 1, 2002.  History of Section.P.L. 2002, ch. 381,  1; P.L. 2011, ch. 167,  1; P.L. 2011, ch. 294,  1. 
 27-14.5-6. Rules and regulations. The commissioner shall promulgate rules and regulations that may be necessary to effectuate the purposes of this chapter including, but not limited to, procedures for transferring commercial liabilities to a new or existing domestic insurer and standards for commutation plans.  History of Section.P.L. 2002, ch. 381,  1; P.L. 2018, ch. 218,  1; P.L. 2018, ch. 290,  1. 
 27-14-1  27-14-23. Repealed.
 27-15-1  27-15-18. Repealed.
 27-16-1.1. Purpose of  27-16-1.1  27-16-2.6  Suits by states. The purpose of  27-16-1.1  27-16-2.6 is to subject certain insurers to the jurisdiction of the insurance commissioner and the courts of this state in suits by or on behalf of the state. The legislature declares that it is concerned with the protection of the residents of this state against acts by insurers not authorized to do an insurance business in this state, by the maintenance of fair and honest insurance markets, by protecting authorized insurers which are subject to regulation from unfair competition by unauthorized insurers, and by protecting against the evasion of the insurance regulatory laws of this state. In furtherance of this state interest, the legislature provides in these sections methods for substituted service of process upon insurers in any proceeding, suit, or action in any court and substituted service of any notice, order, pleading, or process upon insurers in any proceeding by the commissioner of insurance to enforce or effect full compliance with the insurance laws of this state. In so doing, the state exercises its powers to protect the residents of this state and to define what constitutes transacting an insurance business in this state, and also exercises powers and privileges available to this state by virtue of 15 U.S.C.  1011 et seq., which declares that the business of insurance and every person engaged in that business shall be subject to the laws of the several states.  History of Section.P.L. 1973, ch. 231,  1; P.L. 1994, ch. 134,  13. 
 27-16-1.2. Certificate of compliance  Exceptions. (a) It shall be unlawful for any insurer to transact insurance business in this state as set forth in subsection (b) of this section without a certificate of compliance from the commissioner; provided, that this section shall not apply to:  (1) The lawful transaction of surplus lines insurance;  (2) The lawful transaction of reinsurance by insurers;  (3) Transactions in this state involving a policy lawfully solicited, written, and delivered outside of this state covering only subjects of insurance not resident, located, or expressly to be performed in this state at the time of issuance, and which transactions are subsequent to the issuance of the policy;  (4) Attorneys acting in the ordinary relation of attorney and client in the adjustment of claims or losses;  (5) Transactions in this state involving group life and group sickness and accident or blanket sickness and accident insurance or group annuities where the master policy of the groups was lawfully issued and delivered in and pursuant to the laws of a state in which the insurer was authorized to do an insurance business, to a group organized for purposes other than the procurement of insurance, and where the policyholder is domiciled or has a bona fide situs;  (6) Transactions in this state involving any policy of insurance or annuity contract issued prior to May 15, 1973;  (7) Transactions in this state relative to a policy issued outside of this state involving insurance on vessels, craft, or hulls, cargoes, marine protection, and indemnity or other risk, including strikes and war risks commonly insured under ocean or wet marine forms of policy;  (8) Transactions in this state involving contracts of insurance issued to one or more industrial insured. An industrial insured is defined as an insured:  (i) Which procures the insurance of any risk by the use of the services of a full-time employee acting as insurance manager or buyer or the services of a regularly and continuously retained qualified insurance consultant;  (ii) Whose aggregate annual premiums on all risks excluding workers compensation and group total at least twenty-five thousand dollars ($25,000); and  (iii) Which has at least twenty-five (25) full-time employees; and  (9)(i) Transactions in this state involving life insurance, health insurance, or annuities provided to educational or religious or charitable institutions organized and operated without profit to any private shareholder or individual for the benefit of the institutions and individuals engaged in the service of the institutions;  (ii) This exemption shall be conditional upon the company complying with the following requirements:  (A) Payment of an annual registration fee of five hundred dollars ($500);  (B) Filing a copy of any policy or contract form, including annuities issued to any Rhode Island residents with the commissioner of insurance. Each policy and contract form, including annuities, shall contain (on its front and declaration page) in at least twelve (12) point type the following notice:  (B) THIS CONTRACT HAS BEEN PLACED WITH AN INSURER NOT LICENSED TO DO BUSINESS IN THE STATE OF RHODE ISLAND BUT ELIGIBLE AS AN UNLICENSED REGISTERED INSURER PURSUANT TO THE UNAUTHORIZED BUSINESS STATUTE. THE INSURER IS NOT A MEMBER OF THE RHODE ISLAND LIFE AND HEALTH GUARANTY ASSOCIATION. SHOULD THE INSURER BECOME INSOLVENT, THE PROTECTION AND BENEFITS OF THE ASSOCIATION ARE NOT AVAILABLE.   (C) Filing a copy of its annual statement, prepared pursuant to the laws of its state of domicile, and any other financial material that may be requested by the commissioner; and  (D) The company agrees to appoint the commissioner of insurance, and his or her successors in office, as its attorney to receive service of legal process issued against it in Rhode Island. The appointment is to be irrevocable and to bind the commissioner, and any successors in interest, and to remain in effect as long as there is in force in this state any contract issued by the company or any obligations arising from a contract.  (10) Rental car companies and their employees principally engaged in the rental of motor vehicles and which offer in connection with and incidental to the rental of motor vehicles various optional insurance coverage during the term of the rental, which shall be no more than sixty (60) days.  (11) Transactions that are insurance securitization or reinsurance transactions entered into by a protected cell of a protected cell company organized under the Protected Cell Companies Act, chapter 64 of this title, as those terms are defined or utilized in that chapter.  (b) Any of the following acts in this state effected by mail or otherwise, by or on behalf of an insurer, is deemed to constitute the transaction of an insurance business in this state. The venue of an act committed by mail is at the point where the matter transmitted by mail is delivered and takes effect. Unless indicated, insurer, as used in this section, includes all corporations, associations, partnerships, and individuals engaged as principals in the business of insurance and also includes interinsurance exchanges and mutual benefit societies:  (1) The making or proposing to make, as an insurer an insurance contract;  (2) The making of or proposing to make, as guarantor or surety, any contract of guaranty or suretyship as a vocation and not merely incidental to any other legitimate business or activity of the guarantor or surety;  (3) The taking or receiving of any application for insurance;  (4) The receiving or collection of any premium, commission, membership fees, assessments, dues, or other consideration for an insurance or any part of an insurance;  (5) The issuance or delivery of contracts of insurance to residents of this state or to persons authorized to do business in this state;  (6) Directly or indirectly acting as an agent or insurance producer for or representing or aiding on behalf of another any person or insurer in the solicitation, negotiation, procurement, or effectuation of insurance or renewals of insurance or in the dissemination of information as to coverage or rates, forwarding of applications, delivery of policies or contracts, inspection of risks, fixing of rates or investigation or adjustment of claims or losses, or in the transaction of matters subsequent to effectuation of the contract and arising out of it, or in any other manner representing or assisting a person or insurer in the transaction of insurance with respect to subjects of insurance, resident, located, or to be performed in this state. The provisions of this subsection shall not operate to prohibit full-time salaried employees of a corporate insured from acting in the capacity of an insurance manager or buyer in placing insurance in behalf of the employer;  (7) The transaction of any kind of insurance business specifically recognized as transacting an insurance business within the meaning of the statutes relating to insurance; or  (8) The transacting or proposing to transact any insurance business in substance equivalent to any of these in a manner designed to evade the provisions of the statutes.  (c) The failure of an insurer transacting insurance business in this state to obtain a certificate of compliance shall not impair the validity of any act or contract of the insurer and shall not prevent the insurer from defending any action at law or suit in equity in any court of this state, but no insurer transacting insurance business in this state without a certificate of authority shall be permitted to maintain an action in any court of this state to enforce any right, claim, or demand arising out of the transaction of insurance business until the insurer shall have obtained a certificate of authority.  (d) In the event of the failure of any unauthorized insurer to pay any claim or loss within the provisions of the insurance contract, any person who assisted or in any manner aided directly or indirectly in the procurement of the insurance contract shall be liable to the insured for the full amount of the claim or loss in the manner provided by the provisions of the insurance contract.  History of Section.G.L. 1938, ch. 151,  31; P.L. 1940, ch. 856,  2; G.L. 1956,  27-16-1; G.L. 1956,  27-16-1.2; P.L. 1973, ch. 231,  1; P.L. 1996, ch. 188,  8; P.L. 1998, ch. 138,  2; P.L. 1999, ch. 22,  7; P.L. 2002, ch. 292,  31; P.L. 2008, ch. 371,  4. 
 27-16-1.3. Restraining order. Whenever the commissioner believes, from evidence satisfactory to the commissioner, that any insurer is violating or about to violate the provisions of  27-16-1.2, the commissioner may, through the attorney general of this state, cause a complaint to be filed in the superior court to enjoin and restrain the insurer from continuing the violation or engaging in it or doing any act in furtherance of it. The court shall have jurisdiction of the proceeding and shall have the power to make and enter an order or judgment awarding any preliminary or final injunctive relief as in its judgment is proper.  History of Section.P.L. 1973, ch. 231,  1. 
 27-16-1.4. Secretary of state as agent for service of process. (a) Any act of transacting an insurance business as set forth in  27-16-1.2 by any unauthorized insurer is equivalent to and shall constitute an irrevocable appointment by the insurer, binding upon the insurer, his or her executor or administrator, or successor in interest if a corporation, of the secretary of state or the secretarys successor in office, to be the true and lawful attorney of the insurer upon whom may be served all lawful process in any action, suit, or proceeding in any court by the commissioner of insurance or by the state and upon whom may be served any notice, order, pleading, or process in any proceeding before the commissioner of insurance and which arises out of transacting an insurance business in this state by the insurer. Any act of transacting an insurance business in this state by any unauthorized insurer shall be signification of its agreement that any lawful process in a court action, suit, or proceeding and any notice, order, pleading, or process in an administrative proceeding before the commissioner of insurance so served shall be of the same legal force and validity as personal service of process in this state upon the insurer.  (b) Service of process in an action shall be made by delivering to and leaving with the secretary of state, or some person in apparent charge of his or her office, two (2) copies of the process and by payment to the secretary of state of the fee prescribed by law. Service upon the secretary of state as an attorney shall be service upon the principal.  (c) The secretary of state shall immediately forward by certified mail one of the copies of the process or the notice, order, pleading, or process in proceedings before the commissioner to the defendant in the court proceeding or to whom the notice, order, pleading, or process in the administrative proceedings is addressed or directed at its last known principal place of business and shall keep a record of all process served on him or her which shall show the day and hour of service. The service is sufficient, provided:  (1) Notice of service and a copy of the court process or the notice, order, pleading, or process in the administrative proceeding are sent within ten (10) days after this by certified mail by the plaintiff or the plaintiff s attorney in the court proceeding, or by the commissioner of insurance in the administrative proceeding, to the defendant in the court proceeding or to whom the notice, order, pleading, or process in the administrative proceeding is addressed or directed, at the last known principal place of business of the defendant in the court or administrative proceeding; and  (2) The defendants receipt or receipts 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 or insurer to whom the letter is addressed and an affidavit of the plaintiff or the plaintiff s attorney in a court proceeding, or of the commissioner of insurance in an administrative proceeding, showing compliance with this section, are filed with the clerk of the court in which an action, suit, or proceeding is pending or with the commissioner in administrative proceedings, on or before the date the defendant in the court or administrative proceeding is required to appear or respond, or within any further time as the court or commissioner of insurance may allow.  (d) No plaintiff shall be entitled to a judgment or a determination by default in any court or administrative proceeding in which a court process or notice, order, pleading, or process in proceedings before the commissioner of insurance is served under this section until the expiration of forty-five (45) days from the date of the filing of the affidavit of compliance.  (e) Nothing in this section shall limit or affect the right to serve any process, notice, order, or demand upon any person or insurer in any other manner now or after this permitted by law.  History of Section.P.L. 1973, ch. 231,  1. 
 27-16-1.5. Requirements before defensive pleadings. (a) Before any unauthorized insurer files or causes to be filed in any pleading in any court action, suit, or proceeding or in any notice, order, pleading, or process in an administrative proceeding before the commissioner instituted against a person or insurer, by service made as provided in  27-16-1.4, the insurer shall either:  (1) Deposit with the clerk of the court in which the action, suit, or proceeding is pending, or with the commissioner of insurance in administrative proceedings before the commissioner, cash or securities, or file with the clerk or commissioner a bond with good and sufficient sureties, to be approved by the clerk or commissioner in an amount to be fixed by the court or commissioner sufficient to secure the payment of any final judgment which may be rendered in an action or administrative proceeding; or  (2) Procure a certificate of authority to transact the business of insurance in this state. In considering the application of an insurer for a certificate of compliance for the purposes of this subsection, the commissioner need not assert the provisions of  27-2-17 against an insurer with respect to its application if he or she determines that the company would comply with the requirements for the certificate of compliance.  (b) The commissioner of insurance, in any administrative proceeding in which service is made as provided in  27-16-1.4, may in his or her discretion, order any postponement as may be necessary to afford the defendant reasonable opportunity to comply with the provisions of subsection (a) of this section and to defend the action.  (c) Nothing in subsection (a) of this section shall be construed to prevent an unauthorized insurer from filing a motion to quash a writ or to set aside service of it made in the manner provided in  27-16-1.4, on the ground that the unauthorized insurer has not done any of the acts enumerated in  27-16-1.2.  History of Section.P.L. 1973, ch. 231,  1. 
 27-16-1. [Transferred.]
 27-16-10. Security or certificate required before defensive pleadings. Before any unauthorized foreign or alien insurer shall file or cause to be filed any pleading in any action, suit, or proceeding instituted against it, the unauthorized insurer shall deposit with the clerk of the court in which the action, suit, or proceeding is pending, cash or securities, or file with the clerk a bond with good and sufficient sureties, to be approved by the court, in an amount to be fixed by the court sufficient to secure the payment of any final judgment which may be rendered in the action, or procure a certificate of authority to transact the business of insurance in this state.  History of Section.P.L. 1956, ch. 3725,  3; G.L. 1956,  27-16-10. 
 27-16-11. Defensive motions as to jurisdiction. Nothing in  27-16-10 is to be construed to prevent an unauthorized foreign or alien insurer from filing a motion to quash a writ or to set aside service of it made in the manner provided in  27-16-6 or 27-16-7 on the ground either:  (1) That the unauthorized insurer has not done any of the acts enumerated in  27-16-5; or  (2) That the person on whom service was made pursuant to  27-16-7 was not doing any of the acts enumerated in that section.  History of Section.P.L. 1956, ch. 3725,  3; G.L. 1956,  27-16-11. 
 27-16-12. Discretionary postponement of proceedings. The court in any action, suit, or proceeding in which service is made in the manner provided in  27-16-6 or  27-16-7 may, in its discretion, order any postponement as may be necessary to afford the defendant reasonable opportunity to comply with the provisions of  27-16-10 and to defend the action.  History of Section.P.L. 1956, ch. 3725,  3; G.L. 1956,  27-16-12. 
 27-16-13. Attorney fees. In any action against an unauthorized foreign or alien insurer upon a contract of insurance issued or delivered in this state to a resident of this state or to a corporation authorized to do business in this state, if the insurer has failed for thirty (30) days after demand prior to the commencement of the action to make payment in accordance with the terms of the contract, and it appears to the court that the refusal was vexatious and without reasonable cause, the court may allow to the plaintiff a reasonable attorney fee and include the fee in any judgment that may be rendered in the action. The fee shall not exceed twelve and one-half percent ( 12.5%) of the amount which the court or jury finds the plaintiff is entitled to recover against the insurer, but in no event shall the fee be less than twenty-five dollars ($25.00). Failure of an insurer to defend the action shall be deemed prima facie evidence that its failure to make payment was vexatious and without reasonable cause.  History of Section.P.L. 1956, ch. 3725,  4; G.L. 1956,  27-16-13. 
 27-16-14. Severability. If any provision of  27-16-3  27-16-14 or the application of any of these provisions to any person or circumstances is held invalid, the invalidity shall not affect other provisions or applications of the sections which can be given effect without the invalid provision or application, and to this end the provisions of  27-16-3  27-16-14 are declared to be severable.  History of Section.P.L. 1956, ch. 3725,  5; G.L. 1956,  27-16-14. 
 27-16-2.1. Enforcement of orders. (a) Enforcement. The attorney general upon request of the commissioner may proceed in the courts of this state or any reciprocal state to enforce an order of decision in any court proceeding or in any administrative proceeding before the commissioner of insurance.  (b) Definitions. In this section:  (1) Foreign decree means any decree or order in equity of a court located in a reciprocal state, including a court of the United States located in the United States, against any insurer incorporated or authorized to do business in this state;  (2) Qualified party means a state regulatory agency acting in its capacity to enforce the insurance laws of its state; and  (3) Reciprocal state means any state or territory of the United States the laws of which contain procedures substantially similar to those specified in this section for the enforcement of decrees or orders in equity issued by courts located in other states or territories of the United States, against any insurer incorporated or authorized to do business in the state or territory.  (c) List of reciprocal states. The insurance commissioner shall determine which states and territories qualify as reciprocal states and shall maintain at all times an up to date list of those states.  (d) Filing and status of foreign decrees. A copy of any foreign decree authenticated in accordance with the statutes of this state may be filed in the office of the clerk of any superior court of this state. The clerk, upon verifying with the insurance commissioner that the decree or order qualifies as a foreign decree, shall treat the foreign decree in the same manner as a decree of the superior court of this state. A foreign decree filed in this manner has the same effect and shall be deemed as a decree of the superior court of this state, and is subject to the same procedures, defenses, and proceedings for reopening, vacating, or staying as a decree of the superior court of this state and may be enforced or satisfied in a similar manner.  (e) Notice of filing.(1) At the time of the filing of the foreign decree, the attorney general shall make and file with the clerk of the court an affidavit setting forth the name and last known post office address of the defendant;  (2) Promptly upon the filing of the foreign decree and the affidavit, the clerk shall mail a notice of the filing of the foreign decree to the defendant at the address given and to the insurance commissioner of this state and shall make a note of the mailing in the docket. In addition, the attorney general may mail a notice of the filing of the foreign decree to the defendant and to the insurance commissioner of this state and may file proof of mailing with the clerk. Lack of a mailing notice of filing by the clerk shall not affect the enforcement proceedings if proof of the mailing by the attorney general has been filed;  (3) No execution or other process for enforcement of a foreign decree filed under this section shall issue until thirty (30) days after the date the decree is filed.   (f) Stay of execution.(1) If the defendant shows the superior court that an appeal from the foreign decree is pending or will be taken, or that a stay of execution has been granted, the court shall stay the enforcement of the foreign decree until the appeal is concluded, the time for appeal expires, or the stay of execution expires or is vacated, upon proof that the defendant has furnished the security for the satisfaction of the decree required by the state in which it was rendered;  (2) If the defendant shows the superior court any ground upon which enforcement of a decree of the superior court of this state would be stayed, the court shall stay enforcement of the foreign decree for an appropriate period, upon requiring the same security for satisfaction of the decree which is required in this state.   (g) Fees. Any person filing a foreign decree shall pay to the clerk of court five dollars ($5.00). Fees for docketing, transcription, or other enforcement proceedings shall be as provided for decrees of the superior court.  History of Section.P.L. 1973, ch. 231,  2. 
 27-16-2.2. Penalty. Any unauthorized insurer who transacts any unauthorized act of an insurance business as set forth in  27-16-1.1  27-16-2.6 may be fined not more than ten thousand dollars ($10,000).  History of Section.G.L. 1938, ch. 151,  31; P.L. 1940, ch. 856,  2; G.L. 1956,  27-16-1; G.L.,  27-16-2.2; P.L. 1973, ch. 231,  2; P.L. 1994, ch. 134,  13. 
 27-16-2.3. Short title. Sections 27-16-1.1  27-16-2.6 may be cited as the Uniform Unauthorized Insurers Act. History of Section.P.L. 1973, ch. 231,  2; P.L. 1994, ch. 134,  13. 
 27-16-2.4. Severability. If any provision of  27-16-1.1  27-16-2.6 or the application of any of these provisions to any person or circumstances is held invalid, that invalidity shall not affect other provisions or applications of the act which can be given effect without the invalid provision and to this end the provisions are declared to be severable.  History of Section.P.L. 1973, ch. 231,  2; P.L. 1994, ch. 134,  13. 
 27-16-2.5. Exemption for Automobile club service. Nothing in  27-16-1.2 and 27-16-2.2 shall be construed to limit or prevent any automobile club or association from paying or agreeing to pay for the services of an attorney as provided in  11-27-16(a)(8), nor from providing or agreeing to provide or pay for its members bail, towing, or mechanical road service.  History of Section.P.L. 1940, ch. 856,  2; G.L. 1956,  27-16-2; G.L. 1956,  27-16-2.5; P.L. 1973, ch. 231,  2. 
 27-16-2.6. Hospitals affiliated with accredited medical schools  Indemnification of personnel. Nothing in  27-16-1.2  27-16-2.2 shall be construed to limit or prevent hospitals affiliated with an accredited medical school from agreeing to indemnify hospital employees, and physicians, including physicians incorporated or unincorporated practices and employees, and medical, nursing, or allied health students affiliated with the hospital, collectively covered persons, for the legal liability of those covered persons for loss, damage, or expense incident to claims of bodily injury or death arising out of medical malpractice or professional error or mistake, malpractice coverage, whether the hospital charges the covered persons for malpractice coverage or not. The hospitals making the agreements shall be required to establish and maintain a reserve fund with which the malpractice coverage will be provided, which may be either part of or separate from a self-insurance fund maintained by or on behalf of the hospital. Any self-insurance fund shall annually provide a certified financial statement with actuarial projections as to the soundness of its reserving to the director of the department of health and the director of the department of business regulation. The malpractice coverage provided by the agreements shall be in amounts which meet the minimum insurance coverage limits required by any regulation promulgated by the director of business regulation pursuant to  42-14.1-2.  History of Section.P.L. 1990, ch. 65, art. 17,  1. 
 27-16-2. [Transferred.]
 27-16-3. Short title. Sections 27-16-3  27-16-14 may be cited as the Unauthorized Insurers Process Act. History of Section.P.L. 1956, ch. 3725,  6; G.L. 1956,  27-16-3. 
 27-16-4. Purpose of process provisions. (a) The purpose of  27-16-3  27-16-14 is to subject certain insurers to the jurisdiction of the courts of this state in suits by or on behalf of insured or beneficiaries under insurance contracts.  (b) The legislature declares that it is a subject of concern that many residents of this state hold policies of insurance issued or delivered in this state by insurers while not authorized to do business in this state, thus presenting to the residents the often insuperable obstacle of resorting to distant forums for the purpose of asserting legal rights under the policies. In furtherance of the state interest, the legislature provides in these sections a method of substituted service of process upon the insurers and declares that in doing this that it exercises its power to protect its residents and to define, for the purpose of  27-16-3  27-16-14 what constitutes doing business in this state, and also exercises powers and privileges available to the state by virtue of 15 U.S.C.  1011 et seq., which declares that the business of insurance and every person engaged in that business shall be subject to the laws of the several states.  History of Section.P.L. 1956, ch. 3725,  1; G.L. 1956,  27-16-4. 
 27-16-5. Acts constituting appointment of attorney to receive process. Any of the following acts in this state, effected by mail or otherwise, by an unauthorized foreign or alien insurer is equivalent to and shall constitute an appointment by the insurer of the insurance commissioner and the commissioners successor or successors in office to be the insurers true and lawful attorney, upon whom may be served all lawful process in any action, suit, or proceeding instituted by or on behalf of an insured or beneficiary arising out of the contract of insurance, and the act shall be signification of its agreement that service of process is of the same legal force and validity as personal service of process in this state upon the insurer: (1) the issuance or delivery of contracts of insurance or reinsurance to residents of this state or to corporations authorized to do business in this state; (2) the solicitation of applications for the contracts; (3) the collection of premiums, membership fees, assessments or other considerations for the contracts; or (4) any other transaction of insurance business.  History of Section.P.L. 1956, ch. 3725,  2; G.L. 1956,  27-16-5; P.L. 2002, ch. 292,  31. 
 27-16-6. Service of process on commissioner. (a) Service of process shall be made by delivering to and leaving with the insurance commissioner, or some person in apparent charge of the commissioners 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 defendants 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.  History of Section.P.L. 1956, ch. 3725,  2; G.L. 1956,  27-16-6. 
 27-16-7. Service of process on agent or insurance producer. Service of process in an action, suit, or proceeding shall, in addition to the manner provided in  27-16-6, be valid if served upon any person within this state who, in this state on behalf of the insurer, is: (1) soliciting insurance or reinsurance; (2) making, issuing or delivering any contract of insurance or reinsurance; or (3) collecting or receiving any premium, membership fee, assessment, or other consideration for insurance or reinsurance; and a copy of the process is sent within ten (10) days after this by registered mail by the plaintiff or plaintiff s attorney to the defendant at the last known principal place of business of the defendant, and the defendants 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 a 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.  History of Section.P.L. 1956, ch. 3725,  2; G.L. 1956,  27-16-7. 
 27-16-8. Time allowed before default judgment. 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.  History of Section.P.L. 1956, ch. 3725,  2; G.L. 1956,  27-16-8. 
 27-16-9. Other methods of service preserved. Nothing contained in  27-16-5  27-16-8 shall limit or abridge the right to serve any process, notice, or demand upon any insurer in any other manner now or after this permitted by law.  History of Section.P.L. 1956, ch. 3725,  2; G.L. 1956,  27-16-9. 
 27-17-1. Admission of foreign exchanges and interinsurers. Any reciprocal exchange or interinsurer formed and doing business under the laws of any state of the United States, other than the state of Rhode Island, for the purpose of transacting any or all of the kinds of insurance which an insurance company may be authorized to transact in this state, other than life or title insurance, may be permitted to transact that business in this state upon complying with the provisions of this chapter.  History of Section.P.L. 1952, ch. 3003,  1; G.L. 1956,  27-17-1. 
 27-17-10. Claim or loss reserve. There shall also be maintained at all times in the hands of the attorney, as a claim or loss reserve, in cash or securities as stated in  27-17-7, assets sufficient to discharge all liabilities on all outstanding or accrued losses arising under policies issued, which are to be calculated in accordance with the laws of this state relating to similar reserves for companies insuring similar risks.  History of Section.P.L. 1952, ch. 3003,  6; G.L. 1956,  27-17-10. 
 27-17-11. Advance of funds for reserves  Maintenance. If it appears that the amount of funds required in  27-17-7  27-17-10 has not been accumulated or maintained, then the subscribers, or the attorney for them, shall immediately advance any sums needed to comply with the provisions of  27-17-7  27-17-10 and the advanced funds shall not be treated as a liability of the exchange, and the advances shall be repaid only out of the surplus over and above the minimum required by  27-17-7  27-17-10. If the subscribers, or their attorneys for them, shall fail to advance sums necessary for the maintenance of the minimum reserves and surplus within thirty (30) days after receipt of notice from the commissioner, the commissioner may revoke its license to transact business in this state.  History of Section.P.L. 1952, ch. 3003,  6; G.L. 1956,  27-17-11. 
 27-17-12. Deficiencies in reserves. If at any time the amounts on hand are less than the requirements specified in this chapter, the subscribers, or their attorney for them, shall make up the deficiency.  History of Section.P.L. 1952, ch. 3003,  6; G.L. 1956,  27-17-12; P.L. 2002, ch. 292,  32. 
 27-17-13. Certificate of deposit by foreign exchange or interinsurer. A foreign reciprocal exchange or interinsurer shall, before being authorized to do business in this state, furnish to the commissioner a certificate issued by a state treasurer or other state financial officer of the state where its principal place of business is located, that there has been deposited with him or her either in cash or securities the sum of one hundred thousand dollars ($100,000) for the benefit of all policyholders.  History of Section.P.L. 1952, ch. 3003,  7; G.L. 1956,  27-17-13. 
 27-17-14. Cash premium deposit and contingent liability of subscriber. The power of attorney under which any contracts of insurance are exchanged pursuant to this chapter shall provide for a cash premium deposit and a contingent liability of the subscriber during each annual period of the term of each contract of insurance issued to the subscriber to be fixed in the power of attorney, but in an amount not less than one nor more than ten (10) times the amount of the annual portion of the cash premium deposit stated in the contract, except that exchanges which have a required surplus equal to three hundred fifty thousand dollars ($350,000) or to the minimum capital, if any, required of a stock insurance company transacting the same kind or kinds of business, whichever is greater, may issue policies without contingent liability; provided, that the exchange which shall have issued policies without contingent liability after the acquisition of the surplus may continue to do so only so long as it maintains a surplus in the amount required by this section, and no exchange shall issue any non-assessable policies, except during a time as it shall continue to maintain the surplus.  History of Section.P.L. 1952, ch. 3003,  8; G.L. 1956,  27-17-14; P.L. 2002, ch. 292,  32. 
 27-17-15. Reports and examination of affairs of exchanges. The attorney shall, within the time limited for filing the annual statement by insurance companies transacting the same kind of business, make a report under oath to the commissioner for each calendar year in any form the commissioner may prescribe, showing the financial condition of the affairs at the office where the contracts are issued, and shall at any reasonable time furnish any additional information and reports required by the commissioner. The records, affairs, and financial condition of the exchange shall be subject to examination by the commissioner, and the examination shall be at the expense of the office examined. The commissioner may, in lieu of the examination provided for in this section, accept a certified copy of the report of examination made by the insurance department of the state where the principal office is located.  History of Section.P.L. 1952, ch. 3003,  9; G.L. 1956,  27-17-15. 
 27-17-16. Penalty for doing business without compliance. Any attorney who exchanges any contracts of insurance of the kind and character specified in this chapter, or any attorney or representative of the attorney who solicits or negotiates any applications for the attorney without the attorney first complying with the provisions of this chapter, shall be deemed guilty of a misdemeanor, and upon conviction shall be subjected to a fine of not less than one hundred dollars ($100) nor more than one thousand dollars ($1,000).  History of Section.P.L. 1952, ch. 3003,  10; G.L. 1956,  27-17-16. 
 27-17-17. Permits to solicit powers of attorney and applications. For the purposes of complying with the requirements of this chapter as set forth in  27-17-4(6) and upon issuance of a permit by the commissioner and under any conditions as he or she may impose, powers of attorney and applications for the insurance contracts may be solicited without compliance with the provisions of this chapter, but no attorney or other person shall execute or issue the contracts of insurance until all of the provisions of this chapter have been complied with and a certificate of authority issued by the commissioner.  History of Section.P.L. 1952, ch. 3003,  10; G.L. 1956,  27-17-17. 
 27-17-18. Insertion of provisions in standard policies. The attorney may insert in any form of policy prescribed by the laws of this state or adopted by this state, any provisions or conditions required by the plan of reciprocal or interinsurance; provided, that the provisions or conditions shall not be in conflict with the laws of this state.  History of Section.P.L. 1952, ch. 3003,  11; G.L. 1956,  27-17-18. 
 27-17-19. Fees and taxes. The exchanges shall be subject to the same fees and taxes provided by the laws of this state, now or after this enacted, applicable to insurance companies organized or admitted to do the same kind or kinds of business under the laws of this state.  History of Section.P.L. 1952, ch. 3003,  12; G.L. 1956,  27-17-19. 
 27-17-2. Power of subscribers to exchange reciprocal and interinsurance contracts. (a) Individuals, partnerships, trustees, and all corporations of this state, designated throughout this chapter as subscribers, are authorized to exchange reciprocal or interinsurance contracts with each other and with individuals, partnerships, trustees, and corporations of other states.  (b) The right of a corporation to exchange those contracts is declared to be incidental to the purpose for which the corporation is organized and as much granted as the rights and powers expressly conferred. Whenever a trustee acting in a representative capacity insures property held in trust at a reciprocal exchange, the trustee may assume the liability and be entitled to the rights of a subscriber, but in doing this shall not personally or individually be liable under the power of attorney executed on behalf of the trust.  (c) The contracts and the exchange of contracts and the subscribers, their attorneys in fact, and representatives, shall be regulated by this chapter and by no other statute of this state relating to insurance, except as otherwise specifically provided in this chapter.  History of Section.P.L. 1952, ch. 3003,  1; G.L. 1956,  27-17-2. 
 27-17-20. Applicability of insurance producers laws. The provisions of the general insurance laws of this state regarding the appointment, licensing, qualification, and regulation of insurance producers shall not apply to an exchange or its attorney, or to a traveling salaried employee, or to an executive officer or the attorney if a corporation, but shall apply to any other person, partnership, or corporation representing the reciprocal or interinsurance exchange in soliciting, negotiating, or effecting of business in this state.  History of Section.P.L. 1952, ch. 3003,  13; G.L. 1956,  27-17-20; P.L. 2002, ch. 292,  32. 
 27-17-21. Applicability of rating laws. The provisions of the laws of this state regulating the making and applying of insurance rates and providing for the licensing of rating organizations as set forth in chapters 6 and 9 of this title and  27-2-13, 27-5-1  27-5-11 and 27-8-4  27-8-6 shall apply to reciprocal or interinsurance contracts, but nothing contained in those sections shall be construed to prohibit the return of savings or dividends to subscribers or policyholders.  History of Section.P.L. 1952, ch. 3003,  14; G.L. 1956,  27-17-21. 
 27-17-22. Maximum liability on policy. No reciprocal exchange or interinsurer shall issue or deliver any policy insuring property or interests in this state, the liability on which shall exceed an amount equivalent to ten percent (10%) of its surplus, unless the excess of liability over the ten percent (10%) is reinsured in a company which maintains financial standards at least equal to those required by the laws of this state.  History of Section.P.L. 1952, ch. 3003,  14; G.L. 1956,  27-17-22. 
 27-17-23. Exchange of workers compensation insurance. Employers are expressly authorized to exchange contracts of workers compensation insurance, at any reciprocal exchange licensed in this state to do that kind of business, but all these exchanges shall be subject to the provisions of the laws of this state relating to the business of workers compensation insurance.  History of Section.P.L. 1952, ch. 3003,  15; G.L. 1956,  27-17-23. 
 27-17-24. Retaliatory laws. The retaliatory laws of this state shall be applicable to reciprocal or interinsurance exchanges.  History of Section.P.L. 1952, ch. 3003,  16; G.L. 1956,  27-17-24. 
 27-17-25. Hearings on rules and decisions of commissioner. 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 his or her previous action, specifying his or her reasons for the action. Pending the hearing and decision on the hearing, the commissioner may suspend or postpone the effective date of his or her previous action. At any hearing before the commissioner, observance of formal rules of pleading or evidence shall not be required.  History of Section.P.L. 1952, ch. 3003,  17; G.L. 1956,  27-17-25. 
 27-17-26. Judicial review of orders and decisions of commissioner. 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.  History of Section.P.L. 1952, ch. 3003,  17; G.L. 1956,  27-17-26. 
 27-17-27. Severability. 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.  History of Section.P.L. 1952, ch. 3003,  19; G.L. 1956,  27-17-27. 
 27-17-3. Execution by attorney  Office in state. The contracts shall be executed by an attorney in fact, designated in this chapter as attorney, duly authorized and acting for the subscribers, and the attorney may be a foreign corporation. An office or offices of the attorney, referred to in this chapter as a reciprocal exchange or interinsurer, acting for subscribers in issuing contracts or policies insuring property or interests in this state, shall be maintained in this state.  History of Section.P.L. 1952, ch. 3003,  2; G.L. 1956,  27-17-3. 
 27-17-4. Declaration filed by attorney  Requirements for admission. The attorney shall file with the insurance commissioner, referred to in this chapter as the commissioner, a declaration verified by the oath of the attorney, or when the attorney is a corporation, by the oath of its president or oaths of its treasurer and secretary setting forth:  (1) The name of the attorney and the name or designation of the exchange under which the contracts are to be issued, which name or designation shall not be so similar to any other name or designation previously adopted by an attorney or by any insurance organization in this state so as to confuse or mislead;  (2) The kind or kinds of insurance to be effected or exchanged;  (3) A copy of the form of policy contract or agreement under or by which the insurance is to be effected or exchanged and forms of application for that insurance;  (4) A certified copy of the power of attorney or other authorization of the attorney under or by which the attorney is to effect or exchange the insurance contracts;  (5) The location of the office or offices from which the contracts or agreements are to be issued;  (6)(i) That, except as to the kinds of insurance specifically mentioned in this subdivision, applications have been made for insurance upon at least one hundred (100) separate risks, the liability to the exchange for premiums due on the risks shall aggregate not less than six hundred thousand dollars ($600,000), represented by executed contracts or bona fide applications to become concurrently effective, or, in lieu of this amount, the exchange or interinsurer is possessed of a surplus of not less than three hundred thousand dollars ($300,000). The minimum amount of surplus established as a requirement for the writing of other lines of insurance as specified in this section shall be in addition to that required by the provisions of this subdivision;  (ii) In the case of employers liability or workers compensation insurance, applications shall have been made for indemnity upon at least one hundred (100) separate risks having a total annual premium of not less than two million five hundred thousand dollars ($2,500,000), as represented by executed contracts or bona fide applications to become concurrently effective, or, in lieu of this amount, the exchange or interinsurer is possessed of a surplus of not less than one hundred thousand dollars ($100,000);  (iii) In the case of automobile insurance, applications shall have been made for insurance for at least two hundred (200) separate risks, or for insurance the premiums due the exchange on the risks shall aggregate not less than two hundred thousand dollars ($200,000) represented by executed contracts or bona fide applications to become concurrently effective on any or all classes of automobile insurance effected by the subscribers through the attorney, or, in lieu of this amount, the exchange or interinsurer is possessed of a surplus of not less than one hundred thousand dollars ($100,000);  (iv) The surplus as provided in this subdivision shall not be acceptable unless invested in securities of the United States of America, the state of Rhode Island, or any other state of the United States or political subdivision of the state;  (7) That there shall be maintained at the exchange, available for the payment of losses, assets conforming to the requirements of  27-17-7  27-17-12;  (8) A financial statement under oath in the form prescribed by the commissioner;  (9) An instrument authorizing the service of process as provided for in this chapter; and  (10) A certificate from the proper official of the state where the principal office is maintained, that the subscribers and the attorney have complied with all provisions of law and are authorized in that state to transact the classes of business which are sought to be transacted in this state.  History of Section.P.L. 1952, ch. 3003,  3; G.L. 1956,  27-17-4; P.L. 2002, ch. 292,  32. 
 27-17-5. Service of process. 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 his or her office, forward one copy to the attorney, and return one copy with his or her 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.  History of Section.P.L. 1952, ch. 3003,  4; G.L. 1956,  27-17-5; P.L. 1960, ch. 71, art. 1,  9. 
 27-17-6. Certificate of authority to do business. If it shall appear upon examination by the commissioner that an exchange or interinsurer has complied with all of the requirements of this chapter and that the persons holding positions of executive and managerial authority are of good repute and will conduct the affairs of the exchange with safety to the public and its policyholders, the commissioner shall issue a certificate stating that the exchange or interinsurer has complied with all of the requirements of this chapter which shall authorize the exchange or interinsurer to transact the kind of business specifically provided in the certificate. The certificate shall expire on the first day of April of the following year, and shall be renewed every year as of the first day of April of that year. The commissioner may, after a hearing, revoke or suspend any certificate of authority issued pursuant to this section, in the case of violation of any of the provisions of this chapter, after reasonable notice of the hearing has been given to the attorney in fact in writing, which notice shall be sufficiently adequate to allow the attorney in fact to appear and show cause why the action should not be taken.  History of Section.P.L. 1952, ch. 3003,  5; G.L. 1956,  27-17-6. 
 27-17-7. Reinsurance reserve. There shall be maintained at all times by the exchange a reinsurance reserve in cash or securities authorized by the laws of the state in which the principal office of the attorney is located for the investment of similar funds of insurance companies doing the same kind of business, in an amount equal to fifty percent (50%) of the net annual premium deposits collected and credited to the accounts of subscribers on policies having one year or less to run and pro rata on those for longer periods or, in lieu of this amount, one hundred percent (100%) of the net unearned premium deposits collected and credited to the accounts of subscribers calculated separately for each policy in force as of any given date.  History of Section.P.L. 1952, ch. 3003,  6; G.L. 1956,  27-17-7. 
 27-17-8. Net premium deposits defined. Net premium deposits, as used in this chapter, mean the premium deposits made by subscribers after deduction from them of the amount paid as return premiums upon cancelled contracts and reinsurance in companies or associations licensed to do business in this state.  History of Section.P.L. 1952, ch. 3003,  6; G.L. 1956,  27-17-8. 
 27-17-9. Contingent reserve. 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 which the exchange is authorized to write under  27-17-1.  History of Section.P.L. 1952, ch. 3003,  6; G.L. 1956,  27-17-9. 
 27-18.1-1. Purpose. The purpose of this chapter is to assure full federal support of the Rhode Island medical assistance program by providing for full compliance with 42 U.S.C.  1301 et seq.  History of Section.P.L. 1979, ch. 52,  1. 
 27-18.1-2. Definitions. (a) Blanket or group policy of insurance means any accident and sickness insurance policy made exempt from the provisions of chapter 18 of this title by the operation of  27-18-19(3).  (b) Contract providing a health benefit or benefits means a policy of accident and health insurance which provides a health benefit or that part of a policy, which provides other benefits in addition to health benefits, which does provide health benefits. It also means a subscriber contract offered by a health maintenance organization or by any nonprofit service corporation, whether or not the contract is described as providing health maintenance organization benefits.  (c) Health benefit means benefit or health benefit as defined in  42-62-4.  (d) Health maintenance organization means a qualified health maintenance organization as referred to in  42-62-9.  (e) Insurance company means a domestic insurance company incorporated by the general assembly and subject to chapter 1 of this title, or a foreign insurance company licensed to do business in Rhode Island and subject to chapter 2 of this title.  (f) Nonprofit service corporation means a nonprofit hospital service corporation as defined in chapter 19 of this title, a nonprofit medical service corporation as defined in chapter 20 of this title, a nonprofit dental service corporation as defined in chapter 20.1 of this title, or a nonprofit optometric service corporation as defined in chapter 20.2 of this title.  (g) Policy of accident and sickness insurance means a policy of accident and sickness insurance as defined in chapter 18 of this title, and, in addition, means any blanket or group policy of insurance, as defined in subsection (a) of this section.  History of Section.P.L. 1979, ch. 52,  1. 
 27-18.1-3. Exclusions and limitations prohibited. No insurance company, health maintenance organization, or nonprofit corporation may issue, deliver, or renew any contract providing a health benefit or benefits which contains any provisions excluding or limiting its benefits on account of eligibility for or payment of benefits under 42 U.S.C.  1396 et seq.; provided, that the application of this section shall not increase the personal liability to health care providers of a medical assistance recipient of health services, as those services are defined in  42-62-4.  History of Section.P.L. 1979, ch. 52,  1; P.L. 2002, ch. 292,  34. 
 27-18.1-4. Rules and regulations. The director of business regulation shall promulgate any rules and regulations as he or she shall deem necessary for the efficient administration of this chapter.  History of Section.P.L. 1979, ch. 52,  1. 
 27-18.1-5. Applicability. In keeping with the provisions of  27-19-2, 27-20-2, 27-20.1-2, and 27-20.2-2, it is expressly provided that all corporations subject to chapters 19, 20, 20.1, and 20.2 of this title are subject to this chapter.  History of Section.P.L. 1979, ch. 52,  1. 
 27-18.1-6. Severability. If any provision of the chapter or the application of a provision to any person or circumstances shall be 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.  History of Section.P.L. 1979, ch. 52  1. 
 27-18.2-1. Definitions. [Effective until July 1, 2023.] (a) Applicant means:  (1) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and  (2) In the case of a group Medicare supplement policy, the proposed certificate holder.  (b) Certificate means, for the purposes of this chapter, any certificate delivered or issued for delivery in this state under a group Medicare supplement policy.  (c) Certificate form means the form on which the certificate is delivered or issued for delivery by the issuer.  (d) Director means the director of the department of business regulation.  (e) Issuer includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates.  (f) Medicare means the Health Insurance for the Aged Act, 42 U.S.C.  1395 et seq.  (g) Medicare supplement policy means a group or individual policy of accident and sickness insurance, as defined in  27-18-1, or a subscriber contract of a nonprofit hospital service corporation or of a nonprofit medical service corporation or an evidence of coverage of a health maintenance organization as defined in  42-62-4(5) or as licensed under chapter 41 of this title, other than a policy issued pursuant to a contract under Section 1876 of the Federal Social Security Act, 42 U.S.C.  1395mm, or an issued policy under a demonstration project specified in 42 U.S.C.  1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare.  (h) Policy form means the form on which the policy is delivered or issued for delivery by the issuer.  History of Section.P.L. 1984, ch. 49,  1; P.L. 1988, ch. 631,  1; P.L. 1989, ch. 428,  1; P.L. 1992, ch. 445,  4; P.L. 1993, ch. 180,  12; P.L. 1996, ch. 190,  1.   27-18.2-1. Definitions. [Effective July 1, 2023.] (1) Applicant means:  (i) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and  (ii) In the case of a group Medicare supplement policy, the proposed certificate holder.  (2) Certificate means, for the purposes of this chapter, any certificate delivered or issued for delivery in this state under a group Medicare supplement policy.  (3) Certificate form means the form on which the certificate is delivered or issued for delivery by the issuer.  (4) Director or Commissioner means the commissioner for the office of the health insurance commissioner.  (5) Issuer includes insurance companies, fraternal benefit societies, healthcare service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates.  (6) Medicare means the Health Insurance for the Aged Act, 42 U.S.C.  1395 et seq.  (7) Medicare supplement policy means a group or individual policy of accident and sickness insurance, as defined in  27-18-1, or a subscriber contract of a nonprofit hospital service corporation or of a nonprofit medical service corporation or an evidence of coverage of a health maintenance organization as defined in  42-62-4 or as licensed under chapter 41 of this title, other than a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act, 42 U.S.C.  1395mm, or an issued policy under a demonstration project specified in 42 U.S.C.  1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare.  (8) Policy form means the form on which the policy is delivered or issued for delivery by the issuer.  History of Section.P.L. 1984, ch. 49,  1; P.L. 1988, ch. 631,  1; P.L. 1989, ch. 428,  1; P.L. 1992, ch. 445,  4; P.L. 1993, ch. 180,  12; P.L. 1996, ch. 190,  1; P.L. 2022, ch. 393,  1, effective July 1, 2023; P.L. 2022, ch. 394,  1, effective July 1, 2023. 
 27-18.2-10. Enforcement and penalties. Whenever the director has cause to believe that a violation of this chapter or the regulations promulgated pursuant to this chapter has occurred, the director may, in accordance with the requirements of the Administrative Procedures Act, chapter 35 of title 42, revoke or suspend a license, levy an administrative penalty in an amount not less than five hundred dollars ($500) nor more than fifty thousand dollars ($50,000), order the violator to cease marketing any Medicare supplement policy or certificate in the state, require the violator to take any actions necessary to comply with the provisions of law, or any combination of these.  History of Section.P.L. 1989, ch. 428,  1. 
 27-18.2-11. Severability. If any provision of this chapter or the application of any provision to any person or circumstances is for any reason held to be invalid, the remainder of the chapter and the application of that provision to other persons or circumstances shall not be affected by that invalidity.  History of Section.P.L. 1989, ch. 428,  1. 
 27-18.2-2. Applicability and scope. (a) Except as otherwise specifically provided, this chapter shall apply to:  (1) All Medicare supplement policies and subscriber contracts delivered or issued for delivery in this state on or after July 1, 1992; and  (2) All certificates issued under group Medicare supplement policies, which certificates have been delivered or issued for delivery in this state.  (b) This chapter shall not apply to a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination of them, for employees or former employees or a combination of them, or for members or former members, or a combination of them, of the labor organizations.  (c) Except as otherwise specifically provided in  27-18.2-6(d), the provisions of this chapter are not intended to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to Medicare eligible persons which policies are not marketed or held to be Medicare supplement policies or benefit plans.  History of Section.P.L. 1988, ch. 631,  2; P.L. 1989, ch. 428,  1; P.L. 1990, ch. 218,  1; P.L. 1992, ch. 445,  4; P.L. 1993, ch. 180,  12; P.L. 1996, ch. 190,  1. 
 27-18.2-3.1. Premium rate review. [Effective July 1, 2023.] (a) An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has been filed with and approved by the commissioner in accordance with filing requirements and procedures prescribed by the commissioner.  (b) The commissioner shall review the rate, rating formula, or rate manual filing and approve the filing, propose to the health insurance issuer how the filing can be amended and approved, or take other actions separately or in combination as the commissioner deems appropriate and as authorized by law.  (c) The commissioner may approve, disapprove, or modify the rates, rating formula, or rating manual filed by the issuer.  (d) A health insurance rate, rating formula, or rate manual shall not be approved unless the commissioner determines that the health insurance issuer has demonstrated to the satisfaction of the commissioner that it is consistent with the proper conduct of the business of the issuer, and consistent with the interests of the public. In considering the interests of the public, the commissioner shall seek to ensure affordability and to minimize unreasonable disparities in access to coverage.  History of Section.P.L. 2022, ch. 393,  2, effective July 1, 2023; P.L. 2022, ch. 394,  2, effective July 1, 2023. 
 27-18.2-3. Standards for policy provisions. [Effective until July 1, 2023.] (a) No Medicare supplement insurance policy or certificate in force in the state shall contain benefits which duplicate benefits provided by Medicare.  (b) Notwithstanding any other provision of law of this state, a Medicare supplement policy or certificate shall not exclude or limit benefits for loss incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.  (c) The director shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies and certificates. Those standards shall be in addition to and in accordance with the applicable laws of this state, including but not limited to  27-18-3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement of this title or chapter 62 of title 42 relating to minimum required policy benefits, other than the minimum standards contained in this chapter, shall apply to Medicare supplement policies and certificates. The standards may cover, but not be limited to:  (1) Terms of renewability;  (2) Initial and subsequent conditions of eligibility;  (3) Nonduplication of coverage;  (4) Probationary periods;  (5) Benefit limitations, exceptions, and reductions;  (6) Elimination periods;  (7) Requirements for replacement;  (8) Recurrent conditions; and  (9) Definitions of terms.  (d) The director may adopt reasonable regulations that specify prohibited policy provisions not specifically authorized by statute, if, in the opinion of the director, those provisions are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured under a Medicare supplement policy or certificate.  (e) The director shall adopt reasonable regulations to establish minimum standards for benefits, claims payment, marketing practices, and compensation arrangements and reporting practices for Medicare supplement policies and certificates.  (f) The director may adopt any reasonable regulations necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations promulgated pursuant to federal law, including but not limited to:  (1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;  (2) Establishing a uniform methodology for calculating and reporting loss ratios;  (3) Assuring public access to policies, premiums, and loss ratio information of issuers of Medicare supplement insurance;  (4) Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;  (5) Establishing a policy for holding public hearings prior to approval of premium increases which may include the applicants provision of notice of the proposed premium increase to all subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and  (6) Establishing standards for Medicare select policies and certificates.  History of Section.P.L. 1988, ch. 631,  2; P.L. 1989, ch. 428,  1; P.L. 1992, ch. 445,  4; P.L. 1993, ch. 180,  12; P.L. 2005, ch. 43,  1; P.L. 2005, ch. 86,  1.   27-18.2-3. Standards for policy provisions. [Effective July 1, 2023.] (a) No Medicare supplement insurance policy or certificate in force in the state shall contain benefits that duplicate benefits provided by Medicare.  (b) Notwithstanding any other provision of law of this state, a Medicare supplement policy or certificate shall not exclude or limit benefits for loss incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.  (c) The commissioner shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies and certificates. Those standards shall be in addition to and in accordance with the applicable laws of this state, including but not limited to  27-18-3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement of this title or chapter 62 of title 42 relating to minimum required policy benefits, other than the minimum standards contained in this chapter, shall apply to Medicare supplement policies and certificates. The standards may cover, but not be limited to:  (1) Terms of renewability;  (2) Initial and subsequent conditions of eligibility;  (3) Nonduplication of coverage;  (4) Probationary periods;  (5) Benefit limitations, exceptions, and reductions;  (6) Elimination periods;  (7) Requirements for replacement;  (8) Recurrent conditions; and  (9) Definitions of terms.  (d) The commissioner may adopt reasonable regulations that specify prohibited policy provisions not specifically authorized by statute, if, in the opinion of the commissioner, those provisions are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured under a Medicare supplement policy or certificate.  (e) The commissioner shall adopt reasonable regulations to establish minimum standards for premium rates, benefits, claims payment, marketing practices, and compensation arrangements and reporting practices for Medicare supplement policies and certificates.  (f) The commissioner may adopt any reasonable regulations necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations promulgated pursuant to federal law, including but not limited to:  (1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;  (2) Establishing a uniform methodology for calculating and reporting loss ratios;  (3) Assuring public access to policies, premiums, and loss ratio information of issuers of Medicare supplement insurance;  (4) Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;  (5) Establishing a policy for holding public hearings prior to approval of premium increases that may include the applicants provision of notice of the proposed premium increase to all subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and  (6) Establishing standards for Medicare select policies and certificates.  (g) Each Medicare supplement Plan A policy or applicable certificate that an issuer currently, or at any time hereafter, makes available in this state shall be made available to any applicant under the age of sixty-five (65) who is eligible for Medicare due to a disability or end-stage renal disease, provided that the applicant submits their application during the first six (6) months immediately following the applicants initial eligibility for Medicare Part B, or alternate enrollment period as determined by the commissioner. The issuance or coverage of any Medicare supplement policy pursuant to this section shall not be conditioned on the medical or health status or receipt of health care by the applicant; and no insurer shall perform individual medical underwriting on any applicant in connection with the issuance of a policy pursuant to this subsection.  History of Section.P.L. 1988, ch. 631,  2; P.L. 1989, ch. 428,  1; P.L. 1992, ch. 445,  4; P.L. 1993, ch. 180,  12; P.L. 2005, ch. 43,  1; P.L. 2005, ch. 86,  1; P.L. 2022, ch. 393,  1, effective July 1, 2023; P.L. 2022, ch. 394,  1, effective July 1, 2023. 
 27-18.2-4. Loss ratio standards. Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director shall issue reasonable regulations to establish minimum standards for loss ratios of Medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices.  History of Section.P.L. 1988, ch. 631,  2; P.L. 1989, ch. 428,  1; P.L. 1990, ch. 218,  1; P.L. 1992, ch. 445,  4; P.L. 1993, ch. 180,  12. 
 27-18.2-5. Repealed.
 27-18.2-6. Disclosure standards. (a) In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time application is made.  (b) The director shall prescribe the format and content of the outline of coverage required by subsection (a) of this section. For the purposes of this section, format means style, arrangements, and overall appearance, including such items as the size, color, and prominence of type and arrangement of text and captions. The outline of coverage shall include:  (1) A description of the principal benefits and coverage provided in the policy;  (2) A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums, and a disclosure of the existence of any automatic renewal premium increase based on the policyholders age; and  (3) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.  (c) The director may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for Medicare, which is intended to improve the buyers ability to select the most appropriate coverage and improve the buyers understanding of Medicare. Except in the case of direct response insurance policies, the director may require by regulation that the information brochure be provided to any prospective insureds eligible for Medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the director may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for Medicare, but in no event later than the time of policy delivery.  (d) The director may adopt regulations for captions or notice requirements, determined to be in the public interest and designed to inform prospective insured that particular insurance coverage is not Medicare supplement coverage, for all accident and sickness insurance policies sold to persons eligible for Medicare other than:  (1) Medicare supplement policies; or  (2) Disability income policies.  (e) The director may adopt reasonable regulations to govern the full and fair disclosure of the information in connection with the replacement of accident and sickness policies, subscriber contracts or certificates by persons eligible for Medicare.  History of Section.P.L. 1988, ch. 631,  2; P.L. 1989, ch. 428,  1; P.L. 1992, ch. 445,  4; P.L. 1993, ch. 180,  12. P.L. 1996, ch. 190,  1. 
 27-18.2-7. Notice of free examination. Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached to it stating in substance that the applicant shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Any refund made pursuant to this section shall be paid in a timely manner directly to the applicant by the insurer.  History of Section.P.L. 1989, ch. 428,  1. 
 27-18.2-8. Filing requirements for advertising. Every issuer of Medicare supplement insurance policies or certificates in this state shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio, or television medium to the director for review or approval by the director to the extent it may be required under state law.  History of Section.P.L. 1989, ch. 428,  1; P.L. 1992, ch. 445,  4. 
 27-18.2-9. Administrative procedures. Regulations adopted pursuant to this chapter shall be subject to the provisions of chapter 35 of title 42.  History of Section.P.L. 1989, ch. 428,  1; P.L. 1992, ch. 445,  4. 
 27-18.3-1  27-18.3-13. Repealed.
 27-18.4-1. Definitions. (a) Insurer means any health insurer (including a group health plan, as defined in  607(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1167(1)), a health maintenance organization as defined in  27-41-2, a qualified health maintenance organization as referred to in  42-62-9, a non-profit hospital service corporation as defined in  27-19-1, a non-profit medical service corporation as defined in  27-20-1, a non-profit dental service corporation as defined in  27-20.1-1, a non-profit optometric service corporation as defined in  27-20.2-1, self insured plans, pharmacy benefit managers (PBM), and other parties that are by statute, contract, or agreement, legally responsible for payment of a claim for a health care item of service doing business in the state, a domestic insurance company subject to chapter 1 of this title, and a foreign insurance company subject to chapter 2 of this title.  (b) Medical assistance and Medicaid mean medical assistance provided in whole or in part by the department of human services pursuant to chapter 5.1, 8, 8.4 of title 40 or 12.3 of title 42 and/or title XIX or XXI of the federal Social Security Act, as amended, 42 U.S.C.  1396 et seq. and 42 U.S.C.  1397aa et seq., respectively.  History of Section.P.L. 1994, ch. 237,  2; P.L. 2002, ch. 65, art. 35,  2; P.L. 2007, ch. 73, art. 18,  5. 
 27-18.4-2. Coordination of benefits with Medical Assistance  Acquired rights to payments. (a) An insurer is prohibited from considering the availability or eligibility for medical assistance in this or any other state when considering eligibility for coverage or making payments under its plan for eligible enrollees, subscribers, policyholders or certificate holders.  (b) To the extent that payment for covered expenses has been made under the state Medicaid program for health care items or services furnished to an individual in any case where a third party, including an insurer, has a legal liability to make payments, the department of human services is considered to have acquired the rights of the individual to payment by any other party, including an insurer, for those health care items or services. These rights are further defined and are enforceable in accordance with  40-6-9 and 40-6-9.1.  History of Section.P.L. 1994, ch. 237,  2; P.L. 2002, ch. 65, art. 35,  2. 
 27-18.4-3. Nondiscrimination in enrollment  Claims submission. (a) An insurer shall not deny enrollment of a child under any health plan of the childs parent on the grounds that:  (1) The child was born out of wedlock;  (2) The child is not claimed as a dependent on the parents federal tax return; or  (3) The child does not reside with the parent or in the insurers service area.  (b) Where a child has health coverage through an insurer of a noncustodial parent the insurer shall:  (1) Provide any information to the custodial parent as may be necessary for the child to obtain benefits through that coverage;  (2) Permit the custodial parent (or the provider, with the custodial parents approval) to submit claims for covered services without the approval of the noncustodial parent; and  (3) Make payments on claims submitted in accordance with subsection (b)(2) of this section directly to the custodial parent, the provider or the department of human services.  (c) Where a parent is required by a court or administrative order to provide health coverage for a child, and the parent is eligible for family health coverage, the insurer is required:  (1) To permit the parent to enroll, under the family coverage, a child who is eligible for the coverage without regard to any enrollment season restrictions;  (2) If the parent is enrolled but fails to make application to obtain coverage for the child, to enroll the child under family coverage upon application of the childs other parent, or the department of human services which administers the Medicaid program and the child support enforcement program under 42 U.S.C.  651 et seq.; and  (3) Not to disenroll (or eliminate coverage of) the child unless the insurer is provided satisfactory written evidence that:  (i) The court or administrative order is no longer in effect; or  (ii) The child is or will be enrolled in comparable health coverage through another insurer that will take effect not later than the effective date of disenrollment.  (d) An insurer may not impose requirements on the department of human services, which has been assigned the rights of an individual eligible for medical assistance pursuant to  40-6-9 and covered for health benefits from the insurer, that are different from requirements applicable to an agent or assignee of any other covered individual.  History of Section.P.L. 1994, ch. 237,  2. 
 27-18.4-4. Employer obligations. Where a parent is required by a court or administrative order to provide health coverage, which is available through an employer doing business in this state, the employer is required:  (1) To permit the parent to enroll under family coverage any child who is eligible for coverage without regard to any enrollment season restrictions;  (2) If the parent is enrolled but fails to make application to obtain coverage of the child, to enroll the child under family coverage upon application by the childs other parent, or by the department of human services acting as the state Medicaid and/or child support enforcement program;  (3) Not to disenroll (or eliminate coverage of) this child unless the employer is provided satisfactory written evidence that:  (i) The court order is no longer in effect;  (ii) The child is or will be enrolled in comparable coverage which will take effect no later than the effective date of disenrollment; or  (iii) The employer has eliminated family health coverage for all of its employees.  (4) To withhold from the employees compensation the employees share (if any) of premiums for health coverage and to pay this amount to the insurer.  History of Section.P.L. 1994, ch. 237,  2. 
 27-18.4-5. Rules and regulations. The director of business regulation may promulgate any rules and regulations as he or she shall deem necessary for the efficient administration of this chapter.  History of Section.P.L. 1994, ch. 237,  2. 
 27-18.4-6. Severability. If any provision of the 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.  History of Section.P.L. 1994, ch. 237,  2. 
 27-18.5-1. Purpose. The purpose of this chapter is, among other things, to insure compliance of all policies, contracts, certificates, and agreements of individual health insurance coverage offered or delivered in this state with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4; P.L. 2006, ch. 273,  2; P.L. 2006, ch. 297,  2. 
 27-18.5-10.1. Special enrollment  Pregnancy. [Effective January 1, 2023.] (a) In general.  A carrier shall establish a special enrollment period that allows for the enrollment of a pregnant individual at any time after the commencement of the pregnancy. Coverage shall be effective as of the first of the month in which the pregnant individual applies for coverage. This special enrollment period shall be applicable to all health insurance coverage offered by a carrier.  (b) Non-interference with federal and state law.  Nothing in subsection (a) shall be construed to conflict with or preempt any other applicable requirements for enrollment in health insurance coverage under federal and state law. The special enrollment period described in subsection (a) is in addition to any other special enrollment periods that are required under federal and state law.  History of Section.P.L. 2022, ch. 145,  1, effective January 1, 2023; P.L. 2022, ch. 146,  1, effective January 1, 2023. 
 27-18.5-10. Prohibition on preexisting condition exclusions. (a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title and/or chapter:  (1) Shall not limit or exclude coverage for an individual under the age of nineteen (19) by imposing a preexisting condition exclusion on that individual.  (2) For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude coverage for any individual by imposing a preexisting condition exclusion on that individual.  (b) As used in this section:  (1) Preexisting condition exclusion means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition (whether physical or mental) was present before the effective date of coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, diagnosis, care or treatment was recommended or received before the effective date of coverage.  (2) Preexisting condition exclusion means any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individuals health status before the individuals effective date of coverage, or if the coverage is denied, the date of denial, under the health benefit plan, such as a condition (whether physical or mental) identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period.  (c) This section shall not apply to grandfathered health plans providing individual health insurance coverage.  (d) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  History of Section.P.L. 2012, ch. 256,  4; P.L. 2012, ch. 262,  4. 
 27-18.5-2. Definitions. The following words and phrases as used in this chapter have the following meanings unless a different meaning is required by the context:  (1) Bona fide association means, with respect to health insurance coverage offered in this state, an association that:  (i) Has been actively in existence for at least five (5) years;  (ii) Has been formed and maintained in good faith for purposes other than obtaining insurance;  (iii) Does not condition membership in the association on any health status-related factor relating to an individual (including an employee of an employer or a dependent of an employee);  (iv) Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to the members (or individuals eligible for coverage through a member);  (v) Does not make health insurance coverage offered through the association available other than in connection with a member of the association;  (vi) Is composed of persons having a common interest or calling;  (vii) Has a constitution and bylaws; and  (viii) Meets any additional requirements that the director may prescribe by regulation;  (2) COBRA continuation provision means any of the following:  (i) Section 4980(B) of the Internal Revenue Code of 1986, 26 U.S.C.  4980B, other than subsection (f)(1) of that section insofar as it relates to pediatric vaccines;  (ii) Part 6 of subtitle B of Title I of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1161 et seq., other than Section 609 of that act, 29 U.S.C.  1169; or  (iii) Title XXII of the United States Public Health Service Act, 42 U.S.C.  300bb-1 et seq.;  (3) Commissioner means the health insurance commissioner;  (4) Creditable coverage has the same meaning as defined in the United States Public Health Service Act, Section 2701(c), 42 U.S.C.  300gg(c), as added by P.L. 104-191;  (5) Director means the director of the department of business regulation;  (6) Eligible individual means an individual:  (i) For whom, as of the date on which the individual seeks coverage under this chapter, the aggregate of the periods of creditable coverage is eighteen (18) or more months and whose most recent prior creditable coverage was under a group health plan, a governmental plan established or maintained for its employees by the government of the United States or by any of its agencies or instrumentalities, or church plan (as defined by the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1001 et seq.);  (ii) Who is not eligible for coverage under a group health plan, part A or part B of title XVIII of the Social Security Act, 42 U.S.C.  1395c et seq. or 42 U.S.C.  1395j et seq., or any state plan under title XIX of the Social Security Act, 42 U.S.C.  1396 et seq. (or any successor program), and does not have other health insurance coverage;  (iii) With respect to whom the most recent coverage within the coverage period was not terminated based on a factor described in  27-18.5-4(b) (relating to nonpayment of premiums or fraud);  (iv) If the individual had been offered the option of continuation coverage under a COBRA continuation provision, or under chapter 19.1 of this title or under a similar state program of this state or any other state, who elected the coverage; and  (v) Who, if the individual elected COBRA continuation coverage, has exhausted the continuation coverage under the provision or program;  (7) Group health plan means an employee welfare benefit plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(1), to the extent that the plan provides medical care and including items and services paid for as medical care to employees or their dependents as defined under the terms of the plan directly or through insurance, reimbursement or otherwise;  (8) Health insurance carrier or carrier means any entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the director, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including, without limitation, an insurance company offering accident and sickness insurance, a health maintenance organization, a nonprofit hospital, medical or dental service corporation, or any other entity providing a plan of health insurance or health benefits by which healthcare services are paid or financed for an eligible individual or his or her dependents by such entity on the basis of a periodic premium, paid directly or through an association, trust, or other intermediary, and issued, renewed, or delivered within or without Rhode Island to cover a natural person who is a resident of this state, including a certificate issued to a natural person that evidences coverage under a policy or contract issued to a trust or association;  (9)(i) Health insurance coverage means a policy, contract, certificate, or agreement offered by a health insurance carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services. Health insurance coverage includes short-term limited-duration policies and any policy that pays on a cost-incurred basis, except as otherwise specifically exempted by subsection (9)(ii), (iii), (iv), or (v) of this section.  (ii) Health insurance coverage does not include one or more, or any combination of, the following:  (A) Coverage only for accident, or disability income insurance, or any combination of those;  (B) Coverage issued as a supplement to liability insurance;  (C) Liability insurance, including general liability insurance and automobile liability insurance;  (D) Workers compensation or similar insurance;  (E) Automobile medical payment insurance;  (F) Credit-only insurance;  (G) Coverage for on-site medical clinics; and  (H) Other similar insurance coverage, specified in federal regulations issued pursuant to P.L. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits;  (I) [Deleted by P.L. 2019, ch. 88, art. 11,  1];  (iii) Health insurance coverage does not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are not an integral part of the coverage:  (A) Limited scope dental or vision benefits;  (B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of these;  (C) Any other similar, limited benefits that are specified in federal regulation issued pursuant to P.L. 104-191;  (iv) Health insurance coverage does not include the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to the event under any group health plan maintained by the same plan sponsor:  (A) Coverage only for a specified disease or illness; or  (B) Hospital indemnity or other fixed indemnity insurance; and  (v) Health insurance coverage does not include the following if it is offered as a separate policy, certificate, or contract of insurance:  (A) Medicare supplemental health insurance as defined under section 1882(g)(1) of the Social Security Act, 42 U.S.C.  1395ss(g)(1);  (B) Coverage supplemental to the coverage provided under 10 U.S.C.  1071 et seq.; and  (C) Similar supplemental coverage provided to coverage under a group health plan;  (10) Health status-related factor means any of the following factors:  (i) Health status;  (ii) Medical condition, including both physical and mental illnesses;  (iii) Claims experience;  (iv) Receipt of health care;  (v) Medical history;  (vi) Genetic information;  (vii) Evidence of insurability, including conditions arising out of acts of domestic violence; and  (viii) Disability;  (11) High-risk individuals means those individuals who do not pass medical underwriting standards due to high healthcare needs or risks;  (12) Individual market means the market for health insurance coverage offered to individuals other than in connection with a group health plan;  (13) Network plan means health insurance coverage offered by a health insurance carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the carrier;  (14) Preexisting condition means, with respect to health insurance coverage, a condition (whether physical or mental), regardless of the cause of the condition, that was present before the date of enrollment for the coverage, for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month (6) period ending on the enrollment date. Genetic information shall not be treated as a preexisting condition in the absence of a diagnosis of the condition related to that information; and  (15) Wellness health benefit plan means that health benefit plan offered in the individual market pursuant to  27-18.5-8.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4; P.L. 2001, ch. 241,  1; P.L. 2001, ch. 331,  1; P.L. 2006, ch. 273,  3; P.L. 2006, ch. 297,  3; P.L. 2007, ch. 164,  2; P.L. 2019, ch. 88, art. 11,  1. 
 27-18.5-3. Guaranteed availability to certain individuals. (a) Notwithstanding any of the provisions of this title to the contrary, all health insurance carriers that offer health insurance coverage in the individual market in this state shall provide for the guaranteed availability of coverage to an eligible individual or an individual who has had health insurance coverage, including coverage in the individual market, or coverage under a group health plan or coverage under 5 U.S.C.  8901 et seq. and had that coverage continuously for at least twelve (12) consecutive months and who applies for coverage in the individual market no later than sixty-three (63) days following termination of the coverage, desiring to enroll in individual health insurance coverage, and who is not eligible for coverage under a group health plan, part A or part B or title XVIII of the Social Security Act, 42 U.S.C.  1395c et seq. or 42 U.S.C.  1395j et seq., or any state plan under title XIX of the Social Security Act, 42 U.S.C.  1396 et seq. (or any successor program) and does not have other health insurance coverage (provided, that eligibility for the other coverage shall not disqualify an individual with twelve (12) months of consecutive coverage if that individual applies for coverage in the individual market for the primary purpose of obtaining coverage for a specific pre-existing condition, and the other available coverage excludes coverage for that pre-existing condition) and may not:  (1) Decline to offer the coverage to, or deny enrollment of, the individual; or  (2) Impose any preexisting condition exclusion with respect to the coverage.  (b)(1) All health insurance carriers that offer health insurance coverage in the individual market in this state shall offer all policy forms of health insurance coverage. Provided, the carrier may elect to limit the coverage offered so long as it offers at least two (2) different policy forms of health insurance coverage (policy forms which have different cost-sharing arrangements or different riders shall be considered to be different policy forms) both of which:  (i) Are designed for, made generally available to, and actively market to, and enroll both eligible and other individuals by the carrier; and  (ii) Meet the requirements of subparagraph (A) or (B) of this paragraph as elected by the carrier:  (A) If the carrier offers the policy forms with the largest, and next to the largest, premium volume of all the policy forms offered by the carrier in this state; or  (B) If the carrier offers a choice of two (2) policy forms with representative coverage, consisting of a lower-level coverage policy form and a higher-level coverage policy form each of which includes benefits substantially similar to other individual health insurance coverage offered by the carrier in this state and each of which is covered under a method that provides for risk adjustment, risk spreading, or financial subsidization.  (2) For the purposes of this subsection, lower-level coverage means a policy form for which the actuarial value of the benefits under the coverage is at least eighty-five percent (85%) but not greater than one hundred percent (100%) of the policy form weighted average.  (3) For the purposes of this subsection, higher-level coverage means a policy form for which the actuarial value of the benefits under the coverage is at least fifteen percent (15%) greater than the actuarial value of lower-level coverage offered by the carrier in this state, and the actuarial value of the benefits under the coverage is at least one hundred percent (100%) but not greater than one hundred twenty percent (120%) of the policy form weighted average.  (4) For the purposes of this subsection, policy form weighted average means the average actuarial value of the benefits provided by all the health insurance coverage issued (as elected by the carrier) either by that carrier or, if the data are available, by all carriers in this state in the individual market during the previous year (not including coverage issued under this subsection), weighted by enrollment for the different coverage. The actuarial value of benefits shall be calculated based on a standardized population and a set of standardized utilization and cost factors.  (5) The carrier elections under this subsection shall apply uniformly to all eligible individuals in this state for that carrier. The election shall be effective for policies offered during a period of not shorter than two (2) years.  (c)(1) A carrier may deny health insurance coverage in the individual market to an eligible individual if the carrier has demonstrated to the director that:  (i) It does not have the financial reserves necessary to underwrite additional coverage; and  (ii) It is applying this subsection uniformly to all individuals in the individual market in this state consistent with applicable state law and without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals.  (2) A carrier upon denying individual health insurance coverage in this state in accordance with this subsection may not offer that coverage in the individual market in this state for a period of one hundred eighty (180) days after the date the coverage is denied or until the carrier has demonstrated to the director that the carrier has sufficient financial reserves to underwrite additional coverage, whichever is later.  (d) Nothing in this section shall be construed to require that a carrier offering health insurance coverage only in connection with group health plans or through one or more bona fide associations, or both, offer health insurance coverage in the individual market.  (e) A carrier offering health insurance coverage in connection with group health plans under this title shall not be deemed to be a health insurance carrier offering individual health insurance coverage solely because the carrier offers a conversion policy.  (f) Except for any high risk pool rating rules to be established by the Office of the Health Insurance Commissioner (OHIC) as described in this section, nothing in this section shall be construed to create additional restrictions on the amount of premium rates that a carrier may charge an individual for health insurance coverage provided in the individual market; or to prevent a health insurance carrier offering health insurance coverage in the individual market from establishing premium rates or modifying applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.  (g) OHIC may pursue federal funding in support of the development of a high risk pool for the individual market, as defined in  27-18.5-2, contingent upon a thorough assessment of any financial obligation of the state related to the receipt of said federal funding being presented to, and approved by, the general assembly by passage of concurrent general assembly resolution. The components of the high risk pool program, including, but not limited to, rating rules, eligibility requirements and administrative processes, shall be designed in accordance with  2745 of the Public Health Service Act (42 U.S.C.  300gg-45) also known as the State High Risk Pool Funding Extension Act of 2006 and defined in regulations promulgated by the office of the health insurance commissioner on or before October 1, 2007.  (h)(1) In the case of a health insurance carrier that offers health insurance coverage in the individual market through a network plan, the carrier may limit the individuals who may be enrolled under that coverage to those who live, reside, or work within the service areas for the network plan; and within the service areas of the plan, deny coverage to individuals if the carrier has demonstrated to the director that:  (i) It will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees; and  (ii) It is applying this subsection uniformly to individuals without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals.  (2) Upon denying health insurance coverage in any service area in accordance with the terms of this subsection, a carrier may not offer coverage in the individual market within the service area for a period of one hundred eighty (180) days after the coverage is denied.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4; P.L. 2001, ch. 241,  1; P.L. 2001, ch. 331,  1; P.L. 2006, ch. 271,  1; P.L. 2006, ch. 283,  1. 
 27-18.5-4. Continuation of coverage  Renewability. (a) A health insurance carrier that provides individual health insurance coverage to an individual in this state shall renew or continue in force that coverage at the option of the individual.  (b) A health insurance carrier may nonrenew or discontinue health insurance coverage of an individual in the individual market based only on one or more of the following:  (1) The individual has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the carrier has not received timely premium payments;  (2) The individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage;  (3) The carrier is ceasing to offer coverage in accordance with subsections (c) and (d) of this section;  (4) In the case of a carrier that offers health insurance coverage in the market through a network plan, the individual no longer resides, lives, or works in the service area (or in an area for which the carrier is authorized to do business) but only if the coverage is terminated uniformly without regard to any health status-related factor of covered individuals; or  (5) In the case of health insurance coverage that is made available in the individual market only through one or more bona fide associations, the membership of the individual in the association (on the basis of which the coverage is provided) ceases but only if the coverage is terminated uniformly and without regard to any health status-related factor of covered individuals.  (c) In any case in which a carrier decides to discontinue offering a particular type of health insurance coverage offered in the individual market, coverage of that type may be discontinued only if:  (1) The carrier provides notice, to each covered individual provided coverage of this type in the market, of the discontinuation at least ninety (90) days prior to the date of discontinuation of the coverage;  (2) The carrier offers to each individual in the individual market provided coverage of this type, the opportunity to purchase any other individual health insurance coverage currently being offered by the carrier for individuals in the market; and  (3) In exercising this option to discontinue coverage of this type and in offering the option of coverage under subdivision (2) of this subsection, the carrier acts uniformly without regard to any health status-related factor of enrolled individuals or individuals who may become eligible for the coverage.  (d) In any case in which a carrier elects to discontinue offering all health insurance coverage in the individual market in this state, health insurance coverage may be discontinued only if:  (1) The carrier provides notice to the director and to each individual of the discontinuation at least one hundred eighty (180) days prior to the date of the expiration of the coverage; and  (2) All health insurance issued or delivered in this state in the market is discontinued and coverage under this health insurance coverage in the market is not renewed.  (e) In the case of a discontinuation under subsection (d) of this section, the carrier may not provide for the issuance of any health insurance coverage in the individual market in this state during the five (5) year period beginning on the date the carrier filed its notice with the department to withdraw from the individual health insurance market in this state. This five (5) year period may be reduced to a minimum of three (3) years at the discretion of the health insurance commissioner, based on his/her analysis of market conditions and other related factors.  (f) The provisions of subsections (d) and (e) of this section do not apply if, at the time of coverage renewal, a health insurance carrier modifies the health insurance coverage for a policy form offered to individuals in the individual market so long as the modification is consistent with this chapter and other applicable law and effective on a uniform basis among all individuals with that policy form.  (g) In applying this section in the case of health insurance coverage made available by a carrier in the individual market to individuals only through one or more associations, a reference to an individual includes a reference to the association (of which the individual is a member).  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4; P.L. 2005, ch. 68,  1; P.L. 2005, ch. 78,  1. 
 27-18.5-5. Enforcement  Limitation on actions. The director has the power to enforce the provisions of this chapter in accordance with  42-14-16 and all other applicable laws.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4. 
 27-18.5-6. Rules and regulations. The director may promulgate rules and regulations necessary to effectuate the purposes of this chapter.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4. 
 27-18.5-7. Severability. If any provision of this chapter or the application of any provision to any person or circumstances is for any reason held invalid, the remainder of the chapter and the application of that provision to other persons or circumstances shall not be affected by the invalidity.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4. 
 27-18.5-8. Wellness health benefit plan. All carriers that offer health insurance in the individual market shall actively market and offer the wellness health direct benefit plan to eligible individuals. The wellness health direct benefit plan shall be determined by regulation promulgated by the office of the health insurance commissioner (OHIC). The OHIC shall develop the criteria for the direct wellness health benefit plan, including, but not limited to, benefit levels, cost sharing levels, exclusions and limitations in accordance with the following:  (1) Form and utilize an advisory committee in accordance with subsection 27-50-10(5).  (2) Set a target for the average annualized individual premium rate for the direct wellness health benefit plan to be less than ten percent (10%) of the average annual statewide wage, dependent upon the availability of reinsurance funds, as reported by the Rhode Island department of labor and training, in their report entitled Quarterly Census of Rhode Island Employment and Wages. In the event that this report is no longer available, or the OHIC determines that it is no longer appropriate for the determination of maximum annualized premium, an alternative method shall be adopted in regulation by the OHIC. The maximum annualized individual premium rate shall be determined no later than August 1st of each year, to be applied to the subsequent calendar year premiums rates.  (3) Ensure that the direct wellness health benefit plan creates appropriate incentives for employers, providers, health plans and consumers to, among other things:  (i) Focus on primary care, prevention and wellness;  (ii) Actively manage the chronically ill population;  (iii) Use the least cost, most appropriate setting; and  (iv) Use evidence based, quality care.  (4) The plan shall be made available in accordance with title 27, chapter 18.5 as required by regulation on or before May 1, 2007.  History of Section.P.L. 2006, ch. 258,  5; P.L. 2006, ch. 296,  5; P.L. 2008, ch. 475,  82. 
 27-18.5-9. Affordable health plan reinsurance program for individuals. (a) The commissioner shall allocate funds from the affordable health plan reinsurance fund for the affordable health reinsurance program.  (b) The affordable health reinsurance program for individuals shall only be available to high-risk individuals as defined in  27-18.5-2, and who purchase the direct wellness health benefit plan pursuant to the provisions of this section. Eligibility shall be determined based on state and federal income tax filings.  (c) The affordable health plan reinsurance shall be in the form of a carrier cost-sharing arrangement, which encourages carriers to offer a discounted premium rate to participating individuals, and whereby the reinsurance fund subsidizes the carriers losses within a prescribed corridor of risk as determined by regulation.  (d) The specific structure of the reinsurance arrangement shall be defined by regulations promulgated by the commissioner.  (e) The commissioner shall determine total eligible enrollment under qualifying individual health insurance contracts by dividing the funds available for distribution from the reinsurance fund by the estimated per member annual cost of claims reimbursement from the reinsurance fund.  (f) The commissioner shall suspend the enrollment of new individuals under qualifying individual health insurance contracts if the director determines that the total enrollment reported under such contracts is projected to exceed the total eligible enrollment, thereby resulting in anticipated annual expenditures from the reinsurance fund in excess of ninety-five percent (95%) of the total funds available for distribution from the fund.  (g) The commissioner shall provide the health maintenance organization, health insurers and health plans with notification of any enrollment suspensions as soon as practicable after receipt of all enrollment data.  (h) The premiums of qualifying individual health insurance contracts must be no more than ninety percent (90%) of the actuarially-determined and commissioner approved premium for this health plan without the reinsurance program assistance.  (i) The commissioner shall prepare periodic public reports in order to facilitate evaluation and ensure orderly operation of the funds, including, but not limited to, an annual report of the affairs and operations of the fund, containing an accounting of the administrative expenses charged to the fund. Such reports shall be delivered to the co-chairs of the joint legislative committee on health care oversight by March 1st of each year.  History of Section.P.L. 2006, ch. 273,  4; P.L. 2006, ch. 297,  4. 
 27-18.6-1. Purpose. The purpose of this chapter is to insure compliance of all policies, contracts, certificates, and agreements of group health insurance coverage offered or delivered in this state with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4; P.L. 2002, ch. 292,  36. 
 27-18.6-10. Severability. If any provision of this chapter or the application of any provision to any person or circumstances is for any reason held invalid, the remainder of the chapter and the application of that provision to other persons or circumstances shall not be affected by that invalidity.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4. 
 27-18.6-11. Health insurance plan payment and expense reporting. A health insurance carrier: (1) providing proposed rate, premium, fee, or other prospective cost information in connection with an offering of health insurance coverage to a large group or large employer setting forth claims cost as an element of cost; or (2) providing information to a large group or large employer (as so defined) regarding claims paid, shall be required to distinguish, set forth and itemize as separate and distinct elements of cost: (i) sums actually payable (or paid) to health care providers; and (ii) sums actually (or proposed to be) retained or paid by the carrier for administration, including, but not limited to, sums relating to claim services, managed care fees, network access fees, and contributions to reserves.  History of Section.P.L. 2004, ch. 196,  1; P.L. 2004, ch. 361,  1. 
 27-18.6-12. Health plan loss information. (a) To ensure maximum competition in the purchase of group health insurance, all employers with at least one hundred (100) employees enrolled in their group health plan shall be entitled to receive their health plan loss information upon request and without charge. No contract between any health insurance carrier, third-party administrator, employer group, or pool of employers shall abridge this right in any manner. For purposes of this section, health plan loss information shall mean: (1) aggregate total cost figures for four (4) separate categories of medical claims covered by the employers group health plan: physician, hospital, prescription drug, and miscellaneous; and (2) that were incurred for the twelve (12) month period paid through the fourteen (14) months which end within the sixty (60) day period prior to the date of the request. Health plan loss information shall not include any information: (1) pertaining to specific medical diagnoses, treatments or drugs; or (2) that identifies or reasonably could lead to the identity of any individuals covered under the group health plan; or (3) that is defined as protected or confidential health information under state or federal laws.  (b) Upon written request from any employer with one hundred (100) or more employees enrolled in its group health plan, every health insurance carrier shall provide that employers health plan loss information within thirty (30) calendar days of receipt of the request. An employer shall not be entitled by this section to more than two (2) health plan loss information requests in any twelve (12) month period, however, nothing shall prohibit a carrier from fulfilling more frequent requests on a mutually agreed upon basis.  (c) If an employer requests health plan loss information from an insurance agent or other authorized representative, the agent or authorized representative shall transmit the request to the health insurance carrier within four (4) working days.  History of Section.P.L. 2004, ch. 406,  1; P.L. 2004, ch. 502,  1. 
 27-18.6-2. Definitions. The following words and phrases as used in this chapter have the following meanings unless a different meaning is required by the context:  (1) Affiliation period means a period which, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective. The health maintenance organization is not required to provide health care services or benefits during the period and no premium shall be charged to the participant or beneficiary for any coverage during the period;  (2) Beneficiary has the meaning given that term under section 3(8) of the Employee Retirement Security Act of 1974, 29 U.S.C.  1002(8);  (3) Bona fide association means, with respect to health insurance coverage in this state, an association which:  (i) Has been actively in existence for at least five (5) years;  (ii) Has been formed and maintained in good faith for purposes other than obtaining insurance;  (iii) Does not condition membership in the association on any health status-relating factor relating to an individual (including an employee of an employer or a dependent of an employee);  (iv) Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to the members (or individuals eligible for coverage through a member);  (v) Does not make health insurance coverage offered through the association available other than in connection with a member of the association;  (vi) Is composed of persons having a common interest or calling;  (vii) Has a constitution and bylaws; and  (viii) Meets any additional requirements that the director may prescribe by regulation;  (4) COBRA continuation provision means any of the following:  (i) Section 4980(B) of the Internal Revenue Code of 1986, 26 U.S.C.  4980B, other than the subsection (f)(1) of that section insofar as it relates to pediatric vaccines;  (ii) Part 6 of subtitle B of title 1 of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1161 et seq., other than section 609 of that act, 29 U.S.C.  1169; or  (iii) Title XXII of the United States Public Health Service Act, 42 U.S.C.  300bb-1 et seq.;  (5) Creditable coverage has the same meaning as defined in the United States Public Health Service Act, section 2701(c), 42 U.S.C.  300gg(c), as added by P.L. 104-191;  (6) Church plan has the meaning given that term under section 3(33) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(33);  (7) Director means the director of the department of business regulation;  (8) Employee has the meaning given that term under section 3(6) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(6);  (9) Employer has the meaning given that term under section 3(5) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(5), except that the term includes only employers of two (2) or more employees;  (10) Enrollment date means, with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for the enrollment;  (11) Governmental plan has the meaning given that term under section 3(32) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(32), and includes any governmental plan established or maintained for its employees by the government of the United States, the government of any state or political subdivision of the state, or by any agency or instrumentality of government;  (12) Group health insurance coverage means, in connection with a group health plan, health insurance coverage offered in connection with that plan;  (13) Group health plan means an employee welfare benefits plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(1), to the extent that the plan provides medical care and including items and services paid for as medical care to employees or their dependents as defined under the terms of the plan directly or through insurance, reimbursement or otherwise;  (14) Health insurance carrier or carrier means any entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the director, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including, without limitation, an insurance company offering accident and sickness insurance, a health maintenance organization, a nonprofit hospital, medical or dental service corporation, or any other entity providing a plan of health insurance, health benefits, or health services;  (15)(i) Health insurance coverage means a policy, contract, certificate, or agreement offered by a health insurance carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. Health insurance coverage does include short-term and catastrophic health insurance policies, and a policy that pays on a cost-incurred basis, except as otherwise specifically exempted in this definition;  (ii) Health insurance coverage does not include one or more, or any combination of, the following excepted benefits:  (A) Coverage only for accident, or disability income insurance, or any combination of those;  (B) Coverage issued as a supplement to liability insurance;  (C) Liability insurance, including general liability insurance and automobile liability insurance;  (D) Workers compensation or similar insurance;  (E) Automobile medical payment insurance;  (F) Credit-only insurance;  (G) Coverage for on-site medical clinics; and  (H) Other similar insurance coverage, specified in federal regulations issued pursuant to P.L. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits;  (iii) Health insurance coverage does not include the following limited, excepted benefits if they are provided under a separate policy, certificate of insurance, or are not an integral part of the plan:  (A) Limited scope dental or vision benefits;  (B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of those; and  (C) Any other similar, limited benefits that are specified in federal regulations issued pursuant to P.L. 104-191;  (iv) Health insurance coverage does not include the following noncoordinated, excepted benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to the event under any group health plan maintained by the same plan sponsor:  (A) Coverage only for a specified disease or illness; and  (B) Hospital indemnity or other fixed indemnity insurance;  (v) Health insurance coverage does not include the following supplemental, excepted benefits if offered as a separate policy, certificate, or contract of insurance:  (A) Medicare supplemental health insurance as defined under section 1882(g)(1) of the Social Security Act, 42 U.S.C.  1395ss(g)(1);  (B) Coverage supplemental to the coverage provided under 10 U.S.C.  1071 et seq.; and  (C) Similar supplemental coverage provided to coverage under a group health plan;  (16) Health maintenance organization (HMO) means a health maintenance organization licensed under chapter 41 of this title;  (17) Health status-related factor means any of the following factors:  (i) Health status;  (ii) Medical condition, including both physical and mental illnesses;  (iii) Claims experience;  (iv) Receipt of health care;  (v) Medical history;  (vi) Genetic information;  (vii) Evidence of insurability, including contributions arising out of acts of domestic violence; and  (viii) Disability;  (18) Large employer means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least fifty-one (51) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year. In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether the employer is a large employer shall be based on the average number of employees that is reasonably expected the employer will employ on business days in the current calendar year;  (19) Large group market means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer;  (20) Late enrollee means, with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during:  (i) The first period in which the individual is eligible to enroll under the plan; or  (ii) A special enrollment period;  (21) Medical care means amounts paid for:  (i) The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body;  (ii) Amounts paid for transportation primarily for and essential to medical care referred to in paragraph (i) of this subdivision; and  (iii) Amounts paid for insurance covering medical care referred to in paragraphs (i) and (ii) of this subdivision;  (22) Network plan means health insurance coverage offered by a health insurance carrier under which the financing and delivery of medical care including items and services paid for as medical care are provided, in whole or in part, through a defined set of providers under contract with the carrier;  (23) Participant has the meaning given such term under section 3(7) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(7);  (24) Placed for adoption means, in connection with any placement for adoption of a child with any person, the assumption and retention by that person of a legal obligation for total or partial support of the child in anticipation of adoption of the child. The childs placement with the person terminates upon the termination of the legal obligation;  (25) Plan sponsor has the meaning given that term under section 3(16)(B) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(16)(B). Plan sponsor also includes any bona fide association, as defined in this section;  (26) Preexisting condition exclusion means, with respect to health insurance coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for the coverage, whether or not any medical advice, diagnosis, care or treatment was recommended or received before the date; and  (27) Waiting period means, with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4; P.L. 2006, ch. 377,  1; P.L. 2006, ch. 469,  1. 
 27-18.6-3.1. Special enrollment  Pregnancy. [Effective January 1, 2023.] (a) In general.  A group health plan and a carrier shall establish a special enrollment period that allows for the enrollment of a pregnant individual at any time after the commencement of the pregnancy. Coverage shall be effective as of the first of the month in which the pregnant individual applies for coverage. This special enrollment period shall be applicable to all group health insurance coverage and health insurance coverage offered by a group health plan or a carrier.  (b) Non-interference with federal and state law.  Nothing in subsection (a) shall be construed to conflict with or preempt any other applicable requirements for enrollment in health insurance coverage under federal and state law. The special enrollment period described in subsection (a) is in addition to any other special enrollment periods that are required under federal and state law.  History of Section.P.L. 2022, ch. 145,  2, effective January 1, 2023; P.L. 2022, ch. 146,  2, effective January 1, 2023. 
 27-18.6-3. Limitation on preexisting condition exclusion. (a)(1) Notwithstanding any of the provisions of this title to the contrary, a group health plan and a health insurance carrier offering group health insurance coverage shall not deny, exclude, or limit benefits with respect to a participant or beneficiary because of a preexisting condition exclusion except if:  (i) The exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six (6) month period ending on the enrollment date;  (ii) The exclusion extends for a period of not more than twelve (12) months (or eighteen (18) months in the case of a late enrollee) after the enrollment date; and  (iii) The period of the preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage, if any, applicable to the participant or the beneficiary as of the enrollment date.  (2) For purposes of this section, genetic information shall not be treated as a preexisting condition in the absence of a diagnosis of the condition related to that information.  (b) With respect to paragraph (a)(1)(iii) of this section, a period of creditable coverage shall not be counted, with respect to enrollment of an individual under a group health plan, if, after that period and before the enrollment date, there was a sixty-three (63) day period during which the individual was not covered under any creditable coverage.  (c) Any period that an individual is in a waiting period for any coverage under a group health plan or for group health insurance or is in an affiliation period shall not be taken into account in determining the continuous period under subsection (b) of this section.  (d) Except as otherwise provided in subsection (e) of this section, for purposes of applying paragraph (a)(1)(iii) of this section, a group health plan and a health insurance carrier offering group health insurance coverage shall count a period of creditable coverage without regard to the specific benefits covered during the period.  (e)(1) A group health plan or a health insurance carrier offering group health insurance may elect to apply paragraph (a)(1)(iii) of this section based on coverage of benefits within each of several classes or categories of benefits. Those classes or categories of benefits are to be determined by the secretary of the United States Department of Health and Human Services pursuant to regulation. The election shall be made on a uniform basis for all participants and beneficiaries. Under the election, a group health plan or carrier shall count a period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within the class or category.  (2) In the case of an election under this subsection with respect to a group health plan (whether or not health insurance coverage is provided in connection with that plan), the plan shall:  (i) Prominently state in any disclosure statements concerning the plan, and state to each enrollee under the plan, that the plan has made the election; and  (ii) Include in the statements a description of the effect of this election.  (3) In the case of an election under this subsection with respect to health insurance coverage offered by a carrier in the large group market, the carrier shall:  (i) Prominently state in any disclosure statements concerning the coverage, and to each employer at the time of the offer or sale of the coverage, that the carrier has made the election; and  (ii) Include in the statements a description of the effect of the election.  (f)(1) A group health plan and a health insurance carrier offering group health insurance coverage may not impose any preexisting condition exclusion in the case of an individual who, as of the last day of the thirty (30) day period beginning with the date of birth, is covered under creditable coverage.  (2) Subdivision (1) of this subsection shall no longer apply to an individual after the end of the first sixty-three (63) day period during all of which the individual was not covered under any creditable coverage. Moreover, any period that an individual is in a waiting period for any coverage under a group health plan (or for group health insurance coverage) or is in an affiliation period shall not be taken into account in determining the continuous period for purposes of determining creditable coverage.  (g)(1) A group health plan and a health insurance carrier offering group health insurance coverage may not impose any preexisting condition exclusion in the case of a child who is adopted or placed for adoption before attaining eighteen (18) years of age and who, as of the last day of the thirty (30) day period beginning on the date of the adoption or placement for adoption, is covered under creditable coverage. The previous sentence does not apply to coverage before the date of the adoption or placement for adoption.  (2) Subdivision (1) of this subsection shall no longer apply to an individual after the end of the first sixty-three (63) day period during all of which the individual was not covered under any creditable coverage. Any period that an individual is in a waiting period for any coverage under a group health plan (or for group health insurance coverage) or is in an affiliation period shall not be taken into account in determining the continuous period for purposes of determining creditable coverage.  (h) A group health plan and a health insurance carrier offering group health insurance coverage may not impose any preexisting condition exclusion relating to pregnancy as a preexisting condition or with regard to an individual who is under nineteen (19) years of age.  (i)(1) Periods of creditable coverage with respect to an individual shall be established through presentation of certifications. A group health plan and a health insurance carrier offering group health insurance coverage shall provide certifications:  (i) At the time an individual ceases to be covered under the plan or becomes covered under a COBRA continuation provision;  (ii) In the case of an individual becoming covered under a continuation provision, at the time the individual ceases to be covered under that provision; and  (iii) On the request of an individual made not later than twenty-four (24) months after the date of cessation of the coverage described in paragraph (i) or (ii) of this subdivision, whichever is later.  (2) The certification under this subsection may be provided, to the extent practicable, at a time consistent with notices required under any applicable COBRA continuation provision.  (3) The certification described in this subsection is a written certification of:  (i) The period of creditable coverage of the individual under the plan and the coverage (if any) under the COBRA continuation provision; and  (ii) The waiting period (if any) (and affiliation period, if applicable) imposed with respect to the individual for any coverage under the plan.  (4) To the extent that medical care under a group health plan consists of group health insurance coverage, the plan is deemed to have satisfied the certification requirement under this subsection if the health insurance carrier offering the coverage provides for the certification in accordance with this subsection.  (5) In the case of an election taken pursuant to subsection (e) of this section by a group health plan or a health insurance carrier, if the plan or carrier enrolls an individual for coverage under the plan and the individual provides a certification of creditable coverage, upon request of the plan or carrier, the entity which issued the certification shall promptly disclose to the requisition plan or carrier information on coverage of classes and categories of health benefits available under that entitys plan or coverage, and the entity may charge the requesting plan or carrier for the reasonable cost of disclosing the information.  (6) Failure of an entity to provide information under this subsection with respect to previous coverage of an individual so as to adversely affect any subsequent coverage of the individual under another group health plan or health insurance coverage, as determined in accordance with rules and regulations established by the secretary of the United States Department of Health and Human Services, is a violation of this chapter.  (j) A group health plan and a health insurance carrier offering group health insurance coverage in connection with a group health plan shall permit an employee who is eligible, but not enrolled, for coverage under the terms of the plan (or a dependent of an employee if the dependent is eligible, but not enrolled, for coverage under the terms) to enroll for coverage under the terms of the plan if each of the following conditions are met:  (1) The employee or dependent was covered under a group health plan or had health insurance coverage at the time coverage was previously offered to the employee or dependent;  (2) The employee stated in writing at the time that coverage under a group health plan or health insurance coverage was the reason for declining enrollment, but only if the plan sponsor or carrier (if applicable) required a statement at the time and provided the employee with notice of that requirement (and the consequences of the requirement) at the time;  (3) The employees or dependents coverage described in subsection (j)(1):  (i) Was under a COBRA continuation provision and the coverage under that provision was exhausted; or  (ii) Was not under a continuation provision and either the coverage was terminated as a result of loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment) or employer contributions towards the coverage were terminated; and  (4) Under the terms of the plan, the employee requests enrollment not later than thirty (30) days after the date of exhaustion of coverage described in paragraph (3)(i) of this subsection or termination of coverage or employer contribution described in paragraph (3)(ii) of this subsection.  (k)(1) If a group health plan makes coverage available with respect to a dependent of an individual, the individual is a participant under the plan (or has met any waiting period applicable to becoming a participant under the plan and is eligible to be enrolled under the plan but for a failure to enroll during a previous enrollment period), and a person becomes a dependent of the individual through marriage, birth, or adoption or placement through adoption, the group health plan shall provide for a dependent special enrollment period during which the person (or, if not enrolled, the individual) may be enrolled under the plan as a dependent of the individual, and in the case of the birth or adoption of a child, the spouse of the individual may be enrolled as a dependent of the individual if the spouse is eligible for coverage.  (2) A dependent special enrollment period shall be a period of not less than thirty (30) days and shall begin on the later of:  (i) The date dependent coverage is made available; or  (ii) The date of the marriage, birth, or adoption or placement for adoption (as the case may be).  (3) If an individual seeks to enroll a dependent during the first thirty (30) days of a dependent special enrollment period, the coverage of the dependent shall become effective:  (i) In the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received;  (ii) In the case of a dependents birth, as of the date of the birth; or  (iii) In the case of a dependents adoption or placement for adoption, the date of the adoption or placement for adoption.  (l)(1) A health maintenance organization which offers health insurance coverage in connection with a group health plan and which does not impose any preexisting condition exclusion allowed under subsection (a) of this section with respect to any particular coverage option may impose an affiliation period for the coverage option, but only if that period is applied uniformly without regard to any health status-related factors, and the period does not exceed two (2) months (or three (3) months in the case of a late enrollee).  (2) For the purposes of this subsection, an affiliation shall begin on the enrollment date.  (3) An affiliation period under a plan shall run concurrently with any waiting period under the plan.  (4) The director may approve alternative methods from those described under this subsection to address adverse selection.  (m) For the purpose of determining creditable coverage pursuant to this chapter, no period before July 1, 1996, shall be taken into account. Individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have the coverage credited but for the prohibition in the preceding sentence may be given credit for creditable coverage for those periods through the presentation of documents or other means in accordance with any rule or regulation that may be established by the secretary of the United States Department of Health and Human Services.  (n) In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before June 30, 1996, the individual may present other credible evidence of coverage in order to establish the period of creditable coverage. The group health plan and a health insurance carrier shall not be subject to any penalty or enforcement action with respect to the plans or carriers crediting (or not crediting) the coverage if the plan or carrier has sought to comply in good faith with the applicable requirements of this section.  (o) Notwithstanding the provisions of any general or public law to the contrary, for plan or policy years beginning on and after January 1, 2014, a group health plan and a health insurance carrier offering group health insurance coverage shall not deny, exclude, or limit benefits with respect to a participant or beneficiary because of a preexisting condition exclusion.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4; P.L. 2001, ch. 241,  2; P.L. 2001, ch. 331,  2; P.L. 2002, ch. 292,  36; P.L. 2012, ch. 256,  12; P.L. 2012, ch. 262,  12. 
 27-18.6-4. Discrimination prohibited. (a)(1) Notwithstanding any of the provisions of this title to the contrary, a group health plan and a health insurance carrier offering group health insurance in connection with a group health plan may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on health status-related factors in relation to the individual or dependent of the individual.  (2) Rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for enrollment.  (b) Subsection (a) of this section shall not be construed:  (1) To require a group health plan or group health insurance coverage to provide particular benefits other than those provided under the terms of the plan or coverage; or  (2) To prevent a plan or coverage from establishing limitations on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the coverage.  (c)(1) A group health plan and a health insurance carrier offering health insurance coverage in connection with a group health plan may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as dependent of the individual.  (2) Nothing contained within this subsection shall be construed to:  (i) Restrict the amount that an employer may be charged for coverage under a group health plan; or  (ii) Prevent a group health plan and a health insurance carrier offering group health insurance coverage from establishing premium discounts or rebates or modifying applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4. 
 27-18.6-5. Continuation of coverage  Renewability. (a) Notwithstanding any of the provisions of this title to the contrary, a health insurance carrier that offers health insurance coverage in the large group market in this state in connection with a group health plan shall renew or continue in force that coverage at the option of the plan sponsor of the plan.  (b) A health insurance carrier may nonrenew or discontinue health insurance coverage offered in connection with a group health plan in the large group market based only on one or more of the following:  (1) The plan sponsor has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the carrier has not received timely premium payments;  (2) The plan sponsor has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage;  (3) The plan sponsor has failed to comply with a material plan provision relating to employer contribution or group participation rules, as permitted by the director pursuant to rule or regulation;  (4) The carrier is ceasing to offer coverage in accordance with subsections (c) and (d) of this section;  (5) The director finds that the continuation of the coverage would:  (i) Not be in the best interests of the policyholders or certificate holders; or  (ii) Impair the carriers ability to meet its contractual obligations;  (6) In the case of a health insurance carrier that offers health insurance coverage in the large group market through a network plan, there is no longer any enrollee in connection with that plan who resides, lives, or works in the service area of the carrier (or in an area for which the carrier is authorized to do business); and  (7) In the case of health insurance coverage that is made available in the large group market only through one or more bona fide associations, the membership of an employer in the association (on the basis of which the coverage is provided) ceases, but only if the coverage is terminated under this section uniformly without regard to any health status-related factor relating to any covered individual.  (c) In any case in which a carrier decides to discontinue offering a particular type of group health insurance coverage offered in the large group market, coverage of that type may be discontinued by the carrier only if:  (1) The carrier provides notice of the decision to all affected plan sponsors, participants, and beneficiaries at least ninety (90) days prior to the date of discontinuation of coverage;  (2) The carrier offers to each plan sponsor provided coverage of this type in the large group market the option to purchase any other health insurance coverage currently being offered by the carrier to a group health plan in the market; and  (3) In exercising this option to discontinue coverage of this type and in offering the option of coverage under subdivision (3) of this subsection, the carrier acts uniformly without regard to the claims experience of those plan sponsors or any health status-related factor relating to any participants or beneficiaries covered or new participants or beneficiaries who may become eligible for coverage.  (d) In any case in which a carrier elects to discontinue offering and to nonrenew all of its health insurance coverage in the large group market in this state, the carrier shall:  (1) Provide advance notice to the director, to the insurance commissioner in each state in which the carrier is licensed, and to each plan sponsor (and participants and beneficiaries covered under that coverage and to the insurance commissioner in each state in which an affected insured individual is known to reside) of the decision at least one hundred eighty (180) days prior to the date of the discontinuation of coverage. Notice to the insurance commissioner shall be provided at least three (3) working days prior to the notice to the affected plan sponsors, participants, and beneficiaries; and  (2) Discontinue all health insurance issued or delivered for issuance in this states large group market and not renew coverage under any health insurance coverage issued to a large employer.  (e) In the case of a discontinuation under subsection (d) of this section, the carrier shall be prohibited from the issuance of any health insurance coverage in the large group market in this state for a period of five (5) years from the date of notice to the director.  (f) At the time of coverage renewal, a health insurance carrier may modify the health insurance coverage for a product offered to a group health plan in the large group market.  (g) In applying this section in the case of health insurance coverage that is made available by a carrier in the large group market to employers only through one or more associations, a reference to a plan sponsor is deemed, with respect to coverage provided to an employer member of the association, to include a reference to that employer.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4; P.L. 2003, ch. 120,  2; P.L. 2003, ch. 286,  2. 
 27-18.6-6. Applicability  Exclusion of certain plans. (a) The requirements of this chapter do not apply to any group health plan (and health insurance coverage offered in connection with a group health plan) for any plan year if, on the first day of the plan year, the plan does not meet the definition of large employer and is subject to the provisions of chapter 50 of this title.  (b)(1) The requirements of this chapter apply with respect to group health plans only:  (i) In the case of a plan that is a nonfederal governmental plan; and  (ii) With respect to group health insurance coverage offered in connection with a group health plan (including a plan that is a church plan or a governmental plan).  (2) If the plan sponsor of a nonfederal governmental plan which is a group health plan to which this chapter otherwise applies makes an election (in the form and manner as the secretary of the United States Department of Health and Human Services may prescribe by regulation), then the requirements of this subsection insofar as they apply directly to group health plans (and not merely to group health insurance coverage) do not apply to those governmental plans for the period except as provided in this section.  (3) An election applies for a single specified plan year (which may be extended through subsequent elections), or in the case of a plan provided pursuant to a collective bargaining agreement, for the term of that agreement.  (4) Under the election in subdivision (3), the plan shall provide for notice to enrollee (on an annual basis and at the time of enrollment under the plan) of the fact and consequences of the election, and certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with  27-18.6-3(i).  (c) The requirements of this chapter do not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of limited, excepted benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, or are not an integral part of the plan.  (d) The requirements of this chapter do not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of noncoordinated, excepted benefits if all of the following conditions are met:  (1) The benefits are provided under a separate policy, certificate, or contract of insurance;  (2) There is no coordination between the provision of benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor; and  (3) The benefits are paid with respect to an event without regard to whether benefits are provided with respect to that event under any group health plan maintained by the same plan sponsor.  (e) The requirements of this chapter do not apply to any group health plan (and group health insurance coverage) in relation to its provision of supplemental, excepted benefits if the benefits are provided under a separate policy, certificate, or contract of insurance.  (f)(1) For purposes of this chapter, any plan, fund, or program which would not be (but for this subsection) an employee welfare benefit plan and which is established or maintained by a partnership, to the extent that the plan, fund, or program provides medical care (including items and services paid as medical care) to present or former partners in the partnership or to their dependents (as defined under the terms of the plan, fund or program), directly or through insurance, reimbursement, or otherwise, shall be treated as an employee welfare benefit plan which is a group health plan.  (2) In the case of a group health plan, the term employer also includes the partnership in relation to any partner.  (3) In the case of a group health plan, the term participant also includes:  (i) In connection with a group health plan maintained by a partnership, an individual who is a partner in relation to the partnership; or  (ii) In connection with a group health plan maintained by a self-employed individual (under which one or more employees are participants), the self-employed individual, if that individual is, or may become, eligible to receive a benefit under the plan or the individuals beneficiaries may be eligible to receive any benefits.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4. 
 27-18.6-7. Collective bargaining agreements. (a) Notwithstanding anything contained in this chapter to the contrary, except as provided in  27-18.6-3(n), in the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before July 13, 2000, this chapter does not apply to plan years beginning before the later of:  (1) The date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension of the collective bargaining agreement agreed to after July 13, 2000); or  (2) July 1, 1997.  (b) For purposes of subdivision (a)(1) of this section, any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement of this chapter shall not be treated as a termination of the collective bargaining agreement.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4; P.L. 2002, ch. 292,  36. 
 27-18.6-8. Enforcement  Limitation on actions. The director has the power to enforce the provisions of this chapter in accordance with  42-14-16 and all other applicable state law.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4. 
 27-18.6-9. Rules and regulations. The director may promulgate rules and regulations necessary to effectuate the purposes of this chapter.  History of Section.P.L. 2000, ch. 200,  4; P.L. 2000, ch. 229,  4. 
 27-18.7-1. Medical benefits for employees on extended medical leave. Whenever an employee who has been employed on a full-time basis by an employer for at least three (3) months and who is an insured member of a group hospital, surgical, or medical insurance plan is placed on extended medical leave by the employer, the employee may remain on the group hospital, surgical, or medical insurance plan and the benefits of the plan may be continued for no more than eighteen (18) months from the date the employee was placed on extended medical leave.  History of Section.P.L. 2010, ch. 180,  1; P.L. 2010, ch. 187,  1. 
 27-18.7-2. Costs of the plan. An employer may continue to contribute to the cost of the plan benefits for an employee on extended medical leave or may require an employee on extended medical leave to pay up to one hundred percent (100%) of the cost of the plan benefits.  History of Section.P.L. 2010, ch. 180,  1; P.L. 2010, ch. 187,  1. 
 27-18.7-3. Eligibility for medical benefits while on extended medical leave. (a) An employee shall be considered eligible for continuing coverage under the group hospital, surgical, or medical insurance plan as an employee on extended medical leave if an employer provides to the group hospital, surgical, or medical insurance plan a written statement that explains that, due to medical reasons pertaining to the employee or a member of the employees family (parent, child, step-child, spouse, sibling or a person for whom the employee serves as a legal guardian), the employee can no longer work full-time, the employee and the employer anticipate that the employee will someday return to full-time employment, and the employer has placed the employee on extended medical leave.  (b) Nothing in this statute shall be construed to give an insurance company, a health maintenance organization or a nonprofit hospital and medical service corporation the ability to determine whether an employee is eligible for extended medical leave. The determination of whether an employee is eligible for extended medical leave rests solely with, and in the discretion of, the employer. Nothing in this statute shall be construed to require an employer to offer extended medical leave to its full-time employees.  History of Section.P.L. 2010, ch. 180,  1; P.L. 2010, ch. 187,  1. 
 27-18.7-4. Transition to extended medical benefits. Once an employee on extended medical leave has remained on a group hospital, surgical, or medical insurance plan for eighteen (18) months and is no longer eligible to participate in that plan, the employee shall be eligible for extended medical benefits under chapter 19.1 of title 27 as if the employee were involuntarily terminated from employment the day he or she is no longer eligible to participate in the plan as an employee on extended medical leave.  History of Section.P.L. 2010, ch. 180,  1; P.L. 2010, ch. 187,  1. 
 27-18.8-1. Purpose. The legislature declares that: (1) It is in the best interest of the public that those individuals and healthcare entities involved with the delivery of health plan coverage in our state meet the standards of this chapter to ensure accessibility and quality for the states patients; and  (2) Nothing in this legislation is intended to prohibit a healthcare entity from forming limited networks of providers; and  (3) It is a vital state function to establish these standards for the conduct of healthcare entities in Rhode Island and for public health well-being; and  (4) Nothing in this chapter is intended to prohibit or discourage the health insurance commissioner from consulting or collaborating with the department of health, or any other state or federal agency, to the extent the commissioner in his or her discretion determines such consultation and/or collaboration is necessary and/or appropriate for the administration and enforcement of this chapter.  History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.8-10. Severability. If any section, clause, or provision of this chapter shall be held either unconstitutional or ineffective in whole or in part, to the extent that it is not unconstitutional or ineffective, it shall be valid and effective and no other section, clause or provision shall on account thereof be termed invalid or ineffective.  History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.8-2. Definitions. As used in this chapter: (1) Adverse benefit determination means a decision not to authorize a healthcare service, including a denial, reduction, or termination of, or a failure to provide or make a payment, in whole or in part, for a benefit. A decision by a utilization review agent to authorize a healthcare service in an alternative setting, a modified extension of stay, or an alternative treatment shall not constitute an adverse determination if the review agent and provider are in agreement regarding the decision. Adverse benefit determinations include:  (i) Administrative adverse benefit determinations, meaning any adverse benefit determination that does not require the use of medical judgment or clinical criteria such as a determination of an individuals eligibility to participate in coverage, a determination that a benefit is not a covered benefit, or any rescission of coverage; and  (ii) Non-administrative adverse benefit determinations, meaning any adverse benefit determination that requires or involves the use of medical judgement or clinical criteria to determine whether the service reviewed is medically necessary and/or appropriate. This includes the denial of treatments determined to be experimental or investigational, and any denial of coverage of a prescription drug because that drug is not on the healthcare entitys formulary.  (2) Appeal or internal appeal means a subsequent review of an adverse benefit determination upon request by a claimant to include the beneficiary or provider to reconsider all or part of the original adverse benefit determination.  (3) Authorized representative means an individual acting on behalf of the beneficiary and shall include: the ordering provider; any individual to whom the beneficiary has given express written consent to act on his or her behalf; a person authorized by law to provide substituted consent for the beneficiary; and, when the beneficiary is unable to provide consent, a family member of the beneficiary.  (4) Beneficiary means a policy holder subscriber, enrollee, or other individual participating in a health benefit plan.  (5) Benefit determination means a decision to approve or deny a request to provide or make payment for a healthcare service.  (6) Certificate means a certificate granted by the commissioner to a healthcare entity meeting the requirements of this chapter.  (7) Commissioner means the commissioner of the office of the health insurance commissioner.  (8) Complaint means an oral or written expression of dissatisfaction by a beneficiary, authorized representative, or provider. The appeal of an adverse benefit determination is not considered a complaint.  (9) Delegate means a person or entity authorized pursuant to a delegation of authority or directly or re-delegation of authority, by a healthcare entity or network plan to perform one or more of the functions and responsibilities of a healthcare entity and/or network plan set forth in this chapter or regulations or guidance promulgated thereunder.  (10) Emergency services or emergent services means those resources provided in the event of the sudden onset of a medical, behavioral health, or other health condition that the absence of immediate medical attention could reasonably be expected, by a prudent layperson, to result in placing the patients health in serious jeopardy, serious impairment to bodily or mental functions, or serious dysfunction of any bodily organ or part.  (11) Health benefit plan or health plan means a policy, contract, certificate, or agreement entered into, offered, or issued by a healthcare entity to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services.  (12) Healthcare entity means an insurance company licensed, or required to be licensed, by the state of Rhode Island or other entity subject to the jurisdiction of the commissioner or the jurisdiction of the department of business regulation that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including, without limitation: a for-profit or nonprofit hospital, medical or dental service corporation or plan, a health maintenance organization, a health insurance company, or any other entity providing health insurance, accident and sickness insurance, health benefits, or healthcare services.  (13) Healthcare services means and includes, but is not limited to: an admission, diagnostic procedure, therapeutic procedure, treatment, extension of stay, the ordering and/or filling of formulary or non-formulary medications, and any other medical, behavioral, dental, vision care services, activities, or supplies that are covered by the beneficiarys health benefit plan.  (14) Most-favored-rate clause means a provision in a provider contract whereby the rates or fees to be paid by a healthcare entity are fixed, established, or adjusted to be equal to or lower than the rates or fees paid to the provider by any other healthcare entity.  (15) Network means the group or groups of participating providers providing healthcare services under a network plan.  (16) Network plan means a health benefit plan or health plan that either requires a beneficiary to use, or creates incentives, including financial incentives, for a beneficiary to use the providers managed, owned, under contract with, or employed by the healthcare entity.  (17) Office means the office of the health insurance commissioner.  (18) Professional provider means an individual provider or healthcare professional licensed, accredited, or certified to perform specified healthcare services consistent with state law and who provides these healthcare services and is not part of a separate facility or institutional contract.  (19) Provider means a physician, hospital, professional provider, pharmacy, laboratory, dental, medical, or behavioral health provider, or other state-licensed or other state-recognized provider of health care or behavioral health services or supplies.  (20) Tiered network means a network that identifies and groups some or all types of providers into specific groups to which different provider reimbursement, beneficiary cost-sharing, or provider access requirements, or any combination thereof, apply for the same services.  History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.8-3. Certification of network plans. (a) Certification and recertification process.(1) A healthcare entity operating a network plan shall not enroll consumers into its plan unless the office has certified the network plan meeting the requirements herein.  (2) The commissioner shall act upon the healthcare entities completed applications for certification of network plans, as determined by the commissioner, within ninety (90) calendar days of receipt of such applications for certification.  (3) To ensure compliance, the commissioner shall establish procedures for the periodic review and recertification of network plans at least every three (3) years; provided, however, that the commissioner may review the certification of a network plan at any time and/or may require periodic compliance attestation from a healthcare entity if, in the commissioners discretion, he or she deems it appropriate to do so.  (4) Cost of certification. The total cost of obtaining and maintaining a certificate under this title and in compliance with the requirements of the applicable rules and regulations shall be borne by the applicant and shall include one hundred fifty percent (150%) of the total salaries paid to the personnel engaged in certifications and ensuring compliance with the requirements herein and the applicable rules and regulations. These monies shall be paid to the commissioner to and for the use of the office and shall be in addition to any taxes and fees otherwise payable to the state.   (b) General requirements. The commissioner shall establish standards and procedures for the certification of network plans that have demonstrated the ability to ensure that healthcare services will be provided in a manner to ensure availability and accessibility, adequate personnel and facilities, and continuity of service, and have demonstrated arrangements for ongoing quality-assurance programs regarding care processes and outcomes. These standards shall consist of, but are not limited to, the following:  (1) As to each network plan, a healthcare entity must demonstrate it has a mechanism for beneficiaries and providers to appeal and grieve decisions and actions of the network plan and/or healthcare entity, including decisions or actions made by a delegate of the healthcare entity in relation to the network plan;  (2) As to each network plan, a healthcare entity must maintain a comprehensive list of participating providers that meets the requirements herein and provides additional information relevant to network adequacy;  (3) In the event of any substantial systemic changes in the healthcare entity, network plan, or any relevant delegates certification information on file with the office, the healthcare entity shall submit notice and explanation of this change for approval by the commissioner at least thirty (30) calendar days prior to implementation of any such change;  (4) As to each network plan, a healthcare entity shall maintain a complaint resolution process acceptable to the office, whereby beneficiaries, their authorized representatives, their physicians, or other healthcare providers may seek resolution of complaints and other matters of which the healthcare entity has received oral or written notice;  (5) As to each network plan, a healthcare entity shall be required to establish a mechanism, under which providers, including local providers participating in the network plans, provide input into the plans healthcare policy, including: technology, medications and procedures, utilization review criteria and procedures, quality and credentialing criteria, and medical management procedures;  (6) As to each network plan, a healthcare entity shall be required to establish a mechanism under which beneficiaries provide input into the healthcare entitys procedures and processes regarding the delivery of healthcare services; and  (7) As to each network plan, a healthcare entity must maintain a process, policies, and procedures for the modification of formularies to include notices to beneficiaries and providers when formularies change in accordance with all state and federal laws.  (c) Network requirements. For each network plan, healthcare entities must ensure the following requirements are met:  (1) Maintain access to professional, facility, and other providers sufficient to provide coverage in a timely manner of the benefits covered in the network plan and in a manner to assure that all covered services will be accessible without unreasonable delay;  (2) Establish a process acceptable to the commissioner to monitor the status of each network plans network adequacy not less frequently than quarterly;  (3) Establish and maintain a transition-of-care policy and process when a network has been narrowed, tiered, and/or providers (facilities and professional) have terminated contracts with the healthcare entity for that network plan;  (4) Establish a mechanism to provide the beneficiaries and consumers with up-to-date information on providers, in a form acceptable to the commissioner, to include:  (i) Location by city, town, county;  (ii) Specialty practice areas;  (iii) Affiliations/admission/privileges with facilities, including whether those facilities are in-network facilities; and  (iv) Whether the provider is accepting new patients.  (d) Contracting and credentialing requirements.(1) A healthcare entity shall not refuse to contract with, or compensate for, covered services of an otherwise eligible provider or non-participating provider solely because that provider has, in good faith, communicated with one or more of their patients regarding the provisions, terms, or requirements of the healthcare entitys products as they relate to the needs of that providers patients.  (2) The healthcare entity or network plan provider contracting and credentialing process shall include the following:  (i) This credentialing process shall begin upon acceptance of a completed application from a provider to the healthcare entity or network plan for inclusion;  (ii) Each application shall be reviewed by the healthcare entitys or network plans credentialing body; and  (iii) All healthcare entities or network plans shall develop and maintain credentialing criteria to be utilized in adding to provider networks. Credentialing criteria shall be based on input from providers credentialed in the healthcare entity or network plan and these standards shall be available to applicants. When economic considerations are part of the decisions, the criteria must be available to applicants. Any economic profiling must factor the specialty, utilization and practice patterns, and general information comparing the applicant to their peers in the same specialty will be made available. Any economic profiling of providers must be adjusted to recognize case mix, severity of illness, age of patients, and other features of a providers practice that may account for higher than or lower than expected costs. Profiles must be made available to those so profiled.  (3) A healthcare entity or network plan shall not exclude a professional provider of covered services from participation in its provider network based solely on:  (i) The professional providers degree or license as applicable under state law; or  (ii) The professional provider of covered services lack of affiliation with, or admitting privileges at, a hospital, if that lack of affiliation is due solely to the professional providers type of license.  (4) As to any network plan, healthcare entities shall not discriminate against providers solely because the provider treats a substantial number of patients who require expensive or uncompensated medical care.  (5) The applicant shall be provided with all reasons used if the application is denied.  (6) Healthcare entities or network plans shall not be allowed to include clauses in physician or other provider contracts that allow for the healthcare entity or network plan to terminate the contract without cause; provided, however, cause shall include lack of need due to economic considerations.  (7) There shall be due process for professional providers for all adverse decisions resulting in a change of privileges or contractual language of a credentialed professional provider.  (i) The details of the healthcare entity or network plans due process shall be included in the professional provider contracts.  (ii) A healthcare entity or network plan is deemed to have met the adequate notice- and-hearing requirement of this section with respect to a professional provider if the following conditions are met (or are waived voluntarily by the professional provider):  (A) The professional provider shall be notified of the proposed actions and the reasons for the proposed action;  (B) The professional provider shall be given the opportunity to contest the proposed action; and  (C) The healthcare entity has developed an appeals process that has reasonable time limits for the resolution of the appeal.  (8) A healthcare entity or network plan shall not include a most-favored-rate clause in a provider contract.  (9) A healthcare entity or network plan may materially modify the terms of a participating agreement it maintains with a professional provider only if it disseminates, in writing, by mail or by electronic means to the professional provider, the contents of the proposed modification and an explanation, in non-technical terms, of the modifications impact.  (10) The healthcare entity or network plan shall provide the professional provider an opportunity to amend or terminate the professional provider contract within sixty (60) calendar days of receipt of the notice of modification. Any termination of a professional provider contract made pursuant to this section shall be effective fifteen (15) calendar days from the mailing of the notice of termination, in writing, by mail to the healthcare entity or network plan. The termination shall not affect the method of payment or reduce the amount of reimbursement to the professional provider by the healthcare entity or network plan for any beneficiary in active treatment for an acute medical condition at the time the beneficiarys professional provider terminates his or her professional provider contract with the healthcare entity or network plan until the active treatment is concluded or, if earlier, one year after the termination; and, with respect to the beneficiary, during the active treatment period the professional provider shall be subject to all the terms and conditions of the terminated professional provider contract, including, but not limited to, all reimbursement provisions that limit the beneficiarys liability.   History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.8-4. Contracts with providers for dental services. No contract between a dental plan of a healthcare entity and a dentist for the provision of services to beneficiaries may require that a dentist provide services to its patients at a fee set by the healthcare entity unless said services are covered services under the applicable subscriber agreement. Covered services, as used herein, means services reimbursable under the applicable beneficiary agreement, subject to such contractual limitations on beneficiary benefits as may apply, including, for example, deductibles, waiting period, or frequency limitations.  History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.8-5. Contracts with providers for optometric services. (a) No contract between an eye care provider and a healthcare entity or vision plan may require that an eye care provider provide services or materials to its beneficiaries at a fee set by the insurer or vision plan, unless the insurer or vision plan compensates the eye care provider for the provision of such services or materials to the beneficiary. Reimbursement paid by the insurer or vision plan for covered services and materials shall not provide nominal reimbursement in order to claim that services and materials are covered services.  (b)(1) Services means services and materials for which reimbursement from the vision plan is provided for by a beneficiarys plan contract, or for which a reimbursement would be available but for the application of the beneficiarys contractual limitations of deductibles, copayments, or coinsurance.  (2) Materials means and includes, but is not limited to: lenses, devices containing lenses, prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa.  (3) Eye care provider means an optometrist, optician, or ophthalmologist.  History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.8-6. Reporting requirements. The office shall establish reporting requirements to determine if healthcare entities and/or network plans are in compliance with the provisions of this chapter and applicable regulations as well as in compliance with applicable federal law.  History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.8-7. Rules and regulations. The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.  History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.8-8. Denial, suspension, or revocation of certificate  Penalties. Adopted pursuant to this chapter; (a) The office may deny a certificate or certification upon review of the application if, upon review of the application, it finds that the applicant proposing to establish a network plan does not meet the standards required by this chapter or by any regulations promulgated pursuant to this chapter.  (b) The office may revoke or suspend a certificate or certification and/or impose monetary penalties not less than one hundred dollars ($100) and not to exceed fifty thousand dollars ($50,000) per violation and/or impose an order requiring a monetary restitution or disgorgement payment in an amount determined by the commissioner to reasonably reflect the amount of damages caused or monies improperly obtained in any case in which:  (1) The network plan and/or healthcare entity fails to comply with the requirements of this chapter or of regulations;  (2) The network plan and/or healthcare entity fails to comply with the criteria used by it in its application for a certificate or certification; or  (3) The network plan and/or healthcare entity refuses to permit or fails to reasonably cooperate with an examination by the commissioner to determine compliance with the requirements of this chapter and regulations promulgated pursuant to the authority granted to the commissioner in this chapter. These determinations may involve consideration of any written grievances filed with the office against the network plan or healthcare entity by patients or providers.  (c) Any applicant for certification or certificate holder aggrieved by an order or a decision of the commissioner made under this chapter without a hearing may, within thirty (30) days after notice of the order or decision, make a written request to the office for a hearing on the order or decision pursuant to  42-35-15.  (d) The procedure governing hearings authorized by this section shall be in accordance with  42-35-9 through 42-35-13 as stipulated in  42-35-14(a). A full and complete record shall be kept of all proceedings, and all testimony shall be recorded but need not be transcribed unless the decision is appealed pursuant to  42-35-15. A copy or copies of the transcript may be obtained by any interested party upon payment of the cost of preparing the copy or copies. Witnesses may be subpoenaed by either party.  History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.8-9. Penalties and enforcement. For the purposes of this chapter, in addition to the provisions of  27-18.8-8, a healthcare entity or any person or entity conducting any activities requiring certification under this chapter shall be subject to the penalty and enforcement provisions of this title and chapters 14 and 14.5 of title 42 and the regulations promulgated thereunder in the same manner as a licensee or any person or entity conducting any activities requiring licensure or certification under this title.  History of Section.P.L. 2017, ch. 302, art. 5,  4. 
 27-18.9-1. Purpose of chapter. (a) The purpose of this chapter is to:  (1) Promote the delivery of quality health care in a cost-effective manner;  (2) Foster greater coordination between healthcare providers, patients, healthcare entities, health benefit plans and utilization-review entities to ensure public health well-being;  (3) Protect beneficiaries, businesses, and providers by ensuring that review agents are qualified to perform review activities and to make informed decisions on the medical necessity and appropriateness of medical care;  (4) Ensure that review agents maintain the confidentiality of medical records in accordance with applicable state and federal laws; and  (5) Interface and maintain compliance with federal benefit determination and adverse benefit determination requirements.  (b) Nothing in this chapter is intended to prohibit or discourage the health insurance commissioner from consulting or collaborating with the department of health, or any other state or federal agency, to the extent the commissioner in his or her discretion determines such consultation and/or collaboration is necessary and/or appropriate for the administration and enforcement of this chapter.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-10. Rules and regulations. The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-11. Waiver of requirements. (a) The office shall waive the requirements of this chapter only when a conflict exists with those activities of a review agent that are conducted pursuant to contracts with the state or the federal government or those activities under other state or federal jurisdictions.  (b) The office shall waive de minimus activity, in accordance with the regulations adopted by the commissioner.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-12. Variance of statutory requirements. Statutory variances shall be issued for a period not to exceed one year and may be subject to such terms and conditions deemed necessary as determined by the commissioner. Prior to issuing a statutory variance, the office may provide notice and public hearing to ensure necessary beneficiary and healthcare provider protections in the process.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-13. Denial, suspension, or revocation of certificate  Penalties. Adopted pursuant to this chapter; (a) The office may deny a certificate or certification upon review of the application if, upon review of the application, it finds that the applicant proposing to conduct utilization review does not meet the standards required by this chapter or by any regulations promulgated pursuant to this chapter.  (b) The office may revoke or suspend a certificate or certification and/or impose monetary penalties not less than one hundred dollars ($100) and not to exceed fifty thousand dollars ($50,000) per violation and/or impose an order requiring a monetary restitution or disgorgement payment in an amount determined by the commissioner to reasonably reflect the amount of damages caused or monies improperly obtained in any case in which:  (1) The healthcare entity and/or review agent fails to comply with the requirements of this chapter or of regulations;  (2) The review agent/network plan and/or healthcare entity and/or review agent fails to comply with the criteria used by it in its application for a certificate or certification; or  (3) The healthcare entity and/or review agent refuses to permit or fails to reasonably cooperate with an examination by the commissioner to determine compliance with the requirements of this chapter and regulations promulgated pursuant to the authority granted to the commissioner in this chapter. These determinations may involve consideration of any written grievances filed with the office against the healthcare entity and/or review agent by patients or providers.  (c) Any applicant or certificate or certification holder aggrieved by an order or a decision of the commissioner made under this chapter without a hearing may, within thirty (30) days after notice of the order or decision, make a written request to the office for a hearing on the order or decision pursuant to  42-35-15.  (d) The procedure governing hearings authorized by this section shall be in accordance with  42-35-9 through 42-35-13 as stipulated in  42-35-14(a). A full and complete record shall be kept of all proceedings, and all testimony shall be recorded but need not be transcribed unless the decision is appealed pursuant to  42-35-15. A copy or copies of the transcript may be obtained by any interested party upon payment of the cost of preparing the copy or copies. Witnesses may be subpoenaed by either party.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-14. Penalties and enforcement. For the purposes of this chapter, in addition to the provisions of  27-18.9-13, a healthcare entity and/or review agent or any person or entity conducting any activities requiring certification under this chapter shall be subject to the penalty and enforcement provisions of title 27 and chapters 14 and 14.5 of title 42 and the regulations promulgated thereunder in the same manner as a licensee or any person or entity conducting any activities requiring licensure or certification under title 27.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-15. Severability. If any provision of this chapter or the application of any provision to any person or circumstance shall be held invalid, that invalidity shall not affect the provisions or application of this chapter which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared to be severable.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-2. Definitions. As used in this chapter, the following terms are defined as follows: (1) Adverse benefit determination means a decision not to authorize a healthcare service, including a denial, reduction, or termination of, or a failure to provide or make a payment, in whole or in part, for a benefit. A decision by a utilization-review agent to authorize a healthcare service in an alternative setting, a modified extension of stay, or an alternative treatment shall not constitute an adverse determination if the review agent and provider are in agreement regarding the decision. Adverse benefit determinations include:  (i) Administrative adverse benefit determinations, meaning any adverse benefit determination that does not require the use of medical judgment or clinical criteria such as a determination of an individuals eligibility to participate in coverage, a determination that a benefit is not a covered benefit, or any rescission of coverage; and  (ii) Non-administrative adverse benefit determinations, meaning any adverse benefit determination that requires or involves the use of medical judgement or clinical criteria to determine whether the service being reviewed is medically necessary and/or appropriate. This includes the denial of treatments determined to be experimental or investigational, and any denial of coverage of a prescription drug because that drug is not on the healthcare entitys formulary.  (2) Appeal or internal appeal means a subsequent review of an adverse benefit determination upon request by a claimant to include the beneficiary or provider to reconsider all or part of the original adverse benefit determination.  (3) Authorization means a review by a review agent, performed according to this chapter, concluding that the allocation of healthcare services ordered by a provider, given or proposed to be given to a beneficiary, was approved or authorized.  (4) Authorized representative means an individual acting on behalf of the beneficiary and shall include: the ordering provider; any individual to whom the beneficiary has given express written consent to act on his or her behalf; a person authorized by law to provide substituted consent for the beneficiary; and, when the beneficiary is unable to provide consent, a family member of the beneficiary.  (5) Beneficiary means a policy-holder subscriber, enrollee, or other individual participating in a health-benefit plan.  (6) Benefit determination means a decision to approve or deny a request to provide or make payment for a healthcare service or treatment.  (7) Certificate means a certificate granted by the commissioner to a review agent meeting the requirements of this chapter.  (8) Claim means a request for plan benefit(s) made by a claimant in accordance with the healthcare entitys reasonable procedures for filing benefit claims. This shall include pre-service, concurrent, and post-service claims.  (9) Claimant means a healthcare entity participant, beneficiary, and/or authorized representative who makes a request for plan benefit(s).  (10) Commissioner means the health insurance commissioner.  (11) Complaint means an oral or written expression of dissatisfaction by a beneficiary, authorized representative, or a provider. The appeal of an adverse benefit determination is not considered a complaint.  (12) Concurrent assessment means an assessment of healthcare services conducted during a beneficiarys hospital stay, course of treatment or services over a period of time, or for the number of treatments. If the medical problem is ongoing, this assessment may include the review of services after they have been rendered and billed.  (13) Concurrent claim means a request for a plan benefit(s) by a claimant that is for an ongoing course of treatment or services over a period of time or for the number of treatments.  (14) Delegate means a person or entity authorized pursuant to a delegation of authority or re-delegation of authority, by a healthcare entity or network plan to perform one or more of the functions and responsibilities of a healthcare entity and/or network plan set forth in this chapter or regulations or guidance promulgated thereunder.  (15) Emergency services or emergent services means those resources provided in the event of the sudden onset of a medical, behavioral health, or other health condition that the absence of immediate medical attention could reasonably be expected, by a prudent layperson, to result in placing the patients health in serious jeopardy, serious impairment to bodily or mental functions, or serious dysfunction of any bodily organ or part.  (16) External review means a review of a non-administrative adverse benefit determination (including final internal adverse benefit determination) conducted pursuant to an applicable external review process performed by an independent review organization.  (17) External review decision means a determination by an independent review organization at the conclusion of the external review.  (18) Final internal adverse benefit determination means an adverse benefit determination that has been upheld by a plan or issuer at the completion of the internal appeals process or when the internal appeals process has been deemed exhausted as defined in  27-18.9-7(b)(1).  (19) Health-benefit plan or health plan means a policy, contract, certificate, or agreement entered into, offered, or issued by a healthcare entity to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services.  (20) Healthcare entity means an insurance company licensed, or required to be licensed, by the state of Rhode Island or other entity subject to the jurisdiction of the commissioner or the jurisdiction of the department of business regulation pursuant to chapter 62 of title 42, that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including, without limitation: a for-profit or nonprofit hospital, medical or dental service corporation or plan, a health maintenance organization, a health insurance company, or any other entity providing a plan of health insurance, accident and sickness insurance, health benefits, or healthcare services.  (21) Healthcare services means and includes, but is not limited to: an admission, diagnostic procedure, therapeutic procedure, treatment, extension of stay, the ordering and/or filling of formulary or non-formulary medications, and any other medical, behavioral, dental, vision care services, activities, or supplies that are covered by the beneficiarys health-benefit plan.  (22) Independent review organization or IRO means an entity that conducts independent external reviews of adverse benefit determinations or final internal adverse benefit determinations.  (23) Network means the group or groups of participating providers providing healthcare services under a network plan.  (24) Network plan means a health-benefit plan or health plan that either requires a beneficiary to use, or creates incentives, including financial incentives, for a beneficiary to use the providers managed, owned, under contract with, or employed by the healthcare entity.  (25) Office means the office of the health insurance commissioner.  (26) Pre-service claim means the request for a plan benefit(s) by a claimant prior to a service being rendered and is not considered a concurrent claim.  (27) Professional provider means an individual provider or healthcare professional licensed, accredited, or certified to perform specified healthcare services consistent with state law and who provides healthcare services and is not part of a separate facility or institutional contract.  (28) Prospective assessment or pre-service assessment means an assessment of healthcare services prior to services being rendered.  (29) Provider means a physician, hospital, professional provider, pharmacy, laboratory, dental, medical, or behavioral health provider or other state-licensed or other state-recognized provider of health care or behavioral health services or supplies.  (30) Retrospective assessment or post-service assessment means an assessment of healthcare services that have been rendered. This shall not include reviews conducted when the review agency has been obtaining ongoing information.  (31) Retrospective claim or post-service claim means any claim for a health-plan benefit that is not a pre-service or concurrent claim.  (32) Review agent means a person or healthcare entity performing benefit determination reviews that is either employed by, affiliated with, under contract with, or acting on behalf of a healthcare entity.  (33) Same or similar specialty means a practitioner who has the appropriate training and experience that is the same or similar as the attending provider in addition to experience in treating the same problems to include any potential complications as those under review.  (34) Therapeutic interchange means the interchange or substitution of a drug with a dissimilar chemical structure within the same therapeutic or pharmacological class that can be expected to have similar outcomes and similar adverse reaction profiles when given in equivalent doses, in accordance with protocols approved by the president of the medical staff or medical director and the director of pharmacy.  (35) Tiered network means a network that identifies and groups some or all types of providers into specific groups to which different provider reimbursement, beneficiary cost-sharing, or provider access requirements, or any combination thereof, apply for the same services.  (36) Urgent healthcare services includes those resources necessary to treat a symptomatic medical, mental health, substance use, or other healthcare condition that a prudent layperson, acting reasonably, would believe necessitates treatment within a twenty-four hour (24) period of the onset of such a condition in order that the patients health status not decline as a consequence. This does not include those conditions considered to be emergent healthcare services as defined in this section.  (37) Utilization review means the prospective, concurrent, or retrospective assessment of the medical necessity and/or appropriateness of the allocation of healthcare services of a provider, given or proposed to be given, to a beneficiary. Utilization review does not include:  (i) The therapeutic interchange of drugs or devices by a pharmacy operating as part of a licensed inpatient healthcare facility; or  (ii) The assessment by a pharmacist licensed pursuant to the provisions of chapter 19.1 of title 5, and practicing in a pharmacy operating as part of a licensed inpatient healthcare facility, in the interpretation, evaluation and implementation of medical orders, including assessments and/or comparisons involving formularies and medical orders.  (38) Utilization review plan means a description of the standards governing utilization review activities performed by a review agent.  History of Section.P.L. 2017, ch. 302, art. 5,  5; P.L. 2018, ch. 346,  20. 
 27-18.9-3. Certification and recertification of review agents. (a) A review agent shall not conduct benefit determination reviews in the state unless the office has granted the review agent a certificate.  (b) Individuals shall not be required to hold a separate review agent certification under this chapter when acting as either an employee of, an affiliate of, a contractor for, or otherwise acting on behalf of a certified review agent.  (c) The commissioner shall establish a process for the certification of review agents meeting the requirements of certification.  (d) The commissioner shall establish procedures for the periodic review and recertification of review agents at least every three (3) years.  (e) A certificate issued under this chapter is not transferable, and the transfer of fifty percent (50%) or more of the ownership of a review agent shall be deemed a transfer.  (f) The office shall issue a review agent certificate to an applicant who or that has met the minimum standards defined in this chapter, and regulations promulgated in accordance with it, including the payment of any fees as required, and other applicable regulations of the office.  (g) In the event of any systemic changes in the review agent certification information on file with the office, the review agent shall submit notice and explanation of this change for approval by the commissioner at least thirty (30) calendar days prior to implementation of any such change.  (h) The total cost of obtaining and maintaining a review agent certification under this title and in compliance with the requirements of the applicable rules and regulations shall be borne by the applicant and shall include one hundred fifty percent (150%) of the total salaries paid to the personnel engaged in certifications and ensuring compliance with the requirements herein and applicable rules and regulations. These monies shall be paid to the commissioner to and for the use of the office and shall be in addition to any taxes and fees otherwise payable to the state.  (i) Notwithstanding any other provision of law, the review agent, the office, and all other parties privy to information that is the subject of this chapter shall comply with all state and federal confidentiality laws, including, but not limited to, chapter 37.3 of title 5 (confidentiality of health care communications and information act) and specifically  5-37.3-4(c), which requires limitation on the distribution of information that is the subject of this chapter on a need to know basis, and  40.1-5-26.  (j) The office may, in response to a complaint or inquiry, review a benefit determination or appeal and may request information of the review agent, provider, or beneficiary regarding the status, outcome, or rationale regarding any decision. The review agent shall promptly respond to any such requests by the office.  (k) The office shall adopt regulations necessary to implement the provisions of this chapter.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-4. Application requirements. An application for review agent certification or recertification shall include, but is not limited to, documentation to evidence the following:  (a) Administrative and non-administrative benefit determinations:(1) That the healthcare entity or its review agent provide beneficiaries and providers with a summary of its benefit determination review programs and adverse benefit determination criteria in a manner acceptable to the commissioner that includes a summary of the standards, procedures, and methods to be used in evaluating proposed, concurrent, or delivered healthcare services;  (2) The circumstances, if any, under which review agent may be delegated to and evidence that the delegated review agent is a certified review agent pursuant to the requirements of this chapter;  (3) A complaint resolution process acceptable to the commissioner, whereby beneficiaries or other healthcare providers may seek resolution of complaints and other matters of which the review agent has received notice;  (4) Policies and procedures to ensure that all applicable state and federal laws to protect the confidentiality of individual medical records are followed;  (5) Requirements that no employee of, or other individual rendering an adverse benefit determination or appeal decision may receive any financial or other incentives based upon the number of denials of certification made by that employee or individual;  (6) Evidence that the review agent has not entered into a compensation agreement or contract with its employees or agents whereby the compensation of its employees or its agents is based, directly or indirectly, upon a reduction of services or the charges for those services, the reduction of length of stay, or use of alternative treatment settings;  (7) An adverse benefit determination and internal appeals process consistent with chapter 18.9 of title 27 and acceptable to the office, whereby beneficiaries, their physicians, or other healthcare service providers may seek prompt reconsideration or appeal of adverse benefit determinations by the review agent according to all state and federal requirements; and  (8) That the healthcare entity or its review agent has a mechanism to provide the beneficiary or claimant with a description of its claims procedures and any procedures for obtaining approvals as a prerequisite for obtaining a benefit or for obtaining coverage for such benefit. This description should, at a minimum, be placed in the summary of benefits document and available on the review agents or the relevant healthcare entitys website and upon request from the claimant, his/her authorized representative and ordering providers.   (b) Non-administrative benefit determinations general requirements:(1) Type and qualifications of personnel (employed or under contract) authorized to perform utilization review, including a requirement that only a provider with the same license status as the ordering professional provider or a licensed physician or dentist is permitted to make a prospective or concurrent utilization review adverse benefit determination;  (2) Requirement that a representative of the utilization review agent is reasonably accessible to beneficiaries and providers at least five (5) days a week during normal business hours in Rhode Island and during the hours of the agencys operations when conducting utilization review;  (3) Policies and procedures regarding the notification and conduct of patient interviews by the utilization review agent to include a process and assurances that such interviews do not disrupt care; and  (4) Requirement that the utilization review agent shall not impede the provision of healthcare services for treatment and/or hospitalization or other use of a providers services or facilities for any beneficiary.   History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-5. Administrative and non-administrative benefit determination procedural requirements. (a) Procedural failure by claimant.(1) In the event of the failure of claimant or an authorized representative to follow the healthcare entities claims procedures for a pre-service claim the healthcare entity or its review agent must:  (i) Notify claimant or the authorized representative, as appropriate, of this failure as soon as possible and no later than five (5) calendar days following the failure and this notification must also inform claimant of the proper procedures to file a pre-service claim; and  (ii) Notwithstanding the above, if the pre-service claim relates to urgent or emergent healthcare services, the healthcare entity or its review agent must notify and inform claimant or the authorized representative, as appropriate, of the failure and proper procedures within twenty-four (24) hours following the failure. Notification may be oral, unless written notification is requested by the claimant or authorized representative.  (2) Claimant must have stated name, specific medical condition or symptom and specific treatment, service, or product for which approval is requested and submitted to proper claim processing unit.   (b) Utilization review agent procedural requirements:(1) All initial, prospective, and concurrent non-administrative, adverse benefit determinations of a healthcare service that had been ordered by a physician, dentist, or other practitioner shall be made, documented, and signed by a licensed practitioner with the same licensure status as the ordering provider;  (2) Utilization review agents are not prohibited from allowing appropriately qualified review agency staff from engaging in discussions with the attending provider, the attending providers designee or appropriate healthcare facility and office personnel regarding alternative service and/or treatment options. Such a discussion shall not constitute an adverse benefit determination; provided, however, that any change to the attending providers original order and/or any decision for an alternative level of care must be made and/or appropriately consented to by the attending provider or the providers designee responsible for treating the beneficiary and must be documented by the review agent; and  (3) A utilization review agent shall not retrospectively deny authorization for healthcare services provided to a covered person when an authorization has been obtained for that service from the review agent unless the approval was based upon inaccurate information material to the review or the healthcare services were not provided consistent with the providers submitted plan of care and/or any restrictions included in the prior approval granted by the review agent.   History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-6. Non-administrative benefit determination notifications. (a) Benefit determination notification timelines. A healthcare entity and/or its review agent shall comply with the following:  (1) For urgent or emergent healthcare services, benefit determinations (adverse or non-adverse) shall be made as soon as possible taking into account exigencies but not later than 72 hours after receipt of the claim.  (2) For concurrent claims (adverse or non-adverse), no later than twenty-four (24) hours after receipt of the claim and prior to the expiration of the period of time or number of treatments. The claim must have been made to the healthcare entity or review agent at least twenty-four (24) hours prior to the expiration of the period of time or number of treatments.  (3) For pre-service claims (adverse or non-adverse), within a reasonable period of time appropriate to the medical circumstances, but not later than fifteen (15) calendar days after the receipt of the claim. This may be extended up to fifteen (15) additional calendar days if required by special circumstances and claimant is noticed within the first fifteen (15) calendar-day period.  (4) For post-service claims adverse benefit determination no later than thirty (30) calendar days after the receipt of the claim. This may be extended for fifteen (15) calendar days if substantiated and claimant is noticed within the first thirty (30) calendar day period.  (5) Provision in the event of insufficient information from a claimant.  (i) For urgent or emergent care, the healthcare entity or review agent must notify claimant as soon as possible, depending on exigencies, but no later than twenty-four (24) hours after receipt of claim giving specifics as to what information is needed. The healthcare entity or review agent must allow claimant at least forty-eight (48) hours to send additional information. The healthcare entity or review agent must provide benefit determination as soon as possible and no later than forty-eight (48) hours after receipt of necessary additional information or end of period afforded to the claimant to provide additional information, whichever is earlier.  (ii) For pre-service and post-service claims, the notice by the healthcare entity or review agent must include what specific information is needed. The claimant has forty-five (45) calendar days from receipt of notice to provide information.  (iii) Timelines for decisions, in the event of insufficient information, are paused from the date on which notice is sent to the claimant and restarted when the claimant responds to the request for information.  (b) Adverse benefit determination notifications form and content requirements. Healthcare entities and review agents shall comply with form and content notification requirements, to include the following:  (1) Notices may be written or electronic with reasonable assurance of receipt by claimant unless urgent or emergent. When urgent or emergent, oral notification is acceptable, absent a specific request by claimant for written or electronic notice, followed by written or electronic notification within three (3) calendar days.  (2) Notification content shall:  (i) Be culturally and linguistically appropriate;  (ii) Provide details of a claim that is being denied to include date of service, provider, amount of claim, a statement describing the availability, upon request, of the diagnosis code and its corresponding meaning, and the treatment code and its corresponding meaning as applicable;  (iii) Give specific reason or reasons for the adverse benefit determination;  (iv) Include the reference(s) to specific health benefit plan or review agent provisions, guideline, protocol, or criterion on which the adverse benefit determination is based;  (v) If the decision is based on medical necessity, clinical criteria or experimental treatment or similar exclusion or limit, then notice must include the scientific or clinical judgment for the adverse determination;  (vi) Provide information for the beneficiary as to how to obtain copies of any and all information relevant to the denied claim free of charge;  (vii) Describe the internal and external appeal processes, as applicable, to include all relevant review agency contacts and OHICs consumer assistance program information;  (viii) Clearly state timeline that the claimant has at least one hundred eighty (180) calendar days following the receipt of notification of an adverse benefit determination to file an appeal; and  (ix) Be written in a manner to convey clinical rationale in layperson terms when appropriate based on clinical condition and age and in keeping with federal and state laws and regulations.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-7. Internal appeal procedural requirements. (a) Administrative and non-administrative appeals. The review agent shall conform to the following for the internal appeal of administrative or non-administrative, adverse benefit determinations:  (1) The review agent shall maintain and make available a written description of its appeal procedures by which either the beneficiary or the provider of record may seek review of determinations not to authorize healthcare services.  (2) The process established by each review agent may include a reasonable period within which an appeal must be filed to be considered and that period shall not be less than one hundred eighty (180) calendar days after receipt of the adverse benefit determination notice.  (3) During the appeal, a review agent may utilize a reconsideration process in assessing an adverse benefit determination. If utilized, the review agent shall develop a reasonable reconsideration and appeal process, in accordance with this section. For non-administrative, adverse benefit determinations, the period for the reconsideration may not exceed fifteen (15) days from the date the request for reconsideration or appeal is received. The review agent shall notify the beneficiary and/or provider of the reconsideration determination with the form and content described in  27-18.9-6(b), as appropriate. Following the decision on reconsideration, the beneficiary and/or provider shall have a period of forty-five (45) calendar days during which the beneficiary and/or provider may request an appeal of the reconsideration decision and/or submit additional information.  (4) Prior to a final internal appeal decision, the review agent must allow the claimant to review the entire adverse determination and appeal file and allow the claimant to present evidence and/or additional testimony as part of the internal appeal process.  (5) A review agent is only entitled to request and review information or data relevant to the benefit determination and utilization review processes.  (6) The review agent shall maintain records of written adverse benefit determinations, reconsiderations, appeals and their resolution, and shall provide reports as requested by the office.  (7)(i) The review agent shall notify, in writing, the beneficiary and/or provider of record of its decision on the administrative appeal in no case later than thirty (30) calendar days after receipt of the request for the review of an adverse benefit determination for pre-service claims, and sixty (60) days for post-service claims, commensurate with 29 C.F.R.  2560.503-1(i)(2)(ii) and (iii).  (ii) The review agent shall notify, in writing, the beneficiary and provider of record of its decision on the non-administrative appeal as soon as practical considering medical circumstances, but in no case later than thirty (30) calendar days after receipt of the request for the review of an adverse benefit determination, inclusive of the period to conduct the reconsideration, if any. The timeline for decision on appeal is paused from the date on which the determination on reconsideration is sent to the beneficiary and/or provider and restarted when the beneficiary and/or provider submits additional information and/or a request for appeal of the reconsideration decision.  (8) The review agent shall also provide for an expedited appeal process for urgent and emergent situations taking into consideration medical exigencies. Notwithstanding any other provision of this chapter, each review agent shall complete the adjudication of expedited appeals, including notification of the beneficiary and provider of record of its decision on the appeal, not later than seventy-two (72) hours after receipt of the claimants request for the appeal of an adverse benefit determination.  (9) Benefits for an ongoing course of treatment cannot be reduced or terminated without providing advance notice and an opportunity for advance review. The review agent or healthcare entity is required to continue coverage pending the outcome of an appeal.  (10) A review agent may not disclose or publish individual medical records or any confidential information obtained in the performance of benefit determination or utilization review activities. A review agent shall be considered a third-party health insurer for the purposes of  5-37.3-6(b)(6) and shall be required to maintain the security procedures mandated in  5-37.3-4(c).  (b) Non-administrative appeals. In addition to subsection (a) of this section the utilization review agent shall conform to the following for its internal appeals adverse benefit determinations:  (1) A claimant is deemed to have exhausted the internal claims appeal process when the utilization review agent or healthcare entity fails to strictly adhere to all benefit determination and appeal processes with respect to a claim. In this case the claimant may initiate an external appeal or remedies under section 502(a) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1001 et seq., or other state and federal law, as applicable.  (2) No reviewer under this section, who has been involved in prior reviews or in the adverse benefit determination under appeal or who has participated in the direct care of the beneficiary, may participate in reviewing the case under appeal.  (3) All internal-level appeals of utilization review determinations not to authorize a healthcare service that had been ordered by a physician, dentist, or other provider shall be made according to the following:  (i) The reconsideration decision of a non-administrative, adverse benefit determination shall not be made until the utilization review agents professional provider with the same licensure status as typically manages the condition, procedure, treatment, or requested service under discussion has spoken to, or otherwise provided for, an equivalent two-way, direct communication with the beneficiarys attending physician, dentist, other professional provider, or other qualified professional provider responsible for treatment of the beneficiary concerning the services under review.  (ii) A review agent who does not utilize a reconsideration process must comply with the peer-review obligation described in subsection (b)(3)(i) of this section as part of the appeal process.  (iii) When the appeal of any adverse benefit determination, including an appeal of a reconsideration decision, is based in whole or in part on medical judgment, including determinations with regard to whether a particular service, treatment, drug, or other item is experimental, investigational or not medically necessary or appropriate, the reviewer making the appeal decision must be appropriately trained having the same licensure status as the ordering provider or be a physician or dentist and be in the same or similar specialty as typically manages the condition. These qualifications must be provided to the claimant upon request.  (iv) The utilization review agency reviewer must document and sign their decisions.  (4) The review agent must ensure that an appropriately licensed practitioner or licensed physician is reasonably available to review the case as required under this subsection (b) and shall conform to the following:  (i) Each agency peer reviewer shall have access to and review all necessary information as requested by the agency and/or submitted by the provider(s) and/or beneficiaries;  (ii) Each agency shall provide accurate peer review contact information to the provider at the time of service, if requested, and/or prior to such service, if requested. This contact information must provide a mechanism for direct communication with the agencys peer reviewer; and  (iii) Agency peer reviewers shall respond to the providers request for a two-way, direct communication defined in this subsection (b) as follows:  (A) For a prospective review of non-urgent and non-emergent healthcare services, a response within one business day of the request for a peer discussion;  (B) For concurrent and prospective reviews of urgent and emergent healthcare services, a response within a reasonable period of time of the request for a peer discussion; and  (C) For retrospective reviews, prior to the internal-level appeal decision.  (5) The review agency will have met the requirements of a two-way, direct communication, when requested and/or as required prior to the internal level of appeal, when it has made two (2) reasonable attempts to contact the attending provider directly. Repeated violations of this section shall be deemed to be substantial violations pursuant to  27-18.9-9 and shall be cause for the imposition of penalties under that section.  (6) For the appeal of an adverse benefit determination decision that a drug is not covered, the review agent shall complete the internal-appeal determination and notify the claimant of its determination:  (i) No later than seventy-two (72) hours following receipt of the appeal request; or  (ii) No later than twenty-four (24) hours following the receipt of the appeal request in cases where the beneficiary is suffering from a health condition that may seriously jeopardize the beneficiarys life, health, or ability to regain maximum function or when a beneficiary is undergoing a current course of treatment using a non-formulary drug.  (iii) And if approved on appeal, coverage of the non-formulary drug must be provided for the duration of the prescription, including refills unless expedited then for the duration of the exigency.  (7) The review agents using clinical criteria and medical judgment in making utilization review decisions shall comply with the following:  (i) The requirement that each review agent shall provide its clinical criteria to OHIC upon request;  (ii) Provide and use written clinical criteria and review procedures established according to nationally accepted standards, evidence-based medicine and protocols that are periodically evaluated and updated or other reasonable standards required by the commissioner;  (iii) Establish and employ a process to incorporate and consider local variations to national standards and criteria identified herein including without limitation, a process to incorporate input from local participating providers; and  (iv) Updated description of clinical decision criteria to be available to beneficiaries, providers, and the office upon request and readily available and accessible on the healthcare entity or the review agents website.  (8) The review agent shall maintain records of written, adverse benefit determination reconsiderations and appeals to include their resolution, and shall provide reports and other information as requested by the office.  History of Section.P.L. 2017, ch. 302, art. 5,  5; P.L. 2018, ch. 346,  20. 
 27-18.9-8. External appeal procedural requirements. (a) General requirements.(1) In cases where the non-administrative, adverse benefit determination or the final internal level of appeal to reverse a non-administrative, adverse benefit determination is unsuccessful, the healthcare entity or review agent shall provide for an external appeal by an independent review organization (IRO) approved by the commissioner and ensure that the external appeal complies with all applicable laws and regulations.  (2) In order to seek an external appeal, claimant must have exhausted the internal claims and appeal process unless the utilization review agent or healthcare entity has waived the internal appeal process by failing to comply with the internal appeal process or the claimant has applied for expedited external review at the same time as applying for expedited internal review.  (3) A claimant shall have at least four (4) months after receipt of a notice of the decision on a final internal appeal to request an external appeal by an IRO.  (4) Healthcare entities and review agents must use a rotational IRO registry system specified by the commissioner, and must select an IRO in the rotational manner described in the IRO registry system.  (5) A claimant requesting an external appeal may be charged no more than a twenty-five dollar ($25.00) external appeal fee by the review agent. The external appeal fee, if charged, must be refunded to the claimant if the adverse benefit determination is reversed through external review. The external appeal fee must be waived if payment of the fee would impose an undue financial hardship on the beneficiary. In addition, the annual limit on external appeal fees for any beneficiary within a single plan year (in the individual market, within a policy year) must not exceed seventy-five dollars ($75.00). Notwithstanding the aforementioned, this subsection shall not apply to excepted benefits as defined in 42 U.S.C.  300gg-91(c).  (6) IRO and/or the review agent and/or the healthcare entity may not impose a minimum dollar amount of a claim for a claim to be eligible for external review by an IRO.  (7) The decision of the external appeal by the IRO shall be binding on the healthcare entity and/or review agent; however, any person who is aggrieved by a final decision of the external appeal agency is entitled to judicial review in a court of competent jurisdiction.  (8) The healthcare entity must provide benefits (including making payment on the claim) pursuant to an external review decision without delay regardless whether the healthcare entity or review agent intends to seek judicial review of the IRO decision.  (9) The commissioner shall promulgate rules and regulations including, but not limited to, criteria for designation, operation, policy, oversight, and termination of designation as an IRO. The IRO shall not be required to be certified under this chapter for activities conducted pursuant to its designation.   (b) The external appeal process shall include, but not be limited to, the following characteristics:  (1) The claimant must be noticed that he/she shall have at least five (5) business days from receipt of the external appeal notice to submit additional information to the IRO.  (2) The IRO must notice the claimant of its external appeal decision to uphold or overturn the review agency decision:  (i) No more than ten (10) calendar days from receipt of all the information necessary to complete the external review and not greater than forty-five (45) calendar days after the receipt of the request for external review; and  (ii) In the event of an expedited external appeal by the IRO for urgent or emergent care, as expeditiously as possible and no more than seventy-two (72) hours after the receipt of the request for the external appeal by the IRO. Notwithstanding provisions in this section to the contrary, this notice may be made orally but must be followed by a written decision within forty-eight (48) hours after oral notice is given.  (3) For an external appeal of an internal appeal decision that a drug is not covered, the IRO shall complete the external appeal determination and notify the claimant of its determination:  (i) No later than seventy-two (72) hours following receipt of the external appeal request; or  (ii) No later than twenty-four (24) hours following the receipt of the external appeal request if the original request was an expedited request; and  (iii) If approved on external appeal, coverage of the non-formulary drug must be provided for the duration of the prescription, including refills, unless expedited then for the duration of the exigencies.  (c) External appeal decision notifications. The healthcare entity and review agent must ensure that the IRO adheres to the following relative to decision notifications:  (1) May be written or electronic with reasonable assurance of receipt by claimant unless urgent or emergent. If urgent or emergent, oral notification is acceptable followed by written or electronic notification within three (3) calendar days;  (2) Must be culturally and linguistically appropriate;  (3) The details of claim that is being denied to include the date of service, provider name, amount of claim, diagnostic code, and treatment costs with corresponding meanings;  (4) Must include the specific reason or reasons for the external appeal decision;  (5) Must include information for claimant as to procedure to obtain copies of any and all information relevant to the external appeal which copies must be provided to the claimant free of charge; and  (6) Must not be written in a manner that could reasonably be expected to negatively impact the beneficiary.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18.9-9. Reporting requirements. The office shall establish reporting requirements to determine if adverse benefit determination and/or utilization review programs are in compliance with the provisions of this chapter and applicable regulations as well as in compliance with applicable federal law.  History of Section.P.L. 2017, ch. 302, art. 5,  5. 
 27-18-1.1. Definitions. As used in this chapter: (1) Adverse benefit determination means any of the following: a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of an individuals eligibility to participate in a plan or to receive coverage under a plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit resulting from the application of any utilization review, as well as a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate. The term also includes a rescission of coverage determination.  (2) Affordable Care Act means the federal Patient Protection and Affordable Care Act of 2010, as amended by the federal Health Care and Education Reconciliation Act of 2010, and federal regulations adopted thereunder.  (3) Commissioner or health insurance commissioner means that individual appointed pursuant to  42-14.5-1 of the general laws.  (4) Essential health benefits shall have the meaning set forth in section 1302(b) of the federal Affordable Care Act,  (5) Grandfathered health plan means any group health plan or health insurance coverage subject to 42 U.S.C.  18011.  (6) Group health insurance coverage means, in connection with a group health plan, health insurance coverage offered in connection with such plan.  (7) Group health plan means an employee welfare benefit plan, as defined in 29 U.S.C.  1002(1), to the extent that the plan provides health benefits to employees or their dependents directly or through insurance, reimbursement, or otherwise.  (8) Health benefits or covered benefits means coverage or benefits for the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body including coverage or benefits for transportation primarily for and essential thereto, and including medical services as defined in  27-19-17;  (9) Healthcare facility means an institution providing healthcare services or a healthcare setting, including, but not limited to, hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings.  (10) Healthcare professional means a physician or other healthcare practitioner licensed, accredited or certified to perform specified healthcare services consistent with state law.  (11) Healthcare provider or provider means a healthcare professional or a healthcare facility.  (12) Healthcare services means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease.  (13) Health insurance carrier means a person, firm, corporation or other entity subject to the jurisdiction of the commissioner under this chapter. Such term does not include a group health plan.  (14) Health plan or health benefit plan means health insurance coverage and a group health plan, including coverage provided through an association plan if it covers Rhode Island residents. Except to the extent specifically provided by the federal Affordable Care Act, the term health plan shall not include a group health plan to the extent state regulation of the health plan is preempted under section 514 [29 U.S.C.  1144] of the federal Employee Retirement Income Security Act of 1974. The term also shall not include:  (A)(i) Coverage only for accident, or disability income insurance, or any combination thereof.  (ii) Coverage issued as a supplement to liability insurance.  (iii) Liability insurance, including general liability insurance and automobile liability insurance.  (iv) Workers compensation or similar insurance.  (v) Automobile medical payment insurance.  (vi) Credit-only insurance.  (vii) Coverage for on-site medical clinics.  (viii) Other similar insurance coverage, specified in federal regulations issued pursuant to Pub. L. No. 104-191, the federal health insurance portability and accountability act of 1996 (HIPAA), under which benefits for medical care are secondary or incidental to other insurance benefits.  (B) The following benefits if they are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the plan:  (i) Limited scope dental or vision benefits.  (ii) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.  (iii) Other excepted benefits specified in federal regulations issued pursuant to federal Pub. L. No. 104-191 (HIPAA).  (C) The following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor:  (i) Coverage only for a specified disease or illness.  (ii) Hospital indemnity or other fixed indemnity insurance.  (D) The following if offered as a separate policy, certificate or contract of insurance:  (i) Medicare supplement health insurance as defined under section 1882(g)(1) [42 U.S.C.  1395ss] of the federal Social Security Act.  (ii) Coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code (Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)).  (iii) Similar supplemental coverage provided to coverage under a group health plan.  (15) Office of the health insurance commissioner means the agency established under  42-14.5-1.  (16) Rescission means a cancellation or discontinuance of coverage that has retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.  History of Section.P.L. 2012, ch. 256,  2; P.L. 2012, ch. 262,  2. 
 27-18-1. Policy of accident and sickness insurance construed. Policy of accident and sickness insurance, as used in this chapter, includes any policy or contract covering against loss resulting from sickness or from bodily injury or death by accident, or both.  History of Section.P.L. 1956, ch. 3808,  1; G.L. 1956,  27-18-1. 
 27-18-10. Compliance by domestic insurer with laws of other states. Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of that other state or country.  History of Section.P.L. 1956, ch. 3808,  3; G.L. 1956,  27-18-10. 
 27-18-11. Application of provisions to policy issued to nonresident. If any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of the insurance laws of the other state has advised the commissioner that the policy is not subject to approval or disapproval by the official, the commissioner may by ruling require that the policy meet the standards set forth in  27-18-2  27-18-10.  History of Section.P.L. 1956, ch. 3808,  2; G.L. 1956,  27-18-11. 
 27-18-12. Less favorable provisions prohibited. No policy provision that is not subject to  27-18-3  27-18-10 shall make a policy, or any portion of a policy, less favorable in any respect to the insured or the beneficiary than the provisions of the policy which are subject to this chapter.  History of Section.P.L. 1956, ch. 3808,  4; G.L. 1956,  27-18-12. 
 27-18-13. Effect of policies inconsistent with chapter. A policy delivered or issued for delivery to any person in this state in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties, and obligations of the insurer, the insured, and the beneficiary shall be governed by the provisions of this chapter.  History of Section.P.L. 1956, ch. 3808,  4; G.L. 1956,  27-18-13. 
 27-18-14. Copies of applications. The insured shall not be bound by any statement made in an application for a policy unless a copy of the application is attached to or endorsed on the policy when issued as a part of the policy. If the policy delivered or issued for delivery to any person in this state shall be reinstated or renewed, and the insured or the beneficiary or assignee of the policy shall make written request to the insurer for a copy of the application, if any, for the reinstatement or renewal, the insurer shall within fifteen (15) days after the receipt of the request at its home office or any branch office of the insurer, deliver or mail to the person making the request a copy of the application. If the copy shall not be delivered or mailed in this manner, the insurer shall be precluded from introducing the application as evidence in any action or proceeding based upon or involving the policy or its reinstatement or renewal.  History of Section.P.L. 1956, ch. 3808,  5; G.L. 1956,  27-18-14. 
 27-18-15. Alteration of application. No alteration of any written application for the policy shall be made by any person other than the applicant without his or her written consent, except that insertions may be made by the insurer, for administrative purposes only, in a manner to indicate clearly that the insertions are not to be ascribed to the applicant.  History of Section.P.L. 1956, ch. 3808,  5; G.L. 1956,  27-18-15. 
 27-18-16. False statements in application. 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.  History of Section.P.L. 1956, ch. 3808,  5; G.L. 1956,  27-18-16. 
 27-18-17. Acts not constituting waiver of insurers defenses. The acknowledgment by an insurer of the receipt of notice given under any policy covered by this chapter, the furnishing of forms for filing proofs of loss, or the acceptance of those proofs, or the investigation of any claim under the policy, shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under the policy.  History of Section.P.L. 1956, ch. 3808,  6; G.L. 1956,  27-18-17. 
 27-18-18. Acceptance of premiums after effective period of policy. If a policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if the date falls within a period for which a premium is accepted by the insurer or if the insurer accepts a premium after the date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which the premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of the premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.  History of Section.P.L. 1956, ch. 3808,  7; G.L. 1956,  27-18-18. 
 27-18-19. Insurance exempt from chapter. Nothing in the chapter shall apply to or affect: (1) Any policy of workers compensation insurance or any policy of liability insurance with or without supplementary expense coverage in the policy;  (2) Any policy or contract of reinsurance; or  (3) [Deleted by P.L. 2017, ch. 196,  4 and P.L. 2017, ch. 322,  4].  (4) Life insurance, endowment, or annuity contracts, or contracts supplemental to those contracts, which contain only those provisions relating to accident and sickness insurance as: (i) Provide additional benefits in case of death or dismemberment or loss of sight by accident, or (ii) Operate to safeguard those contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract.  History of Section.P.L. 1956, ch. 3808,  8; G.L. 1956,  27-18-19; P.L. 2017, ch. 196,  4; P.L. 2017, ch. 322,  4. 
 27-18-2.1. Uniform explanation of benefits and coverage. (a) A health insurance carrier shall provide a summary of benefits and coverage explanation and definitions to policyholders and others required by, and at the times and in the format required, by the federal regulations adopted under section 2715 [42 U.S.C.  300gg-15] of the Public Health Service Act, as amended by the federal Affordable Care Act. The forms required by this section shall be made available to the commissioner on request. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.  (b) The provisions of this section shall apply to grandfathered health plans. This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  (c) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.  History of Section.P.L. 2012, ch. 256,  2; P.L. 2012, ch. 262,  2. 
 27-18-2. Form of policy. No policy of accident and sickness insurance shall be delivered or issued for delivery to any person in this state unless:  (1) The entire money and other considerations for it are expressed in the policy;  (2) The time at which the insurance takes effect and terminates is expressed in the policy;  (3) It purports to insure only one person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family who shall be deemed the policyholder, any two (2) or more eligible members of that family, including husband, wife, dependent children or any children under a specified age which shall not exceed nineteen (19) years, and any other person dependent upon the policyholder;  (4) The style, arrangement, and overall appearance of the policy give no undue prominence to any portion of the text, and unless every printed portion of the text of the policy and of any endorsements or attached papers is plainly printed in light faced type of a style in general use, the size of which shall be uniform and not less than ten-point with a lower case unspaced alphabet length not less than one hundred and twenty (120) point; the text shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description if any, and captions and subcaptions;  (5) The exceptions and reductions of indemnity are set forth in the policy and, except those which are set forth in  27-18-3  27-18-10 are printed, at the insurers option, either included with the benefit provision to which they apply, or under an appropriate caption such as EXCEPTIONS, or EXCEPTIONS AND REDUCTIONS; provided, that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of the exception or reduction shall be included with the benefit provision to which it applies;  (6) Each form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page of the form; and  (7) It contains no provision purporting to make any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy unless the portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short rate table filed with the insurance commissioner, referred to in this chapter as the commissioner.  History of Section.P.L. 1956, ch. 3808,  2; G.L. 1956,  27-18-2. 
 27-18-20. Penalties for violations. Any person, partnership, or corporation willfully violating any provision of this chapter or order of the commissioner made in accordance with this chapter shall forfeit to the people of the state a sum not to exceed one hundred dollars ($100) for each violation, which may be recovered by a civil action. The commissioner may also suspend or revoke the license of an insurer or insurance producer for any of these willful violations.  History of Section.P.L. 1956, ch. 3808,  9; G.L. 1956,  27-18-20. 
 27-18-21. Appeals from commissioner. 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.  History of Section.P.L. 1956, ch. 3808,  10; G.L. 1956,  27-18-21. 
 27-18-22. Effect on other law. Nothing in this chapter shall be construed to repeal the provisions of chapter 13.1 of this title.  History of Section.P.L. 1956, ch. 3808,  12; G.L. 1956,  27-18-22; P.L. 2002, ch. 292,  35. 
 27-18-23. Severability. 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.  History of Section.P.L. 1956, ch. 3808,  11; G.L. 1956,  27-18-23. 
 27-18-24. Immunity of benefits from process. The proceeds, avails, and benefits to be paid by virtue of any policy of accident and sickness insurance shall not be liable to attachment, garnishment, or other process, or be seized, taken, appropriated, or applied by any legal or equitable process or operation of law to pay any debt or liability of the owner, insured, beneficiary, or any person who may have any right under the policy; provided, that, subject to any statute of limitations, the amount of any premiums for the insurance paid with the intent to defraud creditors, with interest on that amount, shall inure to their benefit from the proceeds of the policy, but the company issuing the policy shall be discharged of all liability on it by payment of its proceeds in accordance with its terms unless, before the payment, the company shall have written notice by or on behalf of a creditor of a claim to recover for premiums paid with intent to defraud creditors with specifications of the amounts claimed.  History of Section.P.L. 1962, ch. 179,  1. 
 27-18-25. Unfair discrimination prohibited. Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services that may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37 of title 5.  History of Section.P.L. 1968, ch. 98,  1; P.L. 1989, ch. 542,  79; P.L. 1991, ch. 62,  1; P.L. 1992, ch. 452,  1; P.L. 2002, ch. 292,  33; P.L. 2017, ch. 165,  1; P.L. 2017, ch. 314,  1. 
 27-18-26. Physical examinations by insurance company. 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 which were performed at the request or direction of the company. The reports shall only be provided to a physician of the applicants 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.  History of Section.P.L. 1981, ch. 412,  2. 
 27-18-27. Adoptive children. Subscribers to any accident and sickness insurance plan who have satisfied the continuous membership requirement of the plan and who adopt children under the guardianship and custody of the director of the department of children, youth, and families shall be afforded coverage under the plan for an adopted child without any waiting period, notwithstanding the fact that the adopted child may have any preexisting medical condition.  History of Section.P.L. 1982, ch. 183,  3. 
 27-18-28. [Repealed.] History of Section.P.L. 1983, ch. 212,  1; Repealed by P.L. 2019, ch. 27,  7, effective June 19, 2019. 
 27-18-29. Changing coverage. No group health insurer subject to the provisions of this chapter shall change contract provisions as specified in the group plan master contract during the term of that contract without prior written agreement of the employer, except for changes mandated under state or federal legislative enactment and changes resulting from a labor management collective bargaining agreement, or changes necessary to meet insurance regulations promulgated by the department of business regulation.  History of Section.P.L 1988, ch. 384,  1. 
 27-18-3.1. Alternative coverage by employer. (a) Each employer or other organization which contributes to a group health insurance contract or dental benefit plan covering twenty-five (25) or more persons, which restricts the covered persons in selecting the providers of dental care services to a single dentist or limited number of dentists, shall also offer its employees or eligible dependents at the time a dental benefits plan is offered or renewed at least one alternative cover of comparable benefits which permits covered persons to obtain dental care services from the licensed dentist of their choice if the alternate coverage is proposed to the employer or other organization by either an insurance company licensed to do business in the state of Rhode Island or a hospital, medical, or dental service corporation chartered in the state of Rhode Island. The licensed dentist shall conform to the quality assurance, utilization, and review programs of the party providing alternative coverage.  (b) The employer or other organization shall pay or contribute for the employee or member for the provision of alternative coverage, an amount equal to the lesser of:  (1) The premium or cost which it pays or contributes for the employee or member to the group health insurance contract or dental benefit plan which limits the number of providers of dental services; or  (2) The actual cost or premium of the alternate coverage obtained by the employee or member.  History of Section.P.L. 1986, ch. 163,  1. 
 27-18-3.2. Rules and regulations. The department of business regulation shall promulgate rules and regulations necessary to effectuate the purpose of this chapter, including procedures for notice to covered persons, employers, and other organizations of the provisions of this chapter.  History of Section.P.L. 1986, ch. 163,  1. 
 27-18-3.3. Penalties. In addition to any other penalty provided by law, any person, firm, or corporation who violates  27-18-3.1  27-18-3.5, after a hearing held in accordance with the provisions of  42-35-9 by the department of business regulation, shall be fined civilly not less than one thousand dollars ($1,000) nor more than two thousand five hundred dollars ($2,500).  History of Section.P.L. 1986, ch. 163,  1; P.L. 2002, ch. 292,  33. 
 27-18-3.4. Judicial review. Any person, firm, or corporation aggrieved by a decision or order per  27-18-3.3 shall have a right of appeal pursuant to the provisions of  42-35-15. History of Section.P.L. 1986, ch. 163,  1. 
 27-18-3.5. Non-applicability. Sections 27-18-3.1  27-18-3.5 shall not apply to dental plans offered by any health maintenance organization, its parent, or subsidiary, which as of December 31, 1985, was licensed or had filed an application for a license, under the laws of this state.  History of Section.P.L. 1986, ch. 163,  1. 
 27-18-3. Required provisions. (a) Except as provided in  27-18-5 each policy delivered or issued for delivery to any person in this state shall contain the provisions specified in this section in the words in which the provisions appear in this section; provided, that the insurer may, at its option, substitute, for one or more of the provisions, corresponding provisions of different wording approved by the commissioner which are in each instance not less favorable in any respect to the insured or the beneficiary. The provisions shall be preceded individually by the caption appearing in this subsection or, at the option of the insurer, by the appropriate individual or group captions or subcaptions as the commissioner may approve:  (1) A provision as follows:  ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless the approval is endorsed on it or attached to it. No agent has authority to change this policy or to waive any of its provisions.  (2) A provision as follows:  TIME LIMIT ON CERTAIN DEFENSES: (a) After three (3) years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for this policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of that three-year period.  (This policy provision shall not be construed as to affect any legal requirement for avoidance of a policy or denial of a claim during the initial three (3) year period, nor to limit the application of  27-18-4(1), (2), (3), (4) and (5) in the event of a misstatement with respect to age or occupation or other insurance.)  (A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium: (i) until at least age fifty (50); or (ii) in the case of a policy issued after age forty-four (44), for at least five (5) years from its date of issue, may contain in lieu of this provision the following provision (from which the clause in parentheses may be omitted at the insurer's option) under the caption INCONTESTABLE:  After this policy has been in force for a period of three (3) years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application.)  (b) No claim for loss incurred or disability (as defined in the policy) commencing after three (3) years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy.  (3) A provision as follows:  GRACE PERIOD: A grace period of ____  (insert a number not less than seven (7) for weekly premium policies, ten (10) for monthly premium policies and thirty-one (31) for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force.  (A policy which contains a cancellation provision may add, at the end of the above provision:  subject to the right of the insurer to cancel in accordance with the cancellation provision of this policy.)  (A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision:  Unless not less than ten (10) days prior to the premium due date the insurer has delivered to the insured or has mailed to his or her last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted,)  (4) A provision as follows:  REINSTATEMENT: If any renewal premium is not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurer to accept this premium, without requiring in connection with it an application for reinstatement, shall reinstate the policy; provided, that if the insurer or the agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of the application by the insurer or, lacking approval, upon the forty-fifth day following the date of the conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of the application. The reinstated policy shall cover only loss resulting from an accidental injury as may be sustained after the date of reinstatement and loss due to a sickness as may begin more than ten (10) days after this date. In all other respects the insured and insurer shall have the same rights under the reinstated policy as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed on it or attached to it in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which the premium has not been previously paid, but not to any period more than sixty (60) days prior to the date of reinstatement.  (The last sentence of this provision may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums: (i) until at least age fifty (50); or (ii) in the case of a policy issued after age forty-four (44), for at least five (5) years from its date of issue.)  (5) A provision as follows:  NOTICE OF CLAIM: Written notice of claim must be given to the insurer within twenty (20) days after the occurrence or commencement of any loss covered by the policy, or as soon after this as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at ____________  (insert the location of any office as the insurer may designate for the purpose), or to any authorized agent of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer.  (In a policy providing a loss of time benefit which may be payable for at least two (2) years, an insurer may at its option insert the following between the first and second sentences of this provision:  Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two (2) years, the insured shall, at least once in every six (6) months after having given notice of claim, give to the insurer notice of continuance of the disability, except in the event of legal incapacity. The period of six (6) months following any filing of proof by the insured or any payment by the insurer on account of the claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of notice shall not impair the insured's right to any indemnity which would have accrued during the period of six (6) months preceding the date on which the notice is actually given.)  (6) A provision as follows:  CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the claimant any forms as are usually furnished by it for filing proofs of loss. If the forms are not furnished within fifteen (15) days after the giving of notice, the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character, and the extent of the loss for which claim is made.  (7) A provision as follows:  PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its office in the case of a claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety (90) days after the termination of the period for which the insurer is liable and in the case of a claim for any other loss within ninety (90) days after the date of the loss. Failure to furnish proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within this time, provided the proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is required.  (8) A provision as follows:  TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of this loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid ____________  (insert period for payments which must not be less frequently than monthly) and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof.  (9) A provision as follows:  PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting the payment which may be prescribed in this policy and effective at the time of payment. If no designation or provision is effective, indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured's death may, at the option of the insurer, be paid either to the beneficiary or to the estate. All other indemnities will be payable to the insured.  (The following provisions, or either of them, may be included with this provision at the option of the insurer:  If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or not competent to give a valid release, the insurer may pay the indemnity, up to an amount not exceeding $______  (insert an amount which shall not exceed one thousand dollars ($1,000)), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurer to be equitably entitled to the payment. Any payment made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the extent of the payment. Subject to any written direction of the insured in the application or otherwise, all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical, or surgical services may, at the insurers option and unless the insured requests otherwise in writing not later than the time of filing proofs of the loss, be paid directly to the hospital or person rendering the services; but it is not required that the service be rendered by a particular hospital or person.)  (10) A provision as follows:  PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim under this policy and to make an autopsy in case of death where it is not forbidden by law.  (11) A provision as follows:  LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty (60) days after written proof of loss has been furnished in accordance with the requirements of this policy. No action shall be brought after the expiration of three (3) years after the time written proof of loss is required to be furnished.  (12) A provision as follows:  CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy.  (The first clause of this provision, relating to the irrevocable designation of beneficiary, may be omitted at the insurer's option.)  (13) A provision as follows:   Medical services means those professional services and supplies rendered by or under the direction of persons duly licensed under the laws of this state to practice medicine, surgery, or podiatry as may be specified by any medical service plan. Medical service shall not be construed to include hospital services.  (c)(1) Each policy issued and/or renewed shall contain a minimum home health care benefit as follows:  (i) Home health care is defined as a medically necessary program to reduce the length of a hospital stay or to delay or eliminate an otherwise medically necessary hospital admission;  (ii) The home health care program shall be formulated and supervised by the subscriber's physician;  (iii) Minimum home health care coverage shall not exceed six (6) home or office physician's visits per month, and shall not exceed three (3) nursing visits per week, home health aide visits up to twenty (20) hours per week, and the following services as needed: physical or occupational therapy as a rehabilitative service, respiratory service, speech therapy, medical social work, nutrition counseling, prescription drugs and medication, medical and surgical supplies, such as dressings, bandages, and casts, minor equipment such as commodes and walkers, laboratory testing, x-rays and E.E.G. and E.K.G. evaluations; and  (iv) Communicable diseases and/or nervous, emotional and mental illness are excluded from home health care coverage;  (2) The commissioner shall approve the wording in each policy that in each instance shall not be less favorable in any respect to the insured or the beneficiary, as the benefits are outlined in subdivision (1) of this subsection. Any accident and sickness insurance policy whose benefits are limited to income protection or the furnishing of disability income or a limited benefit health coverage are excluded from this subsection. Notwithstanding the provisions of  27-18-19(3), the minimum home health care benefit shall be included in blanket and/or group policies of accident and sickness insurance;  (3) A limited benefit policy, for the purposes of this section, is any accident and sickness policy that covers one or more specified risks including, but not limited to, accidental death or injury or specified disease. A policy that broadly covers accident and sickness, but which contains exclusions and limitations with respect to certain risks or services, is not a limited benefit policy;  (4) With respect to blanket and/or group policies, the provisions of this subsection shall apply only to services provided to residents of Rhode Island or employees of Rhode Island employers.  History of Section.P.L. 1956, ch. 3808,  3; G.L. 1956,  27-18-3; P.L. 1984, ch. 58,  1; P.L. 1985, ch. 267,  1; P.L. 1987, ch. 107,  4; P.L. 2002, ch. 292,  33. 
 27-18-30. Health insurance contracts  Infertility. (a) Any health insurance contract, plan, or policy delivered or issued for delivery or renewed in this state, except contracts providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a health insurance contract provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, the tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years; provided, that a subscriber co-payment 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) Notwithstanding the provisions of  27-18-19 or any other provision to the contrary, this section shall apply to blanket or group policies of insurance.  (g) The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).  History of Section.P.L. 1989, ch. 478,  1; P.L. 1991, ch. 96,  1; P.L. 2002, ch. 292,  33; P.L. 2006, ch. 246, art. 34,  1; P.L. 2007, ch. 411,  1; P.L. 2017, ch. 132,  1; P.L. 2017, ch. 150,  1. 
 27-18-31. Insurance coverage for services of licensed midwives. (a) For the purposes of this section, licensed midwives means any midwife licensed under  23-13-9.  (b) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for the services of licensed midwives in accordance with each health insurers respective principles and mechanisms of reimbursement credentialing and contracting if the services are within the licensed midwives area of professional competence as defined by regulations promulgated pursuant to  23-13-9, and are currently reimbursed when rendered by any other licensed health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a licensed midwife and any other health care provider. Direct payment for licensed midwives will be contingent upon services rendered in a licensed health care facility and for services rendered in accordance with rules and regulations promulgated by the department of health; provided, that this provision shall not prohibit payment for services pursuant to  42-62-26 or for other services reimbursed by third party payors.  History of Section.P.L. 1990, ch. 168,  1; P.L. 2002, ch. 292,  33. 
 27-18-32. Discontinuance of coverage  Chronic disabilities. Notwithstanding the provisions of  27-18-19, no group health insurer shall discontinue reimbursement or providing services for covered health care services for chronic disabilities, unless the patient has exhausted benefits to which he or she is entitled under the basic subscriber agreement, or unless it is at the end of the open enrollment period provided notice of the discontinuation of 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.  History of Section.P.L. 1991, ch. 127,  1. 
 27-18-33.1. Insurance coverage for post-partum hospital stays. (a) Every individual or group hospital or medical services plan contract delivered, issued for delivery, as renewed in this state which provides maternity benefits shall provide coverage for a forty-eight (48) hour time period in a hospital after a vaginal birth and ninety-six (96) hours after a Cesarean section for a mother and her newly born child. Any decision to shorten this minimum coverage shall be made by the attending health care provider in consultation with the mother. The decision shall be made in accordance with the standards for guidelines for perinatal care published by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics. The standards shall be relative to early discharge, defined as less than forty-eight (48) hours for a vaginal delivery and ninety-six (96) for a Cesarean delivery. In the case of early discharge, post-delivery care shall include: home visits, parent education, assistance and training in breast or bottle feeding and the performance of any necessary and appropriate clinical tests or any other tests or services consistent with these guidelines.  (b) For the purposes of this section, attending health care provider includes the attending obstetrician, pediatrician, family practitioner, general practitioner or certified nurse midwife attending the mother and newly born child.  (c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.  History of Section.P.L. 1996, ch. 246,  2; P.L. 1996, ch. 260,  2; P.L. 2002, ch. 292,  33. 
 27-18-33.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies. (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 pharmacys 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 Administrations 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 pharmacys 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.  History of Section.P.L. 2016, ch. 166,  1; P.L. 2016, ch. 168,  1. 
 27-18-33. Drug coverage. No group health insurer subject to the provisions of this chapter that provides coverage for prescription drugs under a group plan master contract delivered, issued for delivery, or renewed in this state may require any person covered under the contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for the drugs.  History of Section.P.L. 1991, ch. 345,  1; P.L. 2002, ch. 292,  33. 
 27-18-34. Health insurance contracts  Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists. (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 practitioners or psychiatric and mental health nurse clinical specialists 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.  History of Section.P.L. 1991, ch. 361,  1; P.L. 1994, ch. 90,  1; P.L. 2002, ch. 292,  33; P.L. 2009, ch. 351,  1; P.L. 2009, ch. 352,  1. 
 27-18-35. Certified counselors in mental health and therapists in marriage and family practice. Every health insurance contract plan or policy delivered, issued for delivery or renewed in this state, except policies which only provide coverage for specified diseases, fix indemnity, Medicare supplement long term care disability income, or other limited benefit policies, shall provide coverage for the services of counselors in mental health licensed pursuant to  5-63.2-9 and therapists in marriage and family practice licensed pursuant to  5-63.2-10 excluding marital and family therapy unless the individual is diagnosed with a mental disorder.  History of Section.P.L. 1994, ch. 89,  1; P.L. 2002, ch. 292,  33. 
 27-18-36.1. Repealed. History of Section.P.L. 1994, ch. 301,  1; Repealed by P.L. 2012, ch. 256,  14; P.L. 2012, ch. 262,  14, effective July 15, 2013. 
 27-18-36.2. Repealed. History of Section.P.L. 1994, ch. 301,  1; P.L. 1997, ch. 51,  1, 5; P.L. 1997, ch. 92,  1, 5; P.L. 1999, ch. 118,  1; P.L. 1999, ch. 134,  1; Repealed by P.L. 2012, ch. 256,  14; P.L. 2012, ch. 262,  14, effective July 15, 2013. 
 27-18-36.3. Repealed. History of Section.P.L. 1994, ch. 301,  1; Repealed by P.L. 2012, ch. 256,  14; P.L. 2012, ch. 262,  14, effective July 15, 2013. 
 27-18-36. Repealed. History of Section.P.L. 1994, ch. 301,  1; P.L. 1997, ch. 51,  1, 5; P.L. 1997, ch. 92,  1, 5; P.L. 2002, ch. 292,  33; Repealed by P.L. 2012, ch. 256,  14; P.L. 2012, ch. 262,  14, effective July 15, 2013. 
 27-18-37. Repealed.
 27-18-38. Diabetes treatment. (a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage, except for supplemental policies which only provide coverage for specified diseases and other supplemental policies, shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes, if medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation.  (b) Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a physician. These policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self-management and treatment of their diabetes, including information on the nutritional management of diabetes. The coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a significant change in the patients symptoms or conditions which necessitate changes in a patients self-management, or where reeducation or refresher training is necessary. This education when medically necessary and prescribed by a physician, may be provided only by the physician or, upon his or her referral to an appropriately licensed and certified health care provider and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.  (c) Benefit plans offered by an insurer may impose co-payment and/or deductibles for the benefits mandated by this chapter; however, in no instance shall the co-payment or deductible amount be greater than the co-payment or deductible amount imposed for other supplies, equipment or physician office visits. Benefits for services under this section shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.  History of Section.P.L. 1996, ch. 106,  1; P.L. 2002, ch. 292,  33. 
 27-18-39. Mastectomy treatment. (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, excluding supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall provide, in a case of any person covered in the individual market or covered by a group health plan, coverage for:  (1) Reconstruction of the breast on which the mastectomy has been performed;  (2) Surgery and reconstruction of the other breast to produce a symmetrical appearance; and  (3) Prostheses and treatment of physical complications, including lymphademas, at all stages of mastectomy; in a manner determined in consultation with the attending physician, physician assistant as defined in  5-54-2, or an advance practice registered nurse as defined in  5-34-3, and the patient. As used in this section, mastectomy means the removal of all or part of a breast. Written notice of the availability of this coverage shall be delivered to the participant upon enrollment and annually thereafter.  (b) As used in this section, prosthetic devices means and includes the provision of initial and subsequent prosthetic devices pursuant to an order of the patients physician, physician assistant, advance practice registered nurse, or surgeon.  (c) [Deleted by P.L. 2018, ch. 114,  1 and P.L. 2018, ch. 204,  1].  (d) 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.  (e) 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.  (f) 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.  (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.  History of Section.P.L. 1996, ch. 66,  1; P.L. 2002, ch. 292,  33; P.L. 2004, ch. 41,  1; P.L. 2004, ch. 45,  1; P.L. 2018, ch. 114,  1; P.L. 2018, ch. 204,  1. 
 27-18-4. Optional provisions. Except as provided in  27-18-5, no policy delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in this section unless the provisions are in the words in which they appear in this section; provided, that the insurer may, at its option, use in lieu of any provision a corresponding provision of different wording approved by the commissioner which is not less favorable in any respect to the insured or the beneficiary. The provision contained in the policy shall be preceded individually by the appropriate caption appearing in this section or, at the option of the insurer, by any appropriate individual or group captions or subcaptions as the commissioner may approve:  (1) A provision as follows:  CHANGE OF OCCUPATION: If the insured is injured or contracts sickness after having changed his or her occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation classified as more hazardous, the insurer will pay only that portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits fixed by the insurer for the more hazardous occupation. If the insured changes his or her occupation to one classified by the insurer as less hazardous than that stated in this policy, the insurer, upon receipt of proof of the change of occupation, will reduce the premium rate accordingly, and will return the excess pro rata unearned premium from the date of change of occupation or from the policy anniversary date immediately preceding receipt of the proof, whichever is the more recent. In applying this provision, the classification of occupational risk and the premium rates shall be such as have been last filed by the insurer, prior to the occurrence of the loss for which the insurer is liable or prior to the date of proof of change in occupation, with the state official having supervision of insurance in the state where the insured resided at the time this policy was issued; but, if the filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurer in the state prior to the occurrence of the loss or prior to the date of proof of change in occupation.  (2) A provision as follows:  MISSTATEMENT OF AGE: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age.  (3) A provision as follows:  OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured is in force concurrently with it, making the aggregate indemnity for . . . . . . . . . . . (insert type of coverage or coverages) in excess of $. . . . . . . . (insert maximum limit of indemnity or indemnities) the excess insurance shall be void and all premiums paid for the excess shall be returned to the insured or to his or her estate, or, in lieu of this:  Insurance effective at any one time on the insured under a like policy or policies in this insurer is limited to the one such policy elected by the insured, his or her beneficiary or his or her estate and the insurer will return all premiums paid for all other like policies.  (4) A provision as follows:  INSURANCE WITH OTHER INSURERS: If there is other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for the proportion of the loss as the amount which would have been payable under this policy plus the total of the like amounts under all the other valid coverage for the same loss of which this insurer had notice bears to the total like amounts under all valid coverage for the loss, and for the return of the portion of the premiums paid as shall exceed the pro rata portion for the determined amount. For the purpose of applying this provision when other coverage is on a provision of service basis, the like amount of the other coverage shall be taken as the amount which the services rendered would have cost in the absence of the coverage.  (If this policy provision is included in a policy which also contains the next following policy provision, there shall be added to the caption of this provision the phrase   EXPENSE INCURRED BENEFITS. The insurer may, at its option, include in this provision a definition of other valid coverage, approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the commissioner. In the absence of the definition, the term shall not include group insurance, automobile medical payments insurance, or coverage provided by hospital or medical service organizations or by union welfare plans or employer or employee benefit organizations. For the purpose of applying this policy provision with respect to any insured, any amount of benefit provided for the insured pursuant to any compulsory benefit statute, including any workers compensation or employers liability statute, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be other valid coverage of which the insurer has had notice. In applying this policy provision, no third party liability coverage shall be included as other valid coverage.)  (5) A provision as follows:  INSURANCE WITH OTHER INSURERS: If there is other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability for those benefits under this policy shall be for the proportion of the indemnities otherwise provided under this policy for the loss as the like indemnities of which the insurer had notice (including the indemnities under this policy) bear to the total amount of all like indemnities for the loss, and for the return of the portion of the premium paid as shall exceed the pro rata portion for the determined indemnities.  (If this policy provision is included in a policy which also contains the next preceding policy provision, there shall be added to the caption of this provision the phrase   OTHER BENEFITS. The insurer may, at its option, include in this provision a definition of other valid coverage, approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, and to any other coverage the inclusion of which may be approved by the commissioner. In the absence of the definition, this term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying this policy provision with respect to any insured, any amount of benefit provided for the insured pursuant to any compulsory benefit statute, including any workers compensation or employers liability statute, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be other valid coverage of which the insurer has had notice. In applying this policy provision, no third party liability coverage shall be included as other valid coverage.)  (6) A provision as follows:  RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or his or her average monthly earnings for the period of two (2) years immediately preceding a disability for which claim is made, whichever is the greater, the insurer will be liable only for the proportionate amount of the benefits under this policy as the amount of the monthly earnings or the average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all the coverage upon the insured at the time the disability commences, and for the return of the part of the premiums paid during the two (2) years that exceeds the pro rata amount of the premiums for the benefits actually paid under this policy; but this shall not operate to reduce the total monthly amount of benefits payable under all the coverage upon the insured below the sum of two hundred dollars ($200) or the sum of the monthly benefits specified in the coverage, whichever is the lesser, nor shall it operate to reduce benefits other than those payable for loss of time. (This policy provision may be inserted only in a policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums: (i) until at least age fifty (50); or (ii) in the case of a policy issued after age forty-four (44), for at least five (5) years from its date of issue. The insurer may, at its option, include in this provision a definition of valid loss of time coverage, approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, or to any other coverage the inclusion of which may be approved by the commissioner or any combination of this coverage. In the absence of a definition, the term shall not include any coverage provided for the insured pursuant to any compulsory benefit statute, including any workers compensation or employers liability statute, or benefits provided by union welfare plans or by employer or employee benefit organizations.)  (7) A provision as follows:  UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted from this payment.  (8) A provision as follows:  CANCELLATION: The insurer may cancel this policy at any time by written notice delivered to the insured, or mailed to his or her last address as shown by the records of the insurer, stating when, not less than ten (10) days after this, the cancellation shall be effective; and, after the policy has been continued beyond its original term, the insured may cancel this policy at any time by written notice delivered or mailed to the insurer, effective upon receipt or on a later date as may be specified in the notice. In the event of cancellation, the insurer will return promptly the unearned portion of any premium paid. If the insured cancels, the earned premium shall be computed by the use of the short-rate table last filed with the state official having supervision of insurance in the state where the insured resided when the policy was issued. If the insurer cancels, the earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation.  (9) A provision as follows:  CONFORMITY WITH STATE STATUTE: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on that date, is hereby amended to conform to the minimum requirements of those statutes.  (10) A provision as follows:  ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing cause was the insureds commission of or attempt to commit a felony or to which a contributing cause was the insureds being engaged in an illegal occupation.  (11) A provision as follows included in any policy that is not a medical expense policy:  INTOXICANTS AND NARCOTICS: The insurer shall not be liable for any loss sustained or contracted in consequence of the insureds being intoxicated or under the influence of any narcotic unless administered on the advice of a physician.  No such provision may be included in a medical expense policy, which, for purposes of this subsection, shall mean an accident and sickness insurance policy that provides hospital, medical or surgical expense coverage.  History of Section.P.L. 1956, ch. 3808,  3; G.L. 1956,  27-18-4; P.L. 2002, ch. 292,  44; P.L. 2005, ch. 48,  1; P.L. 2005, ch. 58,  1. 
 27-18-40. Insurance coverage for mastectomy hospital stays. (a) The Rhode Island general assembly recognizes that breast cancer is a unique illness with both a physical and emotional impact on patients. Except as otherwise provided, every individual or group hospital or medical services plan contract delivered, issued for delivery, as renewed in this state shall provide coverage for a minimum forty-eight (48) hour time period in a hospital after the surgical procedures known as a mastectomy, and a minimum twenty-four (24) hours after an axillary node dissection.  (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both, and (9) other limited benefit policies. Any decision to shorten these minimum coverages shall be made by the attending physician in consultation with and upon agreement by the patient. If the patient participates in an early discharge, defined as in-patient care following a mastectomy that is less than forty-eight (48) hours and in-patient care following an axillary node dissection that is less than twenty-four (24) hours, coverage shall include a minimum of one home visit conducted by a physician or registered nurse.  (c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.  (d) All plans subject to this section shall provide notice to each enrollee:  (1) In the next mass mailing made by the plan to the employee; or  (2) As part of any informational packet sent to the enrollee.  History of Section.P.L. 1997 ch. 24,  1; P.L. 1997, ch. 25,  1; P.L. 2002, ch. 292,  33. 
 27-18-41. Mammograms and pap smears  Coverage mandated. (a)(1) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for mammograms and pap smears, in accordance with guidelines established by the American Cancer Society.  (2) Notwithstanding the provisions of this chapter, every individual or group hospital or medical insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall pay for two (2) 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 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.  (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 1997, ch. 76,  1; P.L. 2002, ch. 292,  33; P.L. 2005, ch. 405,  1. 
 27-18-42. Mammograms  Quality assurance standards. A mammogram eligible for reimbursement under  27-18-41 shall be reimbursed only if the facility in which the mammogram has been taken and processed, and the licensed physician interpreting the mammogram, both meet state approved quality assurance standards for taking, processing, and interpreting mammograms. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section.  History of Section.P.L. 1997, ch. 76,  1. 
 27-18-43. Pap smears  Quality assurance standards. A pap smear eligible for reimbursement under  27-18-41 shall be reimbursed only if the laboratory in which the pap smear is processed is licensed by the department of health specifically to perform cervical cytology, or is accredited by the American Society of Cytology, or is accredited by the College of American Pathologists, or is a hospital accredited by the joint commission on accreditation health care organizations or the American Osteopathic Association at the time the pap smear is processed.  History of Section.P.L. 1997, ch. 76,  1. 
 27-18-44.1. Hysterectomy or myomectomy treatment. 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.  History of Section.P.L. 2022, ch. 370,  1, effective June 29, 2022; P.L. 2022, ch. 371,  1, effective June 29, 2022. 
 27-18-44. Primary and preventive obstetric and gynecological care. (a) Any insurer or health 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 or issued by a health insurance carrier or a health maintenance organization, shall permit a woman to receive an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the woman to first obtain a referral from a primary care provider.  (b)(1)(A) Any health plan, nonprofit medical service plan or nonprofit hospital service plan, including a health insurance carrier or a health maintenance organization which requires or provides for the designation by a covered person of a participating primary healthcare professional shall permit each covered person to:  (i) Designate any participating primary care healthcare professional who is available to accept the covered person; and  (ii) For a child, designate any participating physician who specializes in pediatrics as the childs primary care healthcare professional and is available to accept the child.  (2) The provisions of subdivision (1) of this subsection shall not be construed to waive any exclusions of coverage under the terms and conditions of the health benefit plan with respect to coverage of pediatric care.  (c)(1) If a health plan, nonprofit medical service plan or nonprofit hospital service plan, including a health insurance carrier or a health maintenance organization, provides coverage for obstetrical or gynecological care and requires the designation by a covered person of a participating primary care healthcare professional, then it:  (A) Shall not require any persons, including a primary care healthcare professionals, prior authorization or referral in the case of a female covered person who seeks coverage for obstetrical or gynecological care provided by a participating healthcare professional who specializes in obstetrics or gynecology; and  (B) Shall treat the provision of obstetrical and gynecological care, and the ordering of related obstetrical and gynecological items and services, pursuant to subdivision (A) of this subdivision (c)(1), by a participating healthcare professional who specializes in obstetrics or gynecology as the authorization of the primary care healthcare professional.  (2)(A) A health plan, nonprofit medical service plan or nonprofit hospital service plan, including a health insurance carrier or a health maintenance organization may require the healthcare professional to agree to otherwise adhere to its policies and procedures, including procedures relating to referrals, obtaining prior authorization, and providing services in accordance with a treatment plan, if any, approved by the plan, carrier or health maintenance organization.  (B) For purposes of subdivision (A) of this subdivision (c)(1), a healthcare professional, who specializes in obstetrics or gynecology, means any individual, including an individual other than a physician, who is authorized under state law to provide obstetrical or gynecological care.  (3) The provisions of subdivision (A) of this subdivision (c)(1) shall not be construed to:  (A) Waive any exclusions of coverage under the terms and conditions of the health benefit plan with respect to coverage of obstetrical or gynecological care; or  (B) Preclude the health plan, nonprofit medical service plan or nonprofit hospital service plan, including a health insurance carrier or a health maintenance organization involved from requiring that the participating healthcare professional providing obstetrical or gynecological care notify the primary care healthcare professional or the plan, carrier or health maintenance organization of treatment decisions.  (d) Notice Requirements:  (1) A health plan, nonprofit medical service plan or nonprofit hospital service plan, including a health insurance carrier or a health maintenance organization subject to this section shall provide notice to covered persons of the terms and conditions of the plan related to the designation of a participating healthcare professional and of a covered persons rights with respect to those provisions.  (2)(A) In the case of group health insurance coverage, the notice described in subdivision (1) of this subsection shall be included whenever the a participant is provided with a summary plan description or other similar description of benefits under the health benefit plan.  (B) In the case of individual health insurance coverage, the notice described in subdivision (1) of this subsection shall be included whenever the primary subscriber is provided with a policy, certificate or contract of health insurance.  (C) A health plan, nonprofit medical service plan or nonprofit hospital service plan, including a health insurance carrier or a health maintenance organization, may use the model language in federal regulation 45 C.F.R.  147.138(a)(4)(iii) to satisfy the requirements of this subsection.  (e) The requirements of subsections (b), (c), and (d) shall not 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.  History of Section.P.L. 1997, ch. 166,  1; P.L. 1997, ch. 174,  1; P.L. 2012, ch. 256,  3; P.L. 2012, ch. 262,  3. 
 27-18-45. Whistleblowers protection. No accident and sickness insurer pursuant to this chapter, or any other insurer offering and/or insuring health services on a prepaid basis as defined in  42-62-4(7), shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state.  History of Section.P.L. 1997, ch. 167,  1. 
 27-18-46. Penalties and remedies. (a) Any person, firm, corporation, association or other legal entity who or which shall violate the provisions of  27-18-45 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one year, or by both fine and imprisonment.  (b) In addition to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall willfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each violation, and each violation shall constitute a separate and distinct offense under this section.  History of Section.P.L. 1997, ch. 167,  1. 
 27-18-47. Additional relief and damages  Reinstatement. (a) A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.  (b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.  (c) The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of the provider agreement.  History of Section.P.L. 1997, ch. 167,  1. 
 27-18-48.1. Third party reimbursement for services of registered nurse first assistants. (a) Every individual or group hospital or medical services plan contract delivered, issued or renewed by an insurer or nonprofit health service corporation which provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a registered nurse first assistant designated as a registered nurse first assistant provided, however, that the following conditions are met:  (1) The registered nurse first assistant provides certain health care services under the supervision of a licensed physician; is currently licensed as a registered nurse in Rhode Island; has successfully completed a course in preparing the registered nurse as a first assistant in accordance with the Association of Operating Room Nurses core curriculum guide for the registered nurse first assistant and includes a minimum of one academic year in a college or university with didactic instruction and clinical internship programs; and is certified in perioperative nursing by the Certification Board Perioperative Nursing (minimum of two years perioperative experience);  (2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and  (3) The registered nurse first assistant is not a salaried employee of the licensed hospital or facility for which the accident and sickness insurer has an alternative contractual relationship to fund the services of a registered nurse first assistant.  (b) It shall remain within the sole discretion of the accident and sicknesses insurer as to which registered nurse first assistant it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, however, that no accident and sicknesses insurer may be required to provide direct reimbursement, or pay for duplicative services actually rendered by a registered nurse first assistant and any other health care provider. Nothing contained in this section shall preclude the health maintenance organization from conducting managed care, medical necessity or utilization review.  (c) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 1999, ch. 509,  1; P.L. 2002, ch. 292,  33. 
 27-18-48. Third party reimbursement for services of certain healthcare workers. (a) Every individual or group hospital or medical services plan contract delivered, issued or renewed by an insurer or nonprofit or for-profit health service corporation that provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the board of nurse registration and nursing education; provided, that the following conditions are met:  (1) The certified registered nurse anesthetist adheres to the practice of certified registered nurse anesthesia as defined by, and in accordance with,  5-34.2-2.  (2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and  (3) The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the accident and sickness insurer has an alternative contractual relationship to fund the services of a certified registered nurse anesthetist.  (b) It shall remain within the sole discretion of the health maintenance organization as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization may be required to pay for duplicative services actually rendered by a certified registered nurse anesthetist and any other healthcare provider. Nothing contained in this section shall preclude the health maintenance organization from conducting managed care, medical necessity, or utilization review.  (c) Providers. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that providers license or certification under applicable state law. This section shall not require that a group health plan or health insurance issuer contract with any healthcare provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures.  History of Section.P.L. 1997, ch. 345,  1; P.L. 1997, ch. 365,  1; P.L. 2002, ch. 292,  33; P.L. 2015, ch. 205,  1; P.L. 2015, ch. 223,  1. 
 27-18-49. Human leukocyte antigen testing. (a) Every individual or group hospital or medical services plan contract delivered or renewed in this state shall include coverage of the cost for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B, and DR antigens for utilization in bone marrow transplantation. The testing must be performed in a facility that is accredited by the American Association of Blood Banks or its successors, and is licensed under the Clinical Laboratory Improvement Act, 42 U.S.C.  263a, as it may be from time to time amended. At the time of the testing, the person being tested must complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program. The group hospital or medical services plan contract may limit each subscriber to one of these testings per lifetime.  (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 1998, ch. 8,  1; P.L. 1998, ch. 9,  1; P.L. 2002, ch. 292,  33. 
 27-18-5. Inapplicable or inconsistent provisions. If any provision of  27-18-3  27-18-10 is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the commissioner, shall omit from that policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of the provision in a manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.  History of Section.P.L. 1956, ch. 3808,  3; G.L. 1956,  27-18-5. 
 27-18-50.1. Medication synchronization. (a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days supply for the purpose of synchronizing the patients medications and the insureds or enrollees maintenance prescription drug(s) to be synchronized meets all of the following requirements:  (1) Is covered by the policy, certificate, or contract described in this chapter;  (2) Is used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee;  (3) Except as otherwise provided in this subparagraph, is not a controlled substance included in schedules II to V;  (4) Meets all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insureds or enrollees multiple, maintenance-prescription drugs;  (5) Is of a formulation that can be effectively split over required short-fill periods to achieve synchronization; and  (6) Does not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insureds or enrollees multiple, maintenance-prescription drugs.  (b) The plan or policy described in subsection (a) shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insureds or enrollees multiple, maintenance-prescription drugs.  (c) The plan or policy described in subsection (a) shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.  (d) A synchronization shall only occur once per year per maintenance-prescription drug.  History of Section.P.L. 2016, ch. 179,  1; P.L. 2016, ch. 196,  1. 
 27-18-50. Drug coverage. (a) Any accident and sickness insurer that utilizes a formulary of medications for which coverage is provided under an individual or group plan master contract shall require any physician or other person authorized by the department of health to prescribe medication to prescribe from the formulary. A physician or other person authorized by the department of health to prescribe medication shall be allowed to prescribe medications previously on, or not on, the accident and sickness insurers formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. An accident and sickness insurer shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the accident and sickness insurers medical-exception criteria for the coverage of that medication.  (b) An accident and sickness insurers medical exception criteria for the coverage of non-formulary medications shall be developed in accordance with  23-17.13-3(c)(3) [repealed].  (c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23 [repealed].  (d) Prior to removing a prescription drug from its plans formulary or making any change in the preferred or tiered, cost-sharing status of a covered prescription drug, an accident and sickness insurer must provide at least thirty (30) days notice to authorized prescribers by established communication methods of policy and program updates and by updating available references on web-based publications. All adversely affected members must be provided at least thirty (30) days notice prior to the date such change becomes effective by a direct notification:  (i) The written or electronic notice must contain the following information:  (A) The name of the affected prescription drug;  (B) Whether the plan is removing the prescription drug from the formulary, or changing its preferred or tiered, cost-sharing status; and  (C) The means by which subscribers may obtain a coverage determination or medical exception, in the case of drugs that will require prior authorization or are formulary exclusions respectively.  (ii) An accident and sickness insurer may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the accident and sickness insurer or the Food and Drug Administration, or removed from the market by their manufacturer, without meeting the requirements of this section.  (e) 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; or (9) Other limited-benefit policies.  History of Section.P.L. 1998, ch. 290,  1; P.L. 2016, ch. 541,  1; P.L. 2017, ch. 274,  1; P.L. 2017, ch. 361,  1. 
 27-18-51. Restricted annual rate payments prohibited. (a) No policy delivered or issued in this state shall contain a provision for compensating any provider of outpatient mental health and/or substance abuse treatment service by using the restricted annual rate method of payment.  (b) The restricted annual rate method of payment is defined as any method of payment that sets, as all or part of its payment scheme, a total payment limit for mental health and/or substance abuse treatment services for each person seeking treatment based on a per person per unit of time criterion that disregards the extent of treatment and/or degree of services rendered.  (c) This prohibition shall not be construed to prohibit or limit capitation or other risk sharing agreements between providers and insurers otherwise permissible by law.  History of Section.P.L. 1998, ch. 352,  1. 
 27-18-52.1. Genetic information. (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the Federal Policy for the Protection of Human Research Subjects (also known as The Common Rule). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.  (b) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state, which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage excluding disability income, long term care and insurance supplemental policies which only provide coverage for specified diseases or other supplemental policies, shall:  (1) Use genetic information or request for genetic information or the results of genetic information or other genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or otherwise affect a group or an individuals health insurance policy, contract, or plan;  (2) Request or require genetic information for the purpose of determining whether or not to issue or renew an individuals health benefits coverage, to set reimbursement/co-pay levels or determine covered benefits and services;  (3) Release the results of genetic information without the prior written authorization of an individual from whom the information was obtained, except in a format where individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure. An exception shall exist for participation in research settings governed by the Federal Policy for the Protection of Human Research Subjects (also known as The Common Rule);  (4) Request or require information as to whether an individual has genetic information, or participated in genetic information of any kind, whether for clinical or research purposes.  (c) For the purposes of this section, genetic information is information about genes, gene product, or inherited characteristics that may derive from the individual or a family member.  History of Section.P.L. 2001, ch. 38,  2; P.L. 2001, ch. 54,  2; P.L. 2002, ch. 292,  33. 
 27-18-52. Genetic testing. (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the Federal Policy for the Protection of Human Research Subjects (also known as The Common Rule). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.  (b) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state which provides health insurance medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage excluding disability income, long term care and insurance supplemental policies which only provide coverage for specified diseases or other supplemental policies, shall:  (1) Use a genetic test or request for genetic tests or the results of a genetic test to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a group or an individual health insurance policy, contract, or plan;  (2) Request or require a genetic test for the purpose of determining whether or not to issue or renew an individuals health benefits coverage, to set reimbursement/co-pay levels or determine covered benefits and services;  (3) Release the results of a genetic test without the prior written authorization of the individual from whom the test was obtained, except in a format whereby individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose this information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure; an exception shall exist for participating in research settings governed by the Federal Policy for the Protection of Human Research Subjects (also known as The Common Rule).  (4) Request or require information as to whether an individual has ever had a genetic test, or participated in genetic testing of any kind, whether for clinical or research purposes.  (c) For the purposes of this section, genetic testing is the analysis of an individuals DNA, RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes include predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be included provided there is an approved release by a parent or guardian. Tests for metabolites are covered only when they are undertaken with high probability that an excess of deficiency of the metabolite indicates the presence of heritable mutations in single genes. Genetic testing does not mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs or for HIV infections.  History of Section.P.L. 1998, ch. 380,  1; P.L. 2001, ch. 38,  1; P.L. 2001, ch. 54,  1; P.L. 2002, ch. 292,  33. 
 27-18-53. Magnetic resonance imaging  Quality assurance standards. (a) Except as otherwise provided in subsection (b) of this section, a magnetic resonance imaging examination eligible for reimbursement under the provisions of any individual or group health insurance contract, plan or policy delivered in this state shall be reimbursed only if the facility at which the examination has been conducted and processed is accredited by either the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC) or an alternate nationally recognized accrediting organization whose accreditation standards are substantially similar and no less stringent than current or subsequent ACR or IAC standards and have been reviewed and deemed adequate by the department of health. All accreditation standards under this section, whether promulgated by the ACR, IAC, or an alternate nationally recognized accrediting organization, shall include, but shall not be limited to, provisions for establishing the qualifications of the physician, standards for quality control and routine performance monitoring by a medical physicist, qualifications of the technologist including minimum standards of supervised clinical experience, personnel and patient safety guidelines, and standards for initial and ongoing quality control using clinical image review and quantitative testing.  (b) Any facility conducting and processing magnetic resonance imaging examinations which, as of June 30, 2006, is receiving reimbursement for such services by a health insurer, health maintenance organization or health plan, but is not accredited pursuant to subsection (a), shall file its application for accreditation within eighteen (18) months of the effective date of this section. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. A facility which begins conducting and processing, magnetic resonance imaging examinations after June 30, 2006 shall file its application for accreditation within twelve (12) months of the date of initiation of the magnetic resonance imaging examinations. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. After such accreditation is obtained, a facility conducting and processing, magnetic resonance imaging examinations shall, at all times, maintain accreditation with the appropriate accrediting body. Notwithstanding anything herein to the contrary, any facility which has filed for accreditation pursuant to this subsection (b) and has not been refused accreditation or withdrawn its application, will be deemed provisionally accredited for the twelve (12) month period dating from the application filing date. Provided, further, that notwithstanding any provision of the general or public laws to the contrary, any facility conducting and processing magnetic resonance imaging examinations shall conform to the standards of the appropriate accrediting body at all times, including during said accreditation process and shall certify said conformance to any reimbursing health insurer, health maintenance organization, or health plan.  History of Section.P.L. 1999, ch. 169,  2; P.L. 2003, ch. 376, art. 34,  3; P.L. 2005, ch. 207,  2; P.L. 2006, ch. 596,  2; P.L. 2007, ch. 140,  2; P.L. 2007, ch. 277,  2. 
 27-18-54. Health insurance rates. No insurance company organized as a stock or mutual corporation which merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or otherwise acquires control of a non-profit hospital service corporation organized under chapter 19 of this title, a non-profit medical service corporation organized under chapter 20 of this title or a health maintenance organization organized under chapter 41 of this title may: (1) file with any state agency for review or approval any proposed rate to be used by the company in the state, or (2) charge to any party in the state any rate or premium, which takes into account or reflects in any manner the value of any contribution, distribution or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or account for the assets of a non-profit hospital service corporation, non-profit medical service corporation or health maintenance organization. For any rate that is to be charged to policy holders, regardless of whether the rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the companys compliance with this section.  History of Section.P.L. 1999, ch. 215,  2; P.L. 1999, ch. 376,  2. 
 27-18-55. Acupuncture services. (a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or renewed in this state which provides medical coverage, and every group policy which 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) Doctor of acupuncture means a practitioner licensed under chapter 37.2 of title 5.  (2) 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).  (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 health care provider. Nothing contained in this section shall preclude the accident and sickness insurer from conducting managed care, medical necessity or utilization review.  History of Section.P.L. 1999, ch. 288,  1. 
 27-18-56. Prohibition against dentists being required to indemnify provider. No accident and sickness insurance provider may contract to require that a dentist indemnify or hold harmless the accident and sickness insurance provider for any expenses and liabilities, including, without limitation, judgments, settlements, attorneys fees, court costs, and any associated charges, incurred in connection with any claim or action brought against the accident and sickness insurance provider based on the accident and sickness insurance providers management decisions or utilization review provisions for any patient.  History of Section.P.L. 1999, ch. 481,  1. 
 27-18-57. F.D.A. approved prescription contraceptive drugs and devices. (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 F.D.A. 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 insurance company 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 employers 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) This section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited-benefit policies.  (e) 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.  (f) 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.  History of Section.P.L. 2000, ch. 120,  1; P.L. 2000, ch. 126,  1; P.L. 2002, ch. 292,  33; P.L. 2018, ch. 230,  2; P.L. 2018, ch. 234,  2. 
 27-18-58. Prostate and colorectal examinations  Coverage mandated  The Maryellen Goodwin Colorectal Cancer Screening Act.  (a) Every accident and sickness insurance policy, medical expense insurance policy or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for prostate and colorectal preventive screening examinations and laboratory tests for cancer for any nonsymptomatic person covered under that policy or contract. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal. Provided, this section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specific disease indemnity; (8) Sickness or bodily injury or death by accident, or both; and (9) Other limited benefit policies.  (b) An insurer may not impose cost sharing on the coverage required by subsection (a) of this section when the services are delivered within the health insurers provider network.  History of Section.P.L. 2000, ch. 125,  1; P.L. 2000, ch. 345,  1; P.L. 2002, ch. 292,  33; P.L. 2021, ch. 7,  2, effective April 29, 2021; P.L. 2021, ch. 8,  2, effective April 29, 2021. 
 27-18-59. Eligibility for childrens benefits. (a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state and every group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state which provides health benefits coverage for dependents, except for supplemental policies which only provide coverage for specified diseases and other supplemental policies, shall make coverage available for children until attainment of twenty-six (26) years of age, and an unmarried child of any age who is financially dependent upon the parent and medically determined to have a physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve (12) months.  (2) With respect to a child who has not attained twenty-six (26) years of age, a health insurance carrier shall not define dependent for purposes of eligibility for dependent coverage of children other than the terms of a relationship between a child and the plan participant, or subscriber.  (3) A health insurance carrier shall not deny or restrict coverage for a child who has not attained twenty-six (26) years of age based on the presence or absence of the childs financial dependency upon the participant, primary subscriber or any other person, residency with the participant and in the individual market the primary subscriber, or with any other person, marital status, student status, employment or any combination of those factors. A health carrier shall not deny or restrict coverage of a child based on eligibility for other coverage, except as provided in subparagraph (b)(1) of this section.  (4) Nothing in this section shall be construed to require a health insurance carrier to make coverage available for the child of a child receiving dependent coverage, unless the grandparent becomes the legal guardian or adoptive parent of that grandchild.  (5) The terms of coverage in a health benefit plan offered by a health insurance carrier providing dependent coverage of children cannot vary based on age except for children who are twenty-six (26) years of age or older.  (b)(1) For plan years beginning before January 1, 2014, a health insurance carrier providing group health insurance coverage that is a grandfathered health plan and makes available dependent coverage of children may exclude an adult child who has not attained twenty-six (26) years of age from coverage only if the adult child is eligible to enroll in an eligible employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of the federal Internal Revenue Code, other than the group health plan of a parent.  (2) For plan years, beginning on or after January 1, 2014, a health insurance carrier providing group health insurance coverage that is a grandfathered health plan shall comply with the requirements of subsections (a) through (e) of this section.  (c) This section does not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; or (8) sickness or bodily injury or death by accident or both; or (9) other limited benefit policies.  History of Section.P.L. 2000, ch. 214,  1; P.L. 2002, ch. 292,  33; P.L. 2006, ch. 377,  2; P.L. 2006, ch. 469,  2; P.L. 2012, ch. 256,  3; P.L. 2012, ch. 262,  3. 
 27-18-6. Sequence of provisions. The provisions which are the subject of  27-18-3 and 27-18-4, or any corresponding provisions used in lieu of them in accordance with those sections, shall be printed in the consecutive order of the provisions in the section or, at the option of the insurer, the provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered, or issued.  History of Section.P.L. 1956, ch. 3808,  3; G.L. 1956,  27-18-6. 
 27-18-60. Hearing aids. (a)(1) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide coverage for one thousand five hundred dollars ($1,500) per individual hearing aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall provide coverage for seven hundred dollars ($700) per individual hearing aid, per ear, every three (3) years for anyone of the age of nineteen (19) years and older.  (2) Every group health insurance contract or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide, as an optional rider, additional hearing aid coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group policies subject to the small employer health insurance availability act, chapter 50 of this title.  (b) For the purposes of this section:  (1) Hearing aid means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices, including, but not limited to FM systems.  (c) It shall remain within the sole discretion of the accident and sickness insurer as to the provider of hearing aids with which they choose to contract. Reimbursement shall be provided according to the respective principles and policies of the accident and sickness insurer. Nothing contained in this section precludes the accident and sickness insurer from conducting managed care, medical necessity, or utilization review.  (d) This section does not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of bodily injury or death by accident or both; (9) and other limited benefit policies.  History of Section.P.L. 2000, ch. 461,  1; P.L. 2004, ch. 539,  1; P.L. 2004, ch. 550,  1; P.L. 2005, ch. 374,  5; P.L. 2005, ch. 395,  1; P.L. 2006, ch. 595,  1; P.L. 2006, ch. 614,  1. 
 27-18-61. Prompt processing of claims. (a) A health care entity or health plan operating in the state shall pay all complete claims for covered health care services submitted to the health care entity or health plan by a health care provider or by a policyholder within forty (40) calendar days following the date of receipt of a complete written claim or within thirty (30) calendar days following the date of receipt of a complete electronic claim. Each health plan shall establish a written standard defining what constitutes a complete claim and shall distribute this standard to all participating providers.  (b) If the health care entity or health plan denies or pends a claim, the health care entity or health plan shall have thirty (30) calendar days from receipt of the claim to notify in writing the health care provider or policyholder of any and all reasons for denying or pending the claim and what, if any, additional information is required to process the claim. No health care entity or health plan may limit the time period in which additional information may be submitted to complete a claim.  (c) Any claim that is resubmitted by a health care provider or policyholder shall be treated by the health care entity or health plan pursuant to the provisions of subsection (a) of this section.  (d) A health care entity or health plan which fails to reimburse the health care provider or policyholder after receipt by the health care entity or health plan of a complete claim within the required timeframes shall pay to the health care provider or the policyholder who submitted the claim, in addition to any reimbursement for health care services provided, interest which shall accrue at the rate of twelve percent (12%) per annum commencing on the thirty-first (31st) day after receipt of a complete electronic claim or on the forty-first (41st) day after receipt of a complete written claim, and ending on the date the payment is issued to the health care provider or the policyholder.  (e) Exceptions to the requirements of this section are as follows:  (1) No health care entity or health plan operating in the state shall be in violation of this section for a claim submitted by a health care provider or policyholder if:  (i) Failure to comply is caused by a directive from a court or federal or state agency;  (ii) The health care entity or health plan is in liquidation or rehabilitation or is operating in compliance with a court-ordered plan of rehabilitation; or  (iii) The health care entity or health plans compliance is rendered impossible due to matters beyond its control that are not caused by it.  (2) No health care entity or health plan operating in the state shall be in violation of this section for any claim: (i) initially submitted more than ninety (90) days after the service is rendered, or (ii) resubmitted more than ninety (90) days after the date the health care provider received the notice provided for in subsection (b) of this section; provided, this exception shall not apply in the event compliance is rendered impossible due to matters beyond the control of the health care provider and were not caused by the health care provider.  (3) No health care entity or health plan operating in the state shall be in violation of this section while the claim is pending due to a fraud investigation by a state or federal agency.  (4) No health care entity or health plan operating in the state shall be obligated under this section to pay interest to any health care provider or policyholder for any claim if the director of business regulation finds that the entity or plan is in substantial compliance with this section. A health care entity or health plan seeking such a finding from the director shall submit any documentation that the director shall require. A health care entity or health plan which is found to be in substantial compliance with this section shall thereafter submit any documentation that the director may require on an annual basis for the director to assess ongoing compliance with this section.  (5) A health care entity or health plan may petition the director for a waiver of the provision of this section for a period not to exceed ninety (90) days in the event the health care entity or health plan is converting or substantially modifying its claims processing systems.  (f) For purposes of this section, the following definitions apply:  (1) Claim means: (i) a bill or invoice for covered services; (ii) a line item of service; or (iii) all services for one patient or subscriber within a bill or invoice.  (2) Date of receipt means the date the health care entity or health plan receives the claim whether via electronic submission or as a paper claim.  (3) Health care 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 described in  23-17.13-2(2), which operates a health plan.  (4) Health care provider means an individual clinician, either in practice independently or in a group, who provides health care services, and otherwise referred to as a non-institutional provider.  (5) Health care services include, but are not limited to, medical, mental health, substance abuse, dental and any other services covered under the terms of the specific health plan.  (6) Health plan means a plan operated by a health care entity that provides for the delivery of health care services to persons enrolled in those plans through:  (i) Arrangements with selected providers to furnish health care services; and/or  (ii) Financial incentive for persons enrolled in the plan to use the participating providers and procedures provided for by the health plan.  (7) Policyholder means a person covered under a health plan or a representative designated by that person.  (8) Substantial compliance means that the health care entity or health plan is processing and paying ninety-five percent (95%) or more of all claims within the time frame provided for in subsections (a) and (b) of this section.  (g) Any provision in a contract between a health care entity or a health plan and a health care provider which is inconsistent with this section shall be void and of no force and effect.  History of Section.P.L. 2001, ch. 119,  1; P.L. 2001, ch. 380,  1. 
 27-18-62. Mandatory coverage for certain lyme disease treatments. Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2004 shall provide coverage for diagnostic testing and long-term antibiotic treatment of chronic lyme disease when determined to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of title 5 entitled lyme disease diagnosis and treatment after making a thorough evaluation of the patients symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as unproven, experimental, or investigational in nature. Provided, however, 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.  History of Section.P.L. 2003, ch. 113,  3; P.L. 2003, ch. 114,  3; P.L. 2004, ch. 34,  2; P.L. 2004, ch. 35,  2. 
 27-18-63. Dental insurance assignment of benefits. Every entity providing a policy of accident and sickness insurance as defined in this chapter shall allow, as a provision in a group or individual policy, contract or health benefit plan for coverage of dental services, any person insured by such entity to direct, in writing, that benefits from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by such entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered. Provided, however, 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.  History of Section.P.L. 2004, ch. 268,  1; P.L. 2004, ch. 386,  1. 
 27-18-64. Coverage for early intervention services. (a) Every individual or group hospital or medical expense insurance policy or contract providing coverage for dependent children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of early-intervention services which coverage shall take effect no later than January 1, 2005. Such coverage shall not be subject to deductibles and coinsurance factors. Any amount paid by an insurer under this section for a dependent child shall not be applied to any annual or lifetime maximum benefit contained in the policy or contract. For the purpose of this section, early-intervention services means, but is not limited to, speech and language therapy, occupational therapy, physical therapy, evaluation, case management, nutrition, service-plan development and review, nursing services, and assistive technology services and devices for dependents from birth to age three (3) who are certified by the executive office of health and human services as eligible for services under part C of the Individuals with Disabilities Education Act (20 U.S.C.  1471 et seq.).  (b) Insurers shall reimburse certified, early intervention providers, who are designated as such by the executive office of health and human services, for early intervention services as defined in this section at rates of reimbursement equal to, or greater than, the prevailing integrated state Medicaid rate for early intervention services as established by the executive office of health and human services.  (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited-benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited-benefit policies.  History of Section.P.L. 2004, ch. 595, art. 22,  1; P.L. 2004, ch. 598,  2; P.L. 2005, ch. 97,  1; P.L. 2005, ch. 99,  1; P.L. 2008, ch. 475,  81; P.L. 2015, ch. 141, art. 5,  4; P.L. 2016, ch. 142, art. 7,  1. 
 27-18-65. Post-payment audits. (a) Except as otherwise provided herein, any review, audit, or investigation by a health insurer or health plan of a healthcare providers 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 payers 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.  History of Section.P.L. 2006, ch. 86,  1; P.L. 2006, ch. 97,  1; P.L. 2013, ch. 251,  1; P.L. 2013, ch. 395,  1; P.L. 2014, ch. 201,  1; P.L. 2014, ch. 214,  1; P.L. 2017, ch. 368,  1; P.L. 2017, ch. 375,  1; P.L. 2022, ch. 157,  1, effective June 27, 2022; P.L. 2022, ch. 158,  1, effective June 27, 2022. 
 27-18-66. Tobacco cessation programs. (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, which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided that if such medical coverage does not include prescription drug coverage, such contract, plan or policy shall not be required to include coverage for FDA approved smoking cessation medications.  (b) As used in this section, smoking cessation treatment includes the use of an over-the-counter (OTC) or prescription U.S. Food and Drug Administration (FDA) approved smoking cessation medication when used in accordance with FDA approval, for not more than two (2) courses of medication of up to fourteen (14) weeks each, annually, when recommended and prescribed by a prescriber who holds prescriptive privileges in the state in which they are licensed, and used in combination with an annual outpatient benefit of sixteen (16) one-half (12) hour evidence based smoking cessation counseling sessions provided by a qualified practitioner for each covered individual. Smoking cessation treatment may be redefined through regulation promulgated by the health insurance commissioner, in accordance with the most current clinical practice guidelines sponsored by the United States department of health and human services or its component agencies.  (c) Health insurance contracts, plans, or policies to which this section applies, may impose copayments and/or deductibles for the benefits mandated by this section consistent with the contracts, plans or policies copayments and/or deductibles for physician services and medications. Nothing contained in this section shall impact the reimbursement, medical necessity or utilization review, managed care, or case management practices of these health insurance contracts, plans or policies.  (d) This section shall not apply to insurance coverage providing benefits for:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Limited benefit health;  (7) Specified disease indemnity;  (8) Sickness or bodily injury or death by accident or both; and  (9) Other limited benefit policies.  History of Section.P.L. 2006, ch. 262,  1; P.L. 2006, ch. 293,  1; P.L. 2008, ch. 475,  81; P.L. 2009, ch. 187,  1; P.L. 2009, ch. 291,  1. 
 27-18-67. Reimbursement for orthotic and prosthetic services. (a) As used in this section:  (1) Federal reimbursement rates means the current listed fee schedule from the Centers for Medicare and Medicaid Services, listing the current Healthcare Common Procedure Coding system (HCPCS) and the corresponding reimbursement rates.  (2) Orthosis means a custom fabricated brace or support that is designed based on medical necessity. Orthosis does not include prefabricated or direct-formed orthotic devices, as defined in this section, or any of the following assistive technology devices: commercially available knee orthoses used following injury or surgery; spastic muscle-tone inhibiting orthoses; upper extremity adaptive equipment; finger splints; hand splints; wrist gauntlets; face masks used following burns; wheelchair seating that is an integral part of the wheelchair and not worn by the patient independent of the wheelchair; fabric or elastic supports; corsets; low-temperature formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; and other similar devices as determined by the director of the department of health, such as those commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility.  (3) Orthotics means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of, an orthosis for the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury, or deformity. The practice of orthotics encompasses evaluation, treatment, and consultation; with basic observational gait and postural analysis, orthotists assess and design orthoses to maximize function and provide not only the support but the alignment necessary to either prevent or correct a deformity or to improve the safety and efficiency of mobility or locomotion or both. Orthotic practice includes providing continuing patient care in order to assess its effect on the patients tissues and to assure proper fit and function of the orthotic device by periodic evaluation.  (4) Prosthesis means an artificial limb that is alignable or, in lower-extremity applications capable of weight bearing. Prosthesis means an artificial medical device that is not surgically implanted and that is used to replace a missing limb, appendage, or other external human body part including an artificial limb, hand, or foot. The term does not include artificial eyes, ears, noses, dental appliances, ostomy products, or devices such as eyelashes or wigs.  (5) Prosthetics means the science and practice of evaluation, measuring, designing, fabricating, assembling, fitting, aligning, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of, a prosthesis through the replacement of external parts of a human body lost due to amputation or congenital deformities or absences. The practice of prosthetics also includes the generation of an image, form, or mold that replicates the patients body or body segment and that requires rectification of dimensions, contours and volumes for use in the design and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial appendage that is designed either to support body weight or to improve or restore function or cosmesis, or both. Involved in the practice of prosthetics is observational gait analysis and clinical assessment of the requirements necessary to refine and mechanically fix the relative position of various parts of the prosthesis to maximize function, stability, and safety of the patient. The practice of prosthetics includes providing and continuing patient care in order to assess the prosthetic devices effect on the patients tissues and to assure proper fit and function of the prosthetic device by periodic evaluation.  (6) Private insurance company means any insurance company, or management company hired by an insurance company, that is any of the following:  (i) Based in the state of Rhode Island; or  (ii) Provides coverage for citizens for the state of Rhode Island; or  (iii) Allows subscribing patients to seek prosthetic or orthotic services in the state of Rhode Island.  (b) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, that provides medical coverage that includes coverage for physician services in a physicians office and every policy that provides major medical or similar comprehensive type coverage shall provide coverage for benefits for orthotic and prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C.  1395k, 1395l and 1395m and 42 C.F.R.  414.202, 414.210, 414.228, and 410.100 as applicable to this section.  (c) A health insurance contract, plan, or policy may require prior authorization for orthotic and prosthetic devices in the same manner that prior authorization is required for any other covered benefit.  (d) Covered benefits for orthotic or prosthetic devices shall be limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insureds treating physician.  (e) The repair and replacement of orthotic or prosthetic devices also shall be covered subject to co-payments and deductibles, unless necessitated by misuse or loss.  (f) An insurer may require, if coverage is provided through a managed care plan, that benefits mandated pursuant to this section be covered benefits only if the orthotic or prosthetic devices are provided by a vendor and orthotic or prosthetic services are rendered by a provider who is licensed by the state of Rhode Island to provide orthotics and prosthetics.  (g) 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.  History of Section.P.L. 2006, ch. 210,  1; P.L. 2006, ch. 380,  1; P.L. 2017, ch. 196,  4; P.L. 2017, ch. 322,  4. 
 27-18-68. Mandatory coverage for scalp hair prosthesis. (a) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2007, which provides coverage for any other prosthesis, shall provide coverage for expenses for scalp hair prosthesis worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia; provided, however, that such coverage shall be subject to the same limitations and guidelines as other prosthesis, and that coverage shall not exceed an amount of three hundred fifty dollars ($350) per covered member per year, exclusive of any deductible.  (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 2006, ch. 538,  1. 
 27-18-69. Licensed ambulance service. (a) No individual or group health insurance contract, plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009 shall provide for a co-payment for ground ambulance services in excess of fifty dollars ($50.00).  (b) As used in this section, the term ground ambulance services shall mean those services provided by an ambulance service licensed to operate in Rhode Island in accordance with  23-4.1-6. The term excludes air and water ambulance services and ambulance services provided outside of Rhode Island.  (c) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 2008, ch. 68,  1; P.L. 2008, ch. 70,  1. 
 27-18-7. Third party ownership. The word insured, as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under the policy to any indemnities, benefits, and rights provided in the policy.  History of Section.P.L. 1956, ch. 3808,  3; G.L. 1956,  27-18-7. 
 27-18-70. Enteral nutrition products. (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and that are medically necessary for the treatment of malabsorption caused by Crohns disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein and shall extend to all recipients regardless of age.  (b) Benefit plans offered by an insurer may impose a copayment and/or deductibles for the benefits mandated by this section, however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for prescription enteral formulas or nutritional aids. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization. Reimbursement shall be provided according to the respective principles and policies of the accident and sickness insurer. Nothing contained in this section precludes the accident and sickness insurer from conducting managed care, medical necessity, or utilization review.  (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited-benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited-benefit policies.  History of Section.P.L. 2008, ch. 253,  1; P.L. 2014, ch. 269,  1; P.L. 2014, ch. 519,  1. 
 27-18-71. Prohibition on preexisting condition exclusions. (a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title and/or chapter:  (1) Shall not limit or exclude coverage for an individual under the age of nineteen (19) by imposing a preexisting condition exclusion on that individual.  (2) For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude coverage for any individual by imposing a preexisting condition exclusion on that individual.  (b) As used in this section:  (1) Preexisting condition exclusion means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition (whether physical or mental) was present before the effective date of coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, diagnosis, care or treatment was recommended or received before the effective date of coverage.  (2) Preexisting condition exclusion means any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individuals health status before the individuals effective date of coverage, or if the coverage is denied, the date of denial, under the health benefit plan, such as a condition (whether physical or mental) identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period.  (c) This section shall not apply to grandfathered health plans providing individual health insurance coverage.  (d) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  History of Section.P.L. 2012, ch. 256,  2; P.L. 2012, ch. 262,  2. 
 27-18-72. Prohibition on rescission of coverage. (a)(1) Coverage under a health benefit plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be rescinded after the individual is covered under the plan, unless:  (A) The individual or a person seeking coverage on behalf of the individual, performs an act, practice or omission that constitutes fraud; or  (B) The individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage.  (2) For purposes of paragraph (a)(1)(A), a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health carrier.  (b) At least thirty (30) days advance written notice shall be provided to each health benefit plan enrollee or, for individual health insurance coverage, primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of, in the case of group health insurance coverage, whether the rescission applies to the entire group or only to an individual within the group.  (c) For purposes of this section, to rescind means to cancel or to discontinue coverage with retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.  (d) This section applies to grandfathered health plans.  History of Section.P.L. 2012, ch. 256,  2; P.L. 2012, ch. 262,  2. 
 27-18-73. Prohibition on annual and lifetime limits. (a) Annual limits.(1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health insurance carrier and a health benefit plan subject to the jurisdiction of the commissioner under this chapter may establish an annual limit on the dollar amount of benefits that are essential health benefits provided the restricted annual limit is not less than the following:  (A) For a plan or policy year beginning after September 22, 2011, but before September 23, 2012  one million two hundred fifty thousand dollars ($1,250,000); and  (B) For a plan or policy year beginning after September 22, 2012, but before January 1, 2014  two million dollars ($2,000,000).  (2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier and a health benefit plan shall not establish any annual limit on the dollar amount of essential health benefits for any individual, except:  (A) A health flexible spending arrangement, as defined in Section 106(c)(2)(i) of the Federal Internal Revenue Code, a medical savings account, as defined in section 220 of the federal Internal Revenue Code, and a health savings account, as defined in Section 223 of the federal Internal Revenue Code are not subject to the requirements of subdivisions (1) and (2) of this subsection.  (B) The provisions of this subsection shall not prevent a health insurance carrier and a health benefit plan from placing annual dollar limits for any individual on specific covered benefits that are not essential health benefits to the extent that such limits are otherwise permitted under applicable federal law or the laws and regulations of this state.  (3) In determining whether an individual has received benefits that meet or exceed the allowable limits, as provided in subdivision (1) of this subsection, a health insurance carrier and a health benefit plan shall take into account only essential health benefits.   (b) Lifetime limits.(1) A health insurance carrier and health benefit plan offering group or individual health insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits for any individual.  (2) Notwithstanding subdivision (1) above, a health insurance carrier and health benefit plan is not prohibited from placing lifetime dollar limits for any individual on specific covered benefits that are not essential health benefits, in accordance with federal laws and regulations.   (c)(1) The provisions of this section relating to lifetime limits apply to any health insurance carrier providing coverage under an individual or group health plan, including grandfathered health plans.  (2) The provisions of this section relating to annual limits apply to any health insurance carrier providing coverage under a group health plan, including grandfathered health plans, but the prohibition and limits on annual limits do not apply to grandfathered health plans providing individual health insurance coverage.  (d) This section shall not apply to a plan or to policy years prior to January 1, 2014 for which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant to 45 C.F.R.  147.126(d)(3). This section also shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  (e) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this subsection shall be construed to limit the authority of the Commissioner to regulate health insurance under existing state law.  History of Section.P.L. 2012, ch. 256,  2; P.L. 2012, ch. 262,  2. 
 27-18-74. Coverage for individuals participating in approved clinical trials. (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:  (A) The study or investigation is approved or funded, which may include funding through in-kind contributions, by one or more of the following:  (i) The federal National Institutes of Health;  (ii) The federal Centers for Disease Control and Prevention;  (iii) The federal Agency for Health Care Research and Quality;  (iv) The federal Centers for Medicare & Medicaid Services;  (v) A cooperative group or center of any of the entities described in items (i) through (iv) or the U.S. Department of Defense or the U.S. Department of Veteran Affairs;  (vi) A qualified non-governmental research entity identified in the guidelines issued by the federal National Institutes of Health for center support grants; or  (vii) A study or investigation conducted by the U.S. Department of Veteran 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 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.  (B) The study or investigation is conducted under an investigational new drug application reviewed by the U.S. Food and Drug Administration; or  (C) The study or investigation is a drug trial that is exempt from having such an investigational new drug application.  (2) Participant has the meaning stated in section 3(7) [29 U.S.C.  1002] of federal ERISA.  (3) 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.  (4) Qualified individual means a participant or beneficiary who meets the following conditions:  (A) 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  (B)(i) The referring healthcare professional is a participating provider and has concluded that the individuals participation in such trial would be appropriate based on the individual meeting the conditions described in subdivision (A) of this subdivision (3); or  (ii) The participant or beneficiary provides medical and scientific information establishing the individuals participation in such trial would be appropriate based on the individual meeting the conditions described in subdivision (A) of this subdivision (3).  (5) 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.  (b)(1) If a health insurance carrier offering group or individual health insurance coverage provides coverage to a qualified individual, the health insurance carrier:  (A) Shall not deny the individual participation in an approved clinical trial.  (B) Subject to subdivision (3) of this subsection, 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  (C) Shall not discriminate against the individual on the basis of the individuals participation in the approved clinical trial.  (2)(A) Subject to subdivision (B) of this subdivision (2), 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.  (B) For purposes of subdivision (B) of this subdivision (2), routine patient costs do not include:  (i) The investigational item, device or service itself;  (ii) 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  (iii) A service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis.  (3) If one or more participating providers are participating in a clinical trial, nothing in subdivision (1) of this subsection shall be construed as preventing a health carrier from requiring that a qualified individual participate in the trial through such a participating provider if the provider will accept the individual as a participant in the trial.  (4) Notwithstanding subdivision (3) of this subsection, subdivision (1) of this subsection 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 insurance carrier offering group or individual health insurance coverage to provide benefits for routine patient care services provided outside of the coverages 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 insurance carriers coverage with respect to clinical trials.  (c) The requirements of this section shall be in addition to the requirements of Rhode Island general laws  27-18-36  27-18-36.3.  (d) This section shall not apply to grandfathered health plans. This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  (e) This section shall be effective for plan years beginning on or after January 1, 2014.  History of Section.P.L. 2012, ch. 256,  2; P.L. 2012, ch. 262,  2. 
 27-18-75. Medical loss ratio reporting and rebates. (a) A health insurance carrier offering group or individual health insurance coverage of a health benefit plan, including a grandfathered health plan, shall comply with the provisions of Section 2718 [42 U.S.C.  300gg-18] of the Public Health Service Act as amended by the federal Affordable Care Act, in accordance with regulations adopted thereunder.  (b) Health insurance carriers required to report medical loss ratio and rebate calculations and other medical loss ratio and rebate information to the U.S. Department of Health and Human Services shall concurrently file such information with the commissioner.  History of Section.P.L. 2012, ch. 256,  2; P.L. 2012, ch. 262,  2. 
 27-18-76. Emergency services. (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:  (A) 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  (B) 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  1867(e)(3) of the Social Security Act (42 U.S.C.  1395dd(e)(3)).  (b) If a health insurance carrier offering health insurance coverage provides any benefits with respect to services in an emergency department of a hospital, the carrier must cover emergency services in compliance with this section.  (c) A health insurance carrier 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:  (A) The exclusion of or coordination of benefits;  (B) An affiliation or waiting period permitted under part 7 of federal ERISA, part A of title XXVII of the federal PHS Act, or chapter 100 of the federal Internal Revenue Code; or  (C) 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 health insurance carrier is required to pay under subdivision (1) of this subsection. A health insurance carrier complies with the requirements of this subsection if it provides benefits with respect to an emergency service in an amount equal to the greatest of the three amounts specified in subdivisions (A), (B), and (C) of this subdivision (1) (which are adjusted for in-network cost-sharing requirements).  (A) 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 subdivision (A) 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 subdivision (A) is disregarded.  (B) The amount for the emergency service shall be 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 subdivision (B) 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.  (C) 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) This section shall not 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.  History of Section.P.L. 2012, ch. 256,  2; P.L. 2012, ch. 262,  2. 
 27-18-77. Internal and external appeal of adverse benefit determinations. (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 which are not subject to the jurisdiction of the department of health pursuant to  23-17.12 et seq. (Utilization Review Act).  (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.  History of Section.P.L. 2012, ch. 256,  2; P.L. 2012, ch. 262,  2. 
 27-18-78. Primary care provider designation requirement. (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2013, shall require that the subscriber and each dependent designate a participating primary care provider and the insurer shall collect the designation from the insured. Designation of a primary care provider shall not be a condition of enrollment and failure to designate a primary care provider shall not constitute grounds for cancellation of coverage. For purposes of this section, primary care provider means the physician, practice or other medical provider considered by the insured to be his or her usual source of medical care.  (b) Requirements for designating a primary care provider enumerated in subsection (a) shall not apply to insurance coverage providing benefits for:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Limited benefit health;  (7) Specified disease indemnity;  (8) Sickness or bodily injury or death by accident or both; or  (9) Other limited benefit policies.  History of Section.P.L. 2012, ch. 189,  3; P.L. 2012, ch. 202,  3. 
 27-18-79. Discretionary clauses. (a) No new or existing policy or certificate issued by an insurer or healthcare entity may contain any provision:  (1) Purporting to reserve sole discretion to the insurer or healthcare entity to determine eligibility for benefits or interpret the terms of a policy or certificate; or  (2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.  (b) For purposes of this section, healthcare entity means a health insurance company or nonprofit hospital or medical or dental service corporation or plan or health maintenance organization which operates or administers a health plan in this state.  (c) Any such clause or language included in a contract, policy or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.  (d) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.  History of Section.P.L. 2013, ch. 85,  2; P.L. 2013, ch. 94,  2. 
 27-18-8.1. Waiting period  Effective date of filings. Each filing shall be on file for a waiting period of sixty (60) days before it becomes effective. The commissioner may authorize a filing that he or she has reviewed to become effective before the expiration of the waiting period or any extension of the waiting period. A filing shall be deemed to meet the requirements of this chapter and become effective unless disapproved by the commissioner within the waiting period.  History of Section.P.L. 1988, ch. 564,  2. 
 27-18-8.2. Notice of disapproval. If within the waiting period the commissioner finds that a filing does not meet the requirements of this chapter, he or she shall send to the insurer which made the filing written notice of disapproval of the filing, specifying in the notice in what respects he or she finds that the filing fails to meet the requirements of this chapter, and stating that the filing is disapproved.  History of Section.P.L. 1988, ch. 564,  2. 
 27-18-8.3. Withdrawal of approval. After proper notice and a hearing in accordance with chapter 35 of title 42, the commissioner may withdraw his or her approval of any form approved under  27-18-8.1 if he or she finds that the form does not meet the requirements of this chapter. If approval is withdrawn, the form or rate shall not be used in this state after the date of withdrawal.  History of Section.P.L. 1988, ch. 564,  2. 
 27-18-8.4. Rules as to filing. The commissioner may make any reasonable rules and regulations concerning the procedure for the filing or submission of policies subject to this chapter as are necessary, proper, or advisable to the administration of this chapter. This provision shall not abridge any other authority granted the commissioner by law.  History of Section.P.L. 1988, ch. 564,  2. 
 27-18-8. Filing of accident and sickness insurance policy forms. (a) Any insurance company authorized to do an accident and sickness business within this state in accordance with the provisions of this title shall file all accident and sickness insurance policy forms and rates used by it in the state with the insurance commissioner, including the forms of any rider, endorsement, application blank, and other matter generally used or incorporated by reference in its policies or contracts of insurance. No such form shall be used if disapproved by the commissioner under this section, or if the commissioners approval has been withdrawn under  27-18-8.3, or until the expiration of the waiting period established under  27-18-8.3. Such a company shall comply with its filed and approved forms. If the commissioner finds from an examination of any form that it is contrary to the public interest, or the requirements of this code or duly promulgated regulations, he or she shall forbid its use, and shall notify the company in writing as provided in  27-18-8.2.  (b) Each rate filing shall include a certification by a qualified actuary that to the best of the actuarys 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.  History of Section.P.L. 1956, ch. 3808,  3; G.L. 1956,  27-18-8; P.L. 1988, ch. 564,  1; P.L. 2012, ch. 256,  3; P.L. 2012, ch. 262,  3. 
 27-18-80. Orally administered anticancer medication  Cost-sharing requirement. (a) Every individual or group hospital or medical expense, insurance policy or individual or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued for delivery, or renewed in this state, on or after January 1, 2014, that offers both medical and prescription drug coverage, and provides coverage for intravenously administered anticancer medication, shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section. Notwithstanding the above, the requirements shall not be construed to impose any form of cap on cost-sharing.  (b) This section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  History of Section.P.L. 2013, ch. 323,  1; P.L. 2013, ch. 405,  1. 
 27-18-81. Consumer notification. Every health insurer or health plan providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a non-duplication of benefits clause: NO DUPLICATION OF BENEFITS.  History of Section.P.L. 2013, ch. 452,  1; P.L. 2013, ch. 479,  1. 
 27-18-82. Opioid antagonists. (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.  (d) Notwithstanding  27-18-19, or any other provision to the contrary, this section shall apply to blanket or group polices of insurance.  History of Section.P.L. 2016, ch. 175,  1; P.L. 2016, ch. 192,  1. 
 27-18-83. Healthcare provider credentialing. (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 providers 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 providers 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 entitys or health plans 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.  History of Section.P.L. 2017, ch. 185,  1; P.L. 2017, ch. 254,  1. 
 27-18-84. Health insurance contracts  Full year coverage for contraception. 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.  History of Section.P.L. 2018, ch. 230,  1; P.L. 2018, ch. 234,  1. 
 27-18-85. Prohibition on discrimination in organ transplants.  Pursuant to chapter 95 of title 23, any health insurer that provides coverage for anatomical gifts, organ transplants, or related treatment and services shall not:  (1) Deny coverage to a covered person solely on the basis of the persons disability;  (2) Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the health benefit plan, solely for the purpose of avoiding the requirements of this section;  (3) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide monetary or nonmonetary incentives to an attending provider, to induce the provider to provide care to an insured or enrollee in a manner inconsistent with this section; or  (4) Reduce or limit coverage benefits to a patient for the medical services or other services related to organ transplantation performed pursuant to this section as determined in consultation with the attending physician and patient.  History of Section.P.L. 2021, ch. 109,  3, effective June 30, 2021; P.L. 2021, ch. 133,  3, effective June 30, 2021. 
 27-18-86. Health insurance contracts  Copayments exemption for COVID-19 vaccinations. (a) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for COVID-19 related services, including, but not limited to: emergency services, inpatient services, provider office visits, and inpatient hospital stays, as long as the COVID-19 state of emergency remains in effect.  (b) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for the administration of the COVID-19 vaccine or a COVID-19 test.  (c) The health insurance commissioner shall promulgate any rules and regulations as the commissioner deems necessary for the efficient administration and enforcement of this section.  History of Section.P.L. 2021, ch. 145,  1, effective July 3, 2021; P.L. 2021, ch. 161,  1, effective July 3, 2021. 
 27-18-87. Perinatal doulas.  (a) As used in this section, doula or perinatal doula means a trained professional providing continuous physical, emotional, and informational support to a pregnant individual, from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.  (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 July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurers respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas area of professional competence as defined by the doula certification standard developed and maintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other healthcare provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement, except when those requirements are also applicable to other categories of healthcare providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other healthcare provider.  (c) 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 that is required to cover perinatal doula services, as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023, and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.  (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.  History of Section.P.L. 2021, ch. 209,  2, effective July 1, 2022; P.L. 2021, ch. 321,  2, effective July 1, 2022. 
 27-18-88. Gender rating. [Effective January 1, 2023.] (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 physicians office, and no policy that provides major medical or similar comprehensive-type coverage, excluding disability income, long-term care, and insurance supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall vary the premium rate for a health coverage plan based on the gender of the individual policy holders, enrollees, subscribers, or members.  (b) This section shall not apply to insurance coverage providing benefits for any of the following:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Limited benefit health;  (7) Specified disease indemnity;  (8) Sickness of bodily injury or death by accident or both; and  (9) Other limited benefit policies.  History of Section.P.L. 2021, ch. 88,  1, effective January 1, 2023; P.L. 2021, ch. 89,  1, effective January 1, 2023. 
 27-18-89. Coverage for biomarker testing.  (a) As used in this section:  (1) Biomarker means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Biomarkers include, but are not limited to, gene mutations or protein expression.  (2) Biomarker testing means the analysis of a patients tissue, blood, or other biospecimen for the presence of a biomarker. Biomarker testing includes, but is not limited to, single-analyte tests, multi-plex panel tests, and whole genome sequencing.  (3) Clinical utility means the test result provides information that is used in the formulation of a treatment or monitoring strategy that informs a patients outcome and impacts the clinical decision. The most appropriate test may include both information that is actionable and some information that cannot be immediately used in the formulation of a clinical decision.  (4) Consensus statements means statements developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure and with a conflict of interest policy. These statements are aimed at specific clinical circumstances and base the statements on the best available evidence for the purpose of optimizing the outcomes of clinical care.  (5) Nationally recognized clinical practice guidelines means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy. Clinical practice guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options and include recommendations intended to optimize patient care.  (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2024, shall provide coverage for the services of biomarker testing in accordance with each health insurers respective principles and mechanisms of reimbursement, credentialing, and contracting. Biomarker testing must be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollees disease or condition to guide treatment decisions, when the test provides clinical utility as demonstrated by medical and scientific evidence, including, but not limited to:  (1) Labeled indications for an FDA-approved or -cleared test or indicated tests for an FDA-approved drug;  (2) Centers for Medicare Services (CMS) national coverage determinations or Medicare Administrative Contractor (MAC) local coverage determinations; or  (3) Nationally recognized clinical practice guidelines and consensus statements.  (c) Coverage as defined in subsection (b) of this section shall be provided in a manner that limits disruptions in care including the need for multiple biopsies or biospecimen samples.  (d) The patient and prescribing practitioner shall have access to clear, readily accessible, and convenient processes to request an exception to a coverage policy of a health insurer, nonprofit health service plan, and health maintenance organization. The process shall be made readily accessible on the health insurers, nonprofit health service plans, or health maintenance organizations website.  History of Section.P.L. 2022, ch. 151,  1, effective June 27, 2022; P.L. 2022, ch. 152,  1, effective June 27, 2022. 
 27-18-9. Policies of foreign insurers. Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provision of this chapter and which is prescribed or required by the law of the state under which the insurer is organized.  History of Section.P.L. 1956, ch. 3808,  3; G.L. 1956,  27-18-9. 
 27-18-90. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.] (a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobin therapy.  (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall be coded as autoimmune encephalitis until the American Medical Association and the Centers for Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome.  (c) The healthcare benefits outlined in this section apply only to services delivered within the state of Rhode Island; provided, that all health insurance carriers shall be required to provide coverage for those benefits mandated by this section outside of the state of Rhode Island where it can be established through a pre-authorization process that the required services are not available in the state of Rhode Island from a provider in the health insurance carriers network.  (d) Each health insurance carrier shall collect and provide to the office of the health insurance commissioner, in a form and frequency acceptable to the commissioner, information and data reflecting the costs and the savings of adding the benefit coverage provided in this section. On or before January 1, 2025, the office of the health insurance commissioner shall report to the general assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage provided in this section produces a net savings to health insurance carriers and to policy holders.  (e) This section shall sunset and be repealed effective December 31, 2025.  History of Section.P.L. 2022, ch. 422,  1, effective June 30, 2022; P.L. 2022, ch. 423,  1, effective June 30, 2022. 
 27-19.1-1. Medical benefits for those who lose eligibility to participate. (a) Whenever the employment of an insured member of a group hospital, surgical, dental, vision or medical insurance plan is terminated because of involuntary layoff or death, or as a result of the workplace ceasing to exist, or the permanent reduction in size of the workforce, the benefits of the plan may be continued as provided in this section for a period of up to eighteen (18) months from the termination date of the insured member, but in any event not to exceed the shorter of the period which represents the period of continuous employment preceding termination with the employer under whose contract the member is insured or the time from the termination date of the insured member until the member, surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, becomes employed by another group and eligible for benefits under another group plan.  (b) The extended coverage for the period defined in subsection (a) of this section shall be available to the terminated member the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, at the same monthly premium rate or subscription fee for the group in which he or she was previously a member or at a monthly premium rate or subscription fee as may be in effect from time to time for the same group subsequent to his or her qualification under subsection (a) of this section. The terminated member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, shall not be required to pay more than a monthly premium rate or subscription fee per month at one time.  (c) The involuntarily laid off member or other member qualifying under subsection (a) of this section, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, may elect to continue participation in the group plan within thirty (30) days after the members qualification under subsection (a) of this section. The involuntarily laid off member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan shall be responsible for the payment of monthly premiums rates or subscription fees directly to the carrier of the surgical, hospital, or medical insurance plan, or the group plans agent or insurance producer, throughout the extended coverage period, if the member had been covered under a group plan consisting of fifty (50) members or less. Those leaving group plans with more than fifty (50) members shall be responsible directly to the employer for the payment of monthly premiums rates or subscription fees, or directly to the carrier if the workplace ceases to exist. The terminated member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, shall not be required to pay more than a monthly premium rate or subscription fee per month at one time.  (d) After timely receipt of the monthly premium rate or subscription fee, as defined in this subsection, from the qualifying member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, if the employer fails to make payment to the carrier with the result that coverage is terminated, the employer shall be liable for benefits to the same extent as the carrier would have been liable if coverage had not been terminated. Timely receipt of the monthly premium payment means the employers receipt of the monthly premium rate or subscription fee for the extended coverage from the qualifying member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan within the dates or by the date indicated by the employer as a requirement of this chapter at the time of the election of the extended coverage. This subsection shall not apply to an employer whose workplace ceases to exist.  (e) Upon termination of the extended coverage period, the qualifying member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan shall be entitled to exercise any option which is provided in the group plan to elect a converted policy.  (f) All employers who provide their employees a group hospital, surgical, or medical insurance plan shall post a conspicuous notice to the employees of their options under the provisions of this chapter.  (g) Group hospital, surgical, dental, vision, or medical insurance plan as used in this section includes any service plan contract of a medical or health service plan corporation. Carrier as used in this section means any insurance company which is the insurer of the group hospital, surgical, dental, vision, or medical plan or the medical, dental, optometric, or health service plan corporation which provides the group service plan contract, either of which an employer provides for his or her employees.  (h) This chapter shall not apply to an employee who is employed in the construction industry or his or her employer if the employee, at the time benefits could be selected under this chapter, is a participant in, and the employer is a contributor to, a multi-employer welfare plan as defined in 29 U.S.C.  1301 et seq., and which the internal revenue service has determined is tax exempt as to contributions received and as to benefits received by its participants.  (i) Notwithstanding any section to the contrary, any member who qualified for the extended coverage as defined in subsection (a) on or after September 1, 2008, but who declined to elect coverage within the timeframe as described within subsection (c) may elect, no later than May 1, 2009, to resume coverage under this section. Coverage elected under this subsection shall commence March 1, 2009, and may be continued as defined in subsection (a).  History of Section.P.L. 1977, ch. 266,  1; P.L. 1988, ch. 79,  2; P.L. 1988, ch. 570,  1; P.L. 1989, ch. 542,  81; P.L. 2003, ch. 244,  1; P.L. 2003, ch. 285,  1; P.L. 2009, ch. 6,  1; P.L. 2009, ch. 7,  1; P.L. 2010, ch. 53,  1; P.L. 2010, ch. 72,  1. 
 27-19.2-1. Legislative findings. The general assembly finds and declares that it is in the best interests of the residents of Rhode Island:  (1) To strengthen and reform the governance structure of nonprofit hospital service and/or medical service corporations;  (2) To ensure a diverse, independent and publicly accountable board of directors;  (3) To prohibit certain activities which may allow self-interest to compromise undivided loyalty to the public interest mission for which such corporations were established; and  (4) To require adoption of principles and procedures to keep such corporations aligned with their public interest mission.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2. 
 27-19.2-10. Nonprofit hospital and/or medical service corporations  Responsibilities. In accordance with their nonprofit hospital and/or medical service corporation mission, nonprofit insurers shall be required to:  (1) Offer products in the small group;  (2) Offer products in the individual market, with at least one 30-day open enrollment period every twelve (12) months;  (3) Employ pricing strategies that enhance the affordability of health care coverage; and  (4) Protect the financial condition of the nonprofit hospital and/or medical service plan.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2. 
 27-19.2-11. Application to subsidiary entities. The terms of this act shall apply to any insurer or health maintenance organization, or other entity involved in delivering health insurance, whether or not organized as a nonprofit corporation, that is owned or controlled by a nonprofit hospital and/or medical service plan, unless specifically exempted by law.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2. 
 27-19.2-2. Definitions. (a) Affiliate means an entity controlled by, controlling, or in common control with, a nonprofit hospital service corporation.  (b) Health insurer means an insurer defined in  27-20.6-1(1).  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2. 
 27-19.2-3. Mission statement contents. All nonprofit hospital and/or medical service corporations and any affiliate or subsidiary of such corporation shall on or before December 31, 2004 have a declared and published mission statement identifying the purposes of said nonprofit as including:  (1) To provide affordable and accessible health insurance to insureds, including those persons insured by an affiliate or subsidiary of said plan;  (2) To assist and support public and private health care initiatives for individuals without health care insurance;  (3) To promote integration, efficiency and coherence of a statewide health care system that meets the needs of all Rhode Island residents;  (4) To contribute through its operations, procedures and investments to the improvement of medical and prevention services delivered in Rhode Island; and  (5) To provide affordable and accessible health insurance to a comprehensive range of consumers, including business owners, employees and unemployed individuals.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2. 
 27-19.2-4. Board of directors  Duties and functions of the board of directors. (a) The board of a nonprofit hospital and/or medical service corporation and its individual members are fiduciaries and shall act at all times:  (1) In utmost good faith;  (2) In a manner reasonably believed to be in the best interest of fulfilling the corporations mission or the mission of affiliates or subsidiaries;  (3) In a manner reflecting undivided loyalty to the furtherance of the corporations charitable mission;  (4) At the highest standard of fiduciary care and prudence;  (5) In accordance with a conflict of interest policy adopted by the board of directors that will be consistent with guidelines recommended and published by the U.S. Internal Revenue Service for nonprofit entities; and  (6) Physicians who receive compensation from the nonprofit hospital and/or medical service corporation, for services rendered in their professional capacity, directly or indirectly, may serve on board committees that address compensation matters; provided, however, that no such physician member may participate in a vote or deliberate on matters relating to physician compensation.  (b) The proper and principal functions of the board shall include:  (1) Ensuring that the corporation effectively carries out the charitable mission for which it was incorporated under  27-19-2 of this title;  (2) Selecting corporate management and evaluating its performance in light of the corporations charitable purpose;  (3) Recognizing that in the event of a conversion as defined in  27-66-4(3), the reserves and assets with which they are entrusted are charitable assets, and treating them with according stewardship;  (4) Establishing a system of board governance including an annual evaluation of board performance measured against the charitable purpose of the corporation; and  (5) Holding an annual public meeting with proper notice open to providers and subscribers at which comments shall be heard from the floor.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2; P.L. 2005, ch. 39,  1; P.L. 2005, ch. 73,  1. 
 27-19.2-5. Composition of the board of directors. (a)(1) Notwithstanding any public law, rule or regulation to the contrary, six (6) positions on the board of directors of a nonprofit hospital and/or medical service corporation, shall be filled by public appointment for a maximum of three (3) three (3) year terms. Public appointment of two (2) of the directors shall be made by the Governor, two (2) shall be made by the Speaker of the House, and two (2) shall be made by the President of the Senate. Neither state employees nor elected state officials shall serve as public members of the board of directors. Each appointing authority shall make one such appointment on or after July 1, 2004, and the remaining will be made on or after July 1, 2005. Once appointed, public members may only be removed in accordance with the bylaws of the nonprofit hospital and/or medical service corporation. When sufficient public appointments have been made, vacancies shall thereafter be filled for a maximum of three (3) three (3) year terms as the board of directors may determine, and consistent with subsection (2) hereof, except that seats filled by public appointment pursuant to this subsection shall always remain subject to such public appointment, upon the resignation, removal, incapacity or retirement of the incumbent public appointee. Public appointees shall not constitute a majority of the board.  (2) Future vacancies not filled by public appointment pursuant to subsection (1) hereof shall be filled by an open and public process of recruitment and appointment, to be determined by the board and within its discretion, but to include public solicitation of candidates.  (3) At the end of their term, directors shall continue to serve until their successors are appointed and qualified. Nothing herein prevents the reappointment of a board member presently serving.  (4) Public appointees may not:  (i) Be employed by or have a financial interest in:  (A) A nonprofit hospital and/or medical service plan or its affiliates or subsidiaries;  (B) A person regulated under this article; or  (ii) Within three (3) years before appointment, have been employed by, had a financial interest in or have received compensation from:  (A) A nonprofit hospital and/or medical service plan or its affiliates or subsidiaries; or  (B) A person regulated under this article.  (b) An officer or employee of a nonprofit hospital and/or medical service plan or any of its affiliates or subsidiaries may not be appointed or elected to the board.  (c) Each standing committee shall have representation from the public appointee members.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2; P.L. 2006, ch. 616,  1. 
 27-19.2-6. Actions requiring supermajority board approval. Neither a nonprofit hospital service corporation, nor an affiliate (as defined in  27-19.2-2(a)) that is an insurer (as defined in  27-20.6-1(1)), may take any of the following actions without the prior approval of at least two-thirds percent (66.67%) of the corporations entire board of directors:  (1) Authorize a conversion as defined in  27-66-4(3);  (2) Withdraw a health insurance product previously offered in the individual market; or  (3) Result in the withdrawal from a geographic region.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2; P.L. 2008, ch. 475,  84. 
 27-19.2-7. Compensation of board members. (a) Pending appointment and confirmation of the health insurance commissioner, no compensation shall be paid to the board members by a nonprofit hospital or medical services corporation, excluding reimbursement for ordinary and necessary expenses. After such confirmation, the board must file application with the health insurance commissioner for approval of any proposed board compensation. Childcare, parking, transportation and other reasonable expenses for board members attending meetings shall be compensable.  (b) On or before March 1, 2005, and annually thereafter, a corporation subject to this paragraph shall report to the health insurance commissioner the ordinary and necessary expenses paid to each board member in the preceding calendar year.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2. 
 27-19.2-8. Compensation of officers and executives. (a) There shall be a standing compensation committee of the board that shall develop proposed guidelines, for approval by the board, for compensation, including salary, bonuses, perquisites, and severance agreements, of all officers and executives that is reasonable.  (b) On or before December 31, 2004, the board shall file its proposed guidelines for executive compensation with the health insurance commissioner.  (c) No corporation organized pursuant to this chapter shall extend or maintain credit, arrange for the extension of credit or renew an extension of credit in the form of a personal loan to or for any director or officer, nor shall such corporation allow for or arrange any payments or obligations in violation of  27-66-7.1.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2. 
 27-19.2-9. Code of ethics. Each nonprofit hospital and/or medical services corporation shall adopt a code of ethics for its officers and directors which shall include, but is not limited to: a policy protecting the corporation and the public from conflicts of interest and abuse of position; a policy protecting the confidentiality of individuals private information the corporation may obtain; procedures for contracts with government agencies; policies on political contributions by board members (with particular attention to offices involved in the appointment process or regulatory oversight); policies for board education, including education in governance and fiduciary duty; and whistleblower protection and document retention policies. Said code of ethics policy shall be filed with the attorney general and the health insurance commissioner. No policy shall be deemed adequate without providing for appropriate distribution, compliance and enforcement of the policy.  History of Section.P.L. 2004, ch. 330,  2; P.L. 2004, ch. 567,  2. 
 27-19-1. Definitions. As used in this chapter: (1) Contracting hospital means an eligible hospital which has contracted with a nonprofit hospital service corporation to render hospital care to subscribers to the nonprofit hospital service plan operated by the corporation;  (2) Adverse benefit determination means any of the following: a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of an individuals eligibility to participate in a plan or to receive coverage under a plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit resulting from the application of any utilization review, as well as a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate. The term also includes a rescission of coverage determination.  (3) Affordable Care Act means the federal Patient Protection and Affordable Care Act of 2010, as amended by the federal Health Care and Education Reconciliation Act of 2010, and federal regulations adopted thereunder;  (4) Commissioner or health insurance commissioner means that individual appointed pursuant to  42-14.5-1;  (5) Eligible hospital is one which is maintained either by the state or by any of its political subdivisions or by a corporation organized for hospital purposes under the laws of this state or of any other state or of the United States, which is designated as an eligible hospital by a majority of the directors of the nonprofit hospital service corporation;  (6) Essential health benefits shall have the meaning set forth in section 1302(b) of the federal Affordable Care Act [42 U.S.C.  18022(b)].  (7) Grandfathered health plan means any group health plan or health insurance coverage subject to 42 U.S.C.  18011;  (8) Group health insurance coverage means, in connection with a group health plan, health insurance coverage offered in connection with such plan;  (9) Group health plan means an employee welfare benefit plan as defined 29 U.S.C.  1002(1), to the extent that the plan provides health benefits to employees or their dependents directly or through insurance, reimbursement, or otherwise;  (10) Health benefits or covered benefits means coverage or benefits for the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body including coverage or benefits for transportation primarily for and essential thereto, and including medical services as defined in  27-19-17;  (11) Healthcare facility means an institution providing healthcare services or a healthcare setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings;  (12) Healthcare professional means a physician or other healthcare practitioner licensed, accredited or certified to perform specified healthcare services consistent with state law;  (13) Healthcare provider or provider means a healthcare professional or a healthcare facility;  (14) Healthcare services means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease;  (15) Health insurance carrier means a person, firm, corporation or other entity subject to the jurisdiction of the commissioner under this chapter, and includes nonprofit hospital service corporations. Such term does not include a group health plan. The use of this term shall not be construed to subject a nonprofit hospital service corporation to the insurance laws of this state other than as set forth in  27-19-2;  (16) Health plan or health benefit plan means health insurance coverage and a group health plan, including coverage provided through an association plan if it covers Rhode Island residents. Except to the extent specifically provided by the federal Affordable Care Act, the term health plan shall not include a group health plan to the extent state regulation of the health plan is preempted under section 514 of the federal Employee Retirement Income Security Act of 1974 [29 U.S.C.  1144]. The term also shall not include:  (A)(i) Coverage only for accident, or disability income insurance, or any combination thereof.  (ii) Coverage issued as a supplement to liability insurance.  (iii) Liability insurance, including general liability insurance and automobile liability insurance.  (iv) Workers compensation or similar insurance.  (v) Automobile medical payment insurance.  (vi) Credit-only insurance.  (vii) Coverage for on-site medical clinics.  (viii) Other similar insurance coverage, specified in federal regulations issued pursuant to federal Pub. L. No. 104-191, the federal health insurance portability and accountability act of 1996 (HIPAA), under which benefits for medical care are secondary or incidental to other insurance benefits.  (B) The following benefits if they are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the plan:  (i) Limited scope dental or vision benefits.  (ii) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.  (iii) Other excepted benefits specified in federal regulations issued pursuant to federal Pub. L. No. 104-191 (HIPAA).  (C) The following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor:  (i) Coverage only for a specified disease or illness.  (ii) Hospital indemnity or other fixed indemnity insurance.  (D) The following if offered as a separate policy, certificate or contract of insurance:  (i) Medicare supplement health insurance as defined under section 1882(g)(1) of the federal Social Security Act [42 U.S.C.  1395ss].  (ii) Coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code (Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)).  (iii) Similar supplemental coverage provided to coverage under a group health plan.  (17) Nonprofit hospital service corporation means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit hospital service plan;  (18) Nonprofit hospital service plan means a plan by which specified hospital care is to be provided to subscribers to the plan by a contracting hospital;  (19) Office of the health insurance commissioner means the agency established under  42-14.5-1;  (20) Rescission means a cancellation or discontinuance of coverage that has retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage; and  (21) Subscribers mean those persons, whether or not residents of this state, who have contracted with a nonprofit hospital service corporation for hospital care pursuant to a nonprofit hospital service plan operated by the corporation.  History of Section.P.L. 1939, ch. 719,  1; G.L. 1956,  27-19-1; P.L. 2012, ch. 256,  5; P.L. 2012, ch. 262,  5. 
 27-19-10. Commission plans for solicitors or insurance producers. No person shall be engaged to solicit subscribers to any nonprofit hospital service plan upon a commission basis or upon any other basis by which the payment of the compensation or expenses of that person shall be conditioned upon the enrollment of subscribers, unless the method of solicitation and rate of compensation shall have had the prior written approval of the insurance commissioner.  History of Section.P.L. 1939, ch. 719,  6; G.L. 1956,  27-19-10. 
 27-19-11. Investment standards. (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.  History of Section.P.L. 1939, ch. 719,  7; G.L. 1956,  27-19-11; P.L. 1999, ch. 45,  1. 
 27-19-12. Corporations deemed public charitable institutions. Every nonprofit hospital service corporation is declared to be and shall be deemed to be a charitable corporation and an incorporated public charitable institution.  History of Section.P.L. 1939, ch. 719,  8; G.L. 1956, 27-19-12. 
 27-19-13. Services rendered in certain institutions. No nonprofit hospital service corporation may deny payments for services rendered to its subscribers by hospitals operated by the state or any municipality of the state if the nonprofit hospital service corporation permits payment for similar services rendered by contracting hospitals as provided in this chapter.  History of Section.P.L. 1961, ch. 191,  1. 
 27-19-14. Repealed. History of Section.P.L. 1971, ch. 208,  1; P.L. 1984, ch. 4,  4; P.L. 1988, ch. 213,  2; P.L. 1990, ch. 132,  2; P.L. 1991, ch. 290,  3; P.L. 1994, ch. 392,  1; P.L. 2009, ch. 68, art. 23,  8; Repealed by its own terms and pursuant to  40-8-13.4(g), effective March 30, 2010. 
 27-19-15. Repealed. History of Section.P.L. 1971, ch. 208,  1; P.L. 1984, ch. 4,  4; P.L. 1989, ch. 542,  80; P.L. 1994, ch. 392,  1; P.L. 2009, ch. 68, art. 23,  8; Repealed by its own terms and pursuant to  40-8-13.4(g), effective March 30, 2010. 
 27-19-16. Repealed. History of Section.P.L. 1971, ch. 208,  1; P.L. 2009, ch. 68, art. 23,  8; Repealed by its own terms and pursuant to  40-8-13.4(g), effective March 30, 2010. 
 27-19-17. Additional benefits. Notwithstanding the provisions of this chapter, any nonprofit hospital service corporation organized under this chapter may contract with any of its subscribers for coverage or benefits for medical services as may from time to time be provided under any plan adopted by the corporation. Subscribers as used in this chapter includes, in addition to those set forth in  27-19-1, persons contracting with the corporation for coverage or benefits for medical services. Medical services as used in this chapter means professional services rendered by physicians, dentists, podiatrists, or other providers of health services for any medical, dental, surgical, and other health services as may lawfully be rendered by them to subscribers; the term includes appliances, drugs, medicines, supplies, and nursing care necessary in connection with those services, or the expense indemnity for those services, appliances, drugs, medicines, supplies, and care, as may be specified in any nonprofit medical service plan.  History of Section.P.L. 1978, ch. 64,  2; P.L. 1998, ch. 441,  20. 
 27-19-18. Coverage for adoptive children. Subscribers to any nonprofit hospital service plan who have satisfied the continuous membership requirements of the plan, and who adopt children under the guardianship and custody of the director of the department of children, youth, and families, shall be afforded coverage under the plan for any adopted child without any waiting period, notwithstanding the fact that the adopted child may have any preexisting medical condition.  History of Section.P.L. 1982, ch. 183,  1. 
 27-19-19. Changing coverage. No group health insurer subject to the provisions of this chapter shall change contract provisions as specified in the group plan master contract during the term of that contract without prior written agreement of the employer, except for changes mandated under state or federal legislative enactment and changes resulting from a labor/management collective bargaining agreement, or changes necessary to meet insurance regulations promulgated by the department of business regulation.  History of Section.P.L. 1988, ch. 384,  2. 
 27-19-2.1. Investments and holdings in certain corporations authorized. (a) Each nonprofit hospital service corporation shall have, in addition to all other powers granted under this chapter and the laws of this state, the power to invest in or cause to be organized and established one or more corporations, all or any portion of the issued and outstanding capital stock of which shall be subscribed for or held by the nonprofit hospital service corporation.  (b) As used in this section, corporation means any organization incorporated under the provisions of the law of this or another state for one or more of the following purposes:  (1) To establish, maintain, and operate hospital service and health insurance plans;  (2) To develop, establish, purchase, maintain, perform, sell, and lease in connection with carrying out its corporate purpose: (i) data processing and computer software programs, systems, and techniques; (ii) data processing, bookkeeping, statistical, or software services; or (iii) other administrative and related services; or  (3) To exercise the powers set forth in  27-19-5 or to carry out and fulfill any of the purposes of a hospital service corporation incorporated under this chapter.  (c) Any limitation on investments or holdings contained in  27-19-11 or  27-19-5.3 or any other law shall not apply with respect to investments or holdings under this section; provided, that the value of any investment shall not exceed twenty percent (20%) of the assets of the hospital service corporation.  History of Section.P.L. 1982, ch. 165,  1; P.L. 2006, ch. 182,  1; P.L. 2006, ch. 600,  1. 
 27-19-2. Organization as charitable corporation  Insurance laws inapplicable. Each nonprofit hospital service corporation shall be incorporated as a charitable corporation under the provisions of chapter 6 of title 7, and shall be subject to that chapter and to this chapter. The laws of this state relative to insurance companies or to the business insurance shall not apply to any nonprofit hospital service corporation unless expressly provided in those laws. Each nonprofit hospital service corporation shall be deemed to be an insurer, for the purposes of compliance with chapter 44-17.  History of Section.P.L. 1939, ch. 719,  2; G.L. 1956,  27-19-2; P.L. 2007, ch. 73, art. 28,  1. 
 27-19-20. Mammograms and pap smears  Coverage mandated. (a) Subscribers to any nonprofit hospital 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 hospital service plan shall be afforded coverage for two (2) 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.  History of Section.P.L. 1988, ch. 532,  1; P.L. 2005, ch. 405,  2. 
 27-19-21. Mammograms  Quality assurance standards. A mammogram eligible for reimbursement under  27-19-20 shall be reimbursed only if the facility in which the mammogram has been taken and processed, and the licensed physician interpreting the mammogram, both meet state approved quality assurance standards for taking, processing, and interpreting mammograms. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section.  History of Section.P.L. 1989, ch. 217,  2. 
 27-19-22. Pap smears  Quality assurance standards. A pap smear eligible for reimbursement under  27-19-20 shall be reimbursed only if the laboratory in which the pap smear is processed is licensed by the department of health specifically to perform cervical cytology, or is accredited by the American Society of Cytology, or is accredited by the College of American Pathologists, or is a hospital accredited by the joint commission on accreditation health care organizations or the American Osteopathic Association at the time the pap smear is processed.  History of Section.P.L. 1989, ch. 217,  9. 
 27-19-23.1. Insurance coverage for post-partum hospital stays. (a) Every individual or group hospital or medical services plan contract delivered, issued for delivery, as renewed in this state shall provide coverage for a forty-eight (48) hour time period in a hospital after a vaginal birth and ninety-six (96) hours for a Cesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending health care provider in consultation with the mother. The decision shall be made in accordance with the standards for guidelines for perinatal care published by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics. The standards shall be relative to early discharge, defined as less than forty-eight (48) hours for a vaginal delivery and ninety-six (96) for a cesarean delivery. In the case of early discharge, post-delivery care shall include home visits, parent education, assistance and training in breast or bottle feeding and the performance of any necessary and appropriate clinical tests or any other tests or services consistent with the above guidelines.  (b) For the purposes of this section, attending health care provider includes the attending obstetrician, pediatrician, family practitioner, general practitioner, or certified nurse midwife attending the mother and newly born child.  (c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.  History of Section.P.L. 1996, ch. 246,  3; P.L. 1996, ch. 260,  3; P.L. 2002, ch. 292,  37. 
 27-19-23. Coverage for infertility. (a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a nonprofit hospital service corporation provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, those tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent (20%), may be required for those programs and/or procedures the sole purpose of which is the treatment of infertility.  (b) For purposes of this section, infertility means the condition of an otherwise presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.  (c) For purposes of this section, standard fertility-preservation services means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organizations.  (d) For purposes of this section, iatrogenic infertility means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.  (e) For purposes of this section, may directly or indirectly cause means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organizations.  (f) The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).  History of Section.P.L. 1989, ch. 478,  2; P.L. 2002, ch. 292,  37; P.L. 2006, ch. 246, art. 34,  2; P.L. 2007, ch. 411,  2; P.L. 2017, ch. 132,  2; P.L. 2017, ch. 150,  2. 
 27-19-24. Nonprofit hospital service corporations assessment. (a) Notwithstanding any other provisions of law, each domestic nonprofit hospital service corporation shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.  (b) The assessment referred to in subsection (a) of this section shall be calculated in the same manner as set forth in  27-1-41 [Repealed.].  (c) The minimum assessment charged shall be the greater of the sum determined by subsection (b) of this section or $ 1,000.  History of Section.P.L. 1990, ch. 65, art. 29,  2; P.L. 1993, ch. 180,  14. 
 27-19-25. Discontinuance of coverage  Chronic disabilities. No nonprofit hospital service corporation subject to the provisions of this chapter shall discontinue reimbursement for or providing services for covered health care 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.  History of Section.P.L. 1991, ch. 127,  2. 
 27-19-26.1. Medication synchronization. (a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days supply for the purpose of synchronizing the patients medications and the insureds or enrollees maintenance-prescription drug(s) to be synchronized meets all of the following requirements:  (1) Is covered by the policy, certificate, or contract described in this chapter;  (2) Is used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee;  (3) Except as otherwise provided in this subparagraph, is not a controlled substance included in schedules II to V;  (4) Meets all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insureds or enrollees multiple, maintenance-prescription drugs;  (5) Is of a formulation that can be effectively split over required short-fill periods to achieve synchronization; and  (6) Does not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insureds or enrollees multiple maintenance-prescription drugs.  (b) The plan or policy described in subsection (a) shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insureds or enrollees multiple, maintenance-prescription drugs.  (c) The plan or policy described in subsection (a) shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.  (d) A synchronization shall only occur once per year per maintenance-prescription drug.  History of Section.P.L. 2016, ch. 179,  2; P.L. 2016, ch. 196,  2. 
 27-19-26.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies. (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 pharmacys 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 Administrations 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 pharmacys 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.  History of Section.P.L. 2016, ch. 166,  2; P.L. 2016, ch. 168,  2. 
 27-19-26. Drug coverage. No group health insurer subject to the provisions of this chapter that provides coverage for prescription drugs under a group plan master contract delivered, issued for delivery, or renewed in this state may require any person covered under the contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for the drugs.  History of Section.P.L. 1991, ch. 345,  2; P.L. 2002, ch. 292,  37. 
 27-19-27. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists. (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 practitioners or psychiatric and mental health nurse clinical specialists area of professional competence as established by education and certification, and are currently reimbursed when rendered by any other licensed healthcare provider. No insurer or hospital or medical service corporation may require signature by any other healthcare provider as a condition of reimbursement. No insurer or hospital or medical service corporation may be required to pay for duplicative services actually rendered by both a certified nurse practitioner and any other healthcare provider.  (b) Nothing in this chapter shall preclude the conducting of managed care reviews and medical necessity reviews by an insurer or hospital or medical service corporation or health maintenance organization.  (c) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical service plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for certified registered nurse practitioners to provide primary care, intermediate, home, long-term and inpatient care as primary care providers, when said certified registered nurse practitioner is a participating provider, consistent with, and practicing within, the scope of his/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.  History of Section.P.L. 1991, ch. 361,  3; P.L. 1994, ch. 90,  2; P.L. 2002, ch. 292,  37; P.L. 2009, ch. 351,  2; P.L. 2009, ch. 352,  2. 
 27-19-28. Rehabilitation, liquidation, or conservation. (a) Any rehabilitation, liquidation, administrative supervision, or conservation of a nonprofit hospital service corporation organized under this chapter shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director of business regulation to rehabilitate, liquidate, or conserve a nonprofit hospital service corporation upon any one or more of the following grounds:  (1) That the nonprofit hospital service corporation is insolvent; for the purposes of this section, the term insolvent means the inability of the nonprofit hospital service corporation to meet its debts and financial obligations as they become due;  (2) That the nonprofit hospital service corporation fails or refuses to comply with a lawful order of the director of business regulation reasonably designed to correct unsound business policies or practices which, if uncorrected, could reasonably lead to insolvency as defined in subdivision (1) of this subsection; or  (3) That the nonprofit hospital service corporations financial condition is such as to render its further transaction of business hazardous to the public or its subscribers or members.  (b) A claim by a health care provider shall not be asserted against any subscriber or member of the nonprofit hospital service corporation in the event of the rehabilitation, liquidation, conservation, or administrative supervision of the nonprofit hospital service corporation.  History of Section.P.L. 1993, ch. 180,  15. 
 27-19-29.1. No derogation of attorney general. 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 its terms and purposes.  History of Section.P.L. 1998, ch. 90,  6. 
 27-19-29. Holding company systems. 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.  History of Section.P.L. 1993, ch. 180,  15; P.L. 1998, ch. 90,  1; P.L. 2000, ch. 178,  3; P.L. 2000, ch. 200,  13; P.L. 2000, ch. 229,  13. 
 27-19-3. Repealed.
 27-19-30.1. Health insurance rates. No insurance company organized as a stock or mutual corporation which merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or otherwise acquires control of a non-profit hospital service corporation organized under this chapter, a non-profit medical service corporation organized under chapter 20 of this title or a health maintenance organization organized under chapter 41 of this title, may: (1) file with any state agency for review or approval any proposed rate to be used by the company in the state, or (2) charge to any party in the state any rate or premium, which takes into account or reflects in any manner the value of any contribution, distribution or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or otherwise account for the assets of a non-profit hospital service corporation, non-profit medical service corporation or health maintenance organization. For any rate that is to be charged to policy holders, regardless of whether the rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the companys compliance with this section.  History of Section.P.L. 1999, ch. 215,  3; P.L. 1999, ch. 376,  3. 
 27-19-30. Regulations. The director of the department of business regulation may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.  History of Section.P.L. 1993, ch. 180,  15. 
 27-19-31. Certified counselors in mental health and therapists in marriage and family practice. Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical service plan contract delivered, issued for delivery or renewed in this state will, when deemed medically necessary by the nonprofit hospital service corporation in accordance with its standard medical management protocols and within the nonprofit hospital service corporations subscriber contractual benefit limits, provide coverage for the services of counselors in mental health licensed pursuant to  5-63.2-9 and therapists in marriage and family practice licensed pursuant to  5-63.2-10. In the case of a limited provider network, it shall remain within the sole discretion of the nonprofit hospital service corporation as to which certified counselors in mental health and certified therapists in marriage and family practice with which it shall contract. Nothing contained in this section shall require the nonprofit hospital service corporation to provide coverage other than in conjunction with a related medical illness.  History of Section.P.L. 1994, ch. 89,  2. 
 27-19-32.1. Repealed. History of Section.P.L. 1994, ch. 301,  2; Repealed by P.L. 2012, ch. 256,  15; P.L. 2012, ch. 262,  15, effective June 18, 2012. For comparable provisions, see  27-19-64. 
 27-19-32.2. Repealed. History of Section.P.L. 1994, ch. 301,  2; P.L. 1997, ch. 51,  2, 6; P.L. 1997, ch. 92,  2,6; P.L. 1999, ch. 134,  2; Repealed by P.L. 2012, ch. 256,  15; P.L. 2012, ch. 262,  15, effective June 18, 2012. For comparable provisions, see  27-19-64. 
 27-19-32.3. Repealed. History of Section.P.L. 1994, ch. 301,  2; Repealed by P.L. 2012, ch. 256,  15; P.L. 2012, ch. 262,  15, effective June 18, 2012. For comparable provisions, see  27-19-64. 
 27-19-32. Repealed. History of Section.P.L. 1994, ch. 301,  2; P.L. 2002, ch. 292,  37; Repealed by P.L. 2012, ch. 256,  15; P.L. 2012, ch. 262,  15, effective June 18, 2012. For comparable provisions, see  27-19-64. 
 27-19-33. Repealed.
 27-19-34.1. Insurance coverage for mastectomy hospital stays. (a) The Rhode Island General Assembly recognizes that breast cancer is a unique illness with both a physical and emotional impact on patients. Every individual or group hospital or medical services plan contract delivered, issued for delivery, as renewed in this state shall provide coverage for a minimum forty-eight (48) hour time period in a hospital after the surgical procedures known as a mastectomy, and a minimum twenty-four (24) hours after an axillary node dissection. Any decision to shorten these minimum coverages shall be made by the attending physician in consultation with and upon agreement by the patient. If the patient participates in an early discharge, defined as in-patient care following a mastectomy that is less than forty-eight (48) hours and in-patient care following an axillary node dissection that is less than twenty-four (24) hours, coverage shall include a minimum of one home visit conducted by a physician or registered nurse.  (b) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or otherwise penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.  (c) All plans subject to this section shall provide notice to each enrollee:  (1) In the next mass mailing made by the plan to the employee; or  (2) As part of any informational packet sent to the enrollee.  History of Section.P.L. 1997, ch. 24,  2; P.L. 1997, ch. 25,  2; P.L. 2002, ch. 292,  37. 
 27-19-34. Mastectomy treatment. (a) All individual or group health insurance coverage and health-benefit plans delivered, issued for delivery, or renewed in this state on or after January 1, 2005, that provide medical and surgical benefits with respect to mastectomy shall provide, in a case of any person covered in the individual market or covered by a group health plan, coverage for:  (1) Reconstruction of the breast on which the mastectomy has been performed;  (2) Surgery and reconstruction of the other breast to produce a symmetrical appearance; and  (3) Prostheses and treatment of physical complications, including lymphademas, at all stages of mastectomy; in a manner determined in consultation with the attending physician, physician assistant as defined in  5-54-2, or an advance practice registered nurse as defined in  5-34-3, and the patient. As used in this section, mastectomy means the removal of all or part of a breast. Written notice of the availability of this coverage shall be delivered to the participant upon enrollment and annually thereafter.  (b) Notice. A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, shall provide notice to each participant and beneficiary under the plan regarding the coverage required by this section in accordance with regulations promulgated by the United States Secretary of Health and Human Services. The notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted as part of any yearly informational packet sent to the participant or beneficiary.  (c) As used in this section, prosthetic devices means and includes the provision of initial and subsequent prosthetic devices pursuant to an order of the patients physician, physician assistant, advance practice registered nurse, or surgeon.  (d) [Deleted by P.L. 2018, ch. 114,  2 and P.L. 2018, ch. 204,  2].  (e) Nothing in this section shall be construed to prevent a group health plan or a health insurance carrier offering health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.  (f) Nothing in this section shall preclude the conducting of managed-care reviews and medical-necessity reviews by an insurer, hospital or medical-service corporation or health maintenance organization.  (g) Prohibitions. A group health plan and a health insurance carrier offering group or individual health insurance coverage may not:  (1) Deny to a patient eligibility, or continued eligibility, to enroll or renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section; nor  (2) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide incentives (monetary or otherwise) to an attending provider, to induce the provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section.  History of Section.P.L. 1996, ch. 66,  2; P.L. 2002, ch. 292,  37; P.L. 2004, ch. 41,  2; P.L. 2004, ch. 45,  2; P.L. 2018, ch. 114,  2; P.L. 2018, ch. 204,  2. 
 27-19-35. Diabetes treatment. (a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage, shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this chapter shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a physician. The policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self-management and treatment of their diabetes, including information on the nutritional management of diabetes. The coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnoses of diabetes, where a physician diagnosis a significant change in the patients symptoms or conditions which necessitate changes in a patients self-management, or where reeducation or refresher training is necessary. This education, when medically necessary and prescribed by a physician, may be provided only by the physician or upon his or her referral by an appropriately licensed and certified health care provider and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.  (b) Benefit plans offered by a hospital service corporation may impose copayment and/or deductibles for the benefits mandated by this chapter, however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for other supplies, equipment, or physician office visits. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.  History of Section.P.L. 1996, ch. 106,  2; P.L. 2002, ch. 292,  37. 
 27-19-36.1. Hysterectomy or myomectomy treatment. 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.  History of Section.P.L. 2022, ch. 370,  2, effective June 29, 2022; P.L. 2022, ch. 371,  2, effective June 29, 2022. 
 27-19-36. Primary and preventive obstetric and gynecological care. Any insurer or nonprofit health service plan that provides obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health maintenance organization shall permit a woman to receive an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the woman to first obtain a referral from a primary care provider.  History of Section.P.L. 1997, ch. 166,  2; P.L. 1997, ch. 174,  2. 
 27-19-37. Whistleblowers protection. No nonprofit hospital service corporation pursuant to this chapter or any other insurer offering and/or insuring health services on a prepaid basis as defined in  42-62-4(7) shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state.  History of Section.P.L. 1997, ch. 167,  2. 
 27-19-38. Penalties and remedies. (a) Any person, firm, corporation, association or other legal entity who or which shall violate the provisions of  27-19-37 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one year, or by both a fine and imprisonment.  (b) In addition to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall willfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each violation, and each violation shall constitute a separate and distinct offense under this section.  History of Section.P.L. 1997, ch. 167,  2. 
 27-19-39. Additional relief and damages  Reinstatement. (a) A physician or other medical provider who alleges a violation of this chapter may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.  (b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.  (c) The court rendering a judgment in an action under this chapter shall order, as the court considers appropriate, reinstatement of the provider agreement.  History of Section.P.L. 1997, ch. 167,  2. 
 27-19-4. Certificate of public convenience and advantage. No articles of association of a nonprofit hospital service corporation shall be filed in the office of the secretary of state unless and until the insurance commissioner has certified in writing upon those articles that he or she has determined that public convenience and advantage will be promoted by the establishment of the corporation.  History of Section.P.L. 1939, ch. 719,  2; G.L. 1956,  27-19-4. 
 27-19-40.1. Third party reimbursement for services of registered nurse first assistants. (a) Every individual or group health insurance contract, plan or policy delivered, issued or renewed by an insurer or nonprofit or for profit health service corporation which provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a registered nurse first assistant designated as a registered nurse first assistant provided, that the following conditions are met:  (1) The registered nurse first assistant provides certain health care services under the supervision of a licensed physician; is currently licensed as a registered nurse in Rhode Island; has successfully completed a course in preparing the registered nurse as a first assistant in accordance with the Association of Operating Room Nurses core curriculum guide for the registered nurse first assistant and includes a minimum of one academic year in a college or university with didactic instruction and clinical internship programs; and is certified in perioperative nursing by the Certification Board Perioperative Nursing (minimum of two (2) years perioperative experience);  (2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and  (3) The registered nurse first assistant is not a salaried employee of the licensed hospital or facility for which the nonprofit hospital service corporation has an alternative contractual relationship to fund the services of a registered nurse first assistant.  (b) It shall remain within the sole discretion of the nonprofit hospital service corporation as to which registered nurse first assistant it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation; provided, that no nonprofit hospital service corporation may be required to provide direct reimbursement, or pay for duplicative services actually rendered by a registered nurse first assistant in surgery and any other health care provider. Nothing contained in this section precludes the nonprofit hospital service corporations from conducting managed care, medical necessity or utilization review.  History of Section.P.L. 1999, ch. 509,  2; P.L. 2002, ch. 292,  37. 
 27-19-40. Third-party reimbursement for services of certain healthcare workers. (a) Every individual or group health insurance contract, plan, or policy delivered, issued, or renewed by an insurer or nonprofit or for-profit health service corporation that provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the board of nurse registration and nursing education; provided, that the following conditions are met:  (1) The certified registered nurse anesthetist adheres to the practice of certified registered nurse anesthesia as defined by and in accordance with  5-34.2-2.  (2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and  (3) The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the nonprofit hospital service corporation has an alternative contractual relationship to fund the services of a certified registered nurse anesthetist.  (b) It shall remain within the sole discretion of the nonprofit hospital service corporation as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation; provided, that no nonprofit hospital service corporation may be required to pay for duplicative services actually rendered by a certified registered nurse anesthetist and any other healthcare provider. Nothing contained in this section shall preclude the nonprofit hospital service corporation from conducting managed care, medical necessity, or utilization review.  (c) Providers. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that providers license or certification under applicable state law. This section shall not require that a group health plan or health insurance issuer contract with any healthcare provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures.  History of Section.P.L. 1997, ch. 345,  2; P.L. 1997, ch. 365,  2; P.L. 2002, ch. 292,  37; P.L. 2015, ch. 205,  2; P.L. 2015, ch. 223,  2. 
 27-19-41. Human leukocyte antigen testing. Every individual or group hospital or medical services plan contract delivered or renewed in this state shall include coverage of the cost for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B and DR antigens for utilization in bone marrow transplantation. The testing must be performed in a facility that is accredited by the American Association of Blood Banks or its successors, and is licensed under the Clinical Laboratory Improvement Act, 42 U.S.C.  263a. At the time of the testing, the person being tested must complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program. The group hospital or medical services plan contract may limit each subscriber to one of these testings per lifetime.  History of Section.P.L. 1998, ch. 8,  2; P.L. 1998, ch. 9,  2; P.L. 2002, ch. 292,  37. 
 27-19-42. Drug coverage. (a) Any nonprofit hospital-service corporation that utilizes a formulary of medications for which coverage is provided under an individual or group plan master contract shall require any physician or other person authorized by the department of health to prescribe medication to prescribe from the formulary. A physician or other person authorized by the department of health to prescribe medication shall be allowed to prescribe medications previously on, or not on, the nonprofit hospital-service corporations formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. A nonprofit hospital-service corporation shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the nonprofit hospital-service corporations medical-exception criteria for the coverage of that medication.  (b) A nonprofit hospital-service corporations medical-exception criteria for the coverage of non-formulary medications shall be developed in accordance with  23-17.13-3(c)(3) [repealed].  (c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23 [repealed].  (d) Prior to removing a prescription drug from its plans formulary or making any change in the preferred or tiered cost-sharing status of a covered prescription drug, a nonprofit hospital-service corporation must provide at least thirty (30) days notice to authorized prescribers by established communication methods of policy and program updates and by updating available references on web-based publications. All adversely affected members must be provided at least thirty (30) days notice prior to the date such change becomes effective by a direct notification:  (i) The written or electronic notice must contain the following information:  (A) The name of the affected prescription drug;  (B) Whether the plan is removing the prescription drug from the formulary, or changing its preferred or tiered, cost-sharing status; and  (C) The means by which subscribers may obtain a coverage determination or medical exception, in the case of drugs that will require prior authorization or are formulary exclusions respectively.  (ii) A nonprofit hospital-service corporation may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the nonprofit hospital-service corporation or the Food and Drug Administration, or removed from the market by their manufacturer, without meeting the requirements of this section.  History of Section.P.L. 1998, ch. 290,  2; P.L. 2016, ch. 541,  2; P.L. 2017, ch. 274,  2; P.L. 2017, ch. 361,  2. 
 27-19-43. Restricted annual rate payments prohibited. (a) No corporation organized under this chapter shall compensate any provider of outpatient service by using the restricted annual rate method of payment.  (b) The restricted annual rate method of payment is defined as any method of payment that sets, as all or part of its payment scheme, a total payment limit for mental health and/or substance abuse treatment services for each person seeking treatment based on a per person per unit of time criterion that disregards the extent of treatment and/or degree of services rendered.  (c) This prohibition shall not be construed to prohibit or limit capitation or other risk sharing agreements between providers and insurers otherwise permissible by law.  History of Section.P.L. 1998, ch. 352,  2. 
 27-19-44.1. Genetic information. (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.  (b) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage excluding disability income, long term care and insurance supplemental policies which only provide coverage for specified diseases or other supplemental policies, shall:  (1) Use genetic information or request for genetic information or the results of genetic information or other genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or otherwise affect a group or an individuals health insurance policy, contract, or plan;  (2) Request or require genetic information for the purpose of determining whether or not to issue or renew an individuals health benefits coverage, to set reimbursement/co-pay levels or determine covered benefits and services;  (3) Release the results of genetic information without the prior written authorization of the individual from whom the information was obtained, except in a format by which individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure. An exception shall exist for participation in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule);  (4) Request or require information as to whether an individual has genetic information, or participated in genetic information of any kind, whether for clinical or research purposes.  (c) For the purposes of this section, genetic information is information about genes, gene product, or inherited characteristics that may derive from the individual or a family member.  History of Section.P.L. 2001, ch. 38,  4; P.L. 2001, ch. 54,  4; P.L. 2002, ch. 292,  37. 
 27-19-44. Genetic testing. (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.  (b) No nonprofit health service corporation subject to the provisions of this chapter shall:  (1) Use a genetic test or request for a genetic test or the results of a genetic test or other genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a group or an individuals health insurance policy, contract, or plan;  (2) Request or require a genetic test for the purpose of determining whether or not to issue or renew a group, individual health benefits coverage to set reimbursement/co-pay levels or determine covered benefits and services;  (3) Release the results of a genetic test without the prior written authorization of the individual from whom the test was obtained, except in a format by which individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure. An exception shall exist for participation in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule);  (4) Request or require information as to whether an individual has ever had a genetic test, or participated in genetic testing of any kind, whether for clinical or research purposes.  (c) For the purposes of this section, genetic testing is the analysis of an individuals DNA, RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related genotypes, mutations, phenotypes or karyotypes for clinical purposes. These purposes include predicating risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be included provided there is an approved release by a parent or guardian. Tests for metabolites are covered only when they are undertaken with high probability that an excess of deficiency of the metabolite indicates the presence of heritable mutations in single genes. Genetic testing does not mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs or for HIV infection.  History of Section.P.L. 1998, ch. 380,  2; P.L. 2001, ch. 38,  3; P.L. 2001, ch. 54,  3. 
 27-19-45. Repealed.
 27-19-46. Magnetic resonance imaging  Quality assurance standards. (a) Except as otherwise provided in subsection (b) of this section, a magnetic resonance imaging examination eligible for reimbursement under the provisions of any individual or group health insurance contract, plan or policy delivered in this state shall be reimbursed only if the facility at which the examination has been conducted and processed is accredited by either the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC) or an alternate nationally recognized accrediting organization whose accreditation standards are substantially similar to and no less stringent than current or subsequent ACR or IAC standards and have been reviewed and deemed adequate by the department of health. All accreditation standards under this section, whether promulgated by the ACR, IAC, or an alternate nationally recognized accrediting organization, shall include, but shall not be limited to, provisions for establishing the qualifications of the physician, standards for quality control and routine performance monitoring by a medical physicist, qualifications of the technologist including minimum standards of supervised clinical experience, personnel and patient safety guidelines, and standards for initial and ongoing quality control using clinical image review and quantitative testing.  (b) Any facility conducting and processing magnetic resonance imaging examinations which, as of June 30, 2006 is receiving reimbursement for such services by a health insurer, health maintenance organization or health plan, but is not accredited pursuant to subsection (a), shall file its application for accreditation within eighteen (18) months of June 28, 2007. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. A facility which begins conducting and processing, of magnetic resonance imaging examinations after June 30, 2006 shall file its application for accreditation within twelve (12) months of the date of initiation of the magnetic resonance imaging examinations. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. After such accreditation is obtained, a facility conducting and processing, of magnetic resonance imaging examinations shall, at all times, maintain accreditation with the appropriate accrediting body. Notwithstanding anything herein to the contrary, any facility which has filed for accreditation pursuant to this subsection (b) and which has not been refused accreditation or withdrawn its application, will be deemed provisionally accredited for the twelve (12) month period dating from the application filing date. Provided, further, that notwithstanding any provisions of the general or public laws to the contrary, any facility conducting and processing magnetic resonance imaging examinations shall conform to the standards of the appropriate accrediting body at all times, including during the accreditation process and shall certify said conformance to any reimbursing health insurer, health maintenance organization or health plan.  History of Section.P.L. 1999, ch. 169,  3; P.L. 2003, ch. 376, art. 34,  4; P.L. 2005, ch. 207,  3; P.L. 2006, ch. 596,  3; P.L. 2007, ch. 140,  3; P.L. 2007, ch. 277,  3; P.L. 2008, ch. 475,  83. 
 27-19-47. Acupuncture services. (a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or renewed in this state which provides medical coverage, and every group policy which provides for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition, shall provide, as an optional rider, coverage for the services of a doctor of acupuncture as a provider of acupuncture services.  (b) For the purposes of this section:  (1) Doctor of acupuncture means a practitioner licensed under chapter 37.2 of title 5.  (2) 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).  (c) It remains within the sole discretion of the non-profit hospital service corporation as to which doctor of acupuncture it shall contract with. Reimbursement is provided according to the respective principles and policies of the non-profit hospital service corporation; provided, that no non-profit hospital service corporation is required to pay for duplicative services actually rendered by a doctor of acupuncture and any other health care provider. Nothing contained in this section precludes the non-profit hospital service corporations from conducting managed care, medical necessity or utilization review.  History of Section.P.L. 1999, ch. 288,  2. 
 27-19-48. F.D.A. approved prescription contraceptive drugs and devices. (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 F.D.A. approved contraceptive drugs and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.  (b) Notwithstanding any other provision of this section, any hospital service corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employers 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.  History of Section.P.L. 2000, ch. 120,  2; P.L. 2000, ch. 126,  2; P.L. 2002, ch. 292,  37; P.L. 2018, ch. 230,  4; P.L. 2018, ch. 234,  4. 
 27-19-49. Prostate and colorectal examinations  Coverage mandated  The Maryellen Goodwin Colorectal Cancer Screening Act.  (a) Subscribers to any nonprofit hospital service corporation plan shall be afforded coverage under the plan for prostate and colorectal examinations and laboratory tests for cancer for any nonsymptomatic person covered under the policy or plan. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal.  (b) An insurer or the corporation may not impose cost sharing on the coverage required by subsection (a) when the services are delivered within the health insurers provider network.  History of Section.P.L. 2000, ch. 125,  2; P.L. 2000, ch. 345,  2; P.L. 2021, ch. 7,  3, effective April 29, 2021; P.L. 2021, ch. 8,  3, effective April 29, 2021. 
 27-19-5.1. Cancellation of coverage by employers. 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.  History of Section.P.L. 1971, ch. 228,  1. 
 27-19-5.2. Patient responsibility  Administrative requirements. For health benefit contracts issued, renewed, or delivered on or after April 1, 2002, the following shall apply:  (1) The amount of copayments for physician office visits and hospital emergency room visits shall be printed on the subscriber identification cards issued to insureds.  (2) A schedule of all applicable copayments, by product or by group, in paper or electronic format, or both, shall be published, updated, and distributed to participating providers.  (3) Notification shall be provided to subscribers on an annual basis regarding their responsibility for copayments and deductibles.  History of Section.P.L. 2001, ch. 283,  1. 
 27-19-5.3. Additional powers. Notwithstanding any other law or section of this chapter which may be inconsistent with this section, each nonprofit hospital service corporation may, through a subsidiary, develop, underwrite and/or offer for sale life insurance, disability insurance, long-term care insurance, employee assistance programs and/or other health related programs; provided, however, prior to underwriting risk under policies of insurance listed above, the nonprofit hospital service corporation must first demonstrate that underwriting such risk is consistent with the statutory mission of the nonprofit hospital service corporation and obtain prior written approval from the health insurance commissioner. Each nonprofit hospital service corporation may also directly, or by contracting with another entity, develop and/or offer for sale the policies or programs described in this section. However, the nonprofit hospital service corporation shall not directly underwrite any risk under a policy of insurance described in this section.  History of Section.P.L. 2006, ch. 182,  2; P.L. 2006, ch. 600,  2. 
 27-19-5. Contracts with subscribers, hospitals, and other eligible entities. (a) Each nonprofit hospital service corporation may contract with its subscribers and with any eligible hospital for hospital service to be rendered by the contracting hospital to the subscribers and as to the nature and extent of those services. Each corporation may also contract with any of the following: (1) any hospital or medical service corporation incorporated in this or another state for the joint administration of their business and may enter into reciprocal arrangements with those corporations for the mutual benefit of the subscribers of each; (2) corporations paying or organized for payment of medical, dental, optometric, or legal benefits, for the administration of their business including, without limiting the generality of the foregoing, corporations organized under chapters 20, 20.1, 20.2, and 20.3 of this title; (3) the federal government, the state, county, city, town, or other quasi-municipal corporations or their agencies; and (4) employers, associations, and other third-parties for the administration and underwriting of stop loss or catastrophe insurance, for fully and partially self-insured health benefit plans sponsored by such employers, associations and third parties.  (b) Services for which coverage or benefits may be provided to subscribers by any of the corporations referred to in subsection (a)(2) of this section may also be provided for or underwritten by each nonprofit hospital service corporation.  (c) No contract between a nonprofit hospital service corporation and a dentist for the provisions of services to patients may require that the dentist indemnify or hold harmless the nonprofit hospital service corporation for any expenses and liabilities, including without limitation, judgments, settlements, attorneys fees, court costs, and any associated charges, incurred in connection with any claim or action brought against the nonprofit hospital service corporation based on the nonprofit hospital service corporations management decision, or utilization review provisions for any patient.  (d) The rates proposed to be charged by any corporation organized under this chapter for stop-loss or catastrophe insurance shall be filed by the corporation at the office of the health insurance commissioner. The health insurance commissioner shall review such rates to determine if they are actuarially sound and may hold a public hearing on such rates upon not less than ten (10) days written notice prior to the hearing. The health insurance commissioner, upon the hearing, may administer oaths, examine and cross-examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence, or other documents which he or she deems relevant. The director shall issue a decision as soon as is reasonably possible following the completion of the hearing. The decision may approve, disapprove, or modify the rates proposed to be charged by the applicant.  History of Section.P.L. 1939, ch. 719,  3; G.L. 1956,  27-19-5; P.L. 1978, ch. 64,  1; P.L. 1999, ch. 481,  2; P.L. 2005, ch. 121,  1; P.L. 2005, ch. 129,  1. 
 27-19-50. Eligibility for childrens benefits. (a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state which provides health benefits coverage for dependents, except for supplemental policies which only provide coverage for specified diseases and other supplemental policies, shall make coverage available for children until attainment of twenty-six (26) years of age, and an unmarried child of any age who is financially dependent upon the parent and medically determined to have a physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve (12) months.  (2) With respect to a child who has not attained twenty-six (26) years of age, a health insurance carrier shall not define dependent for purposes of eligibility for dependent coverage of children other than the terms of a relationship between a child and the plan participant or subscriber.  (3) A health insurance carrier shall not deny or restrict coverage for a child who has not attained twenty-six (26) years of age based on the presence or absence of the childs financial dependency upon the participant, primary subscriber or any other person, residency with the participant and in the individual market the primary subscriber, or with any other person, marital status, student status, employment or any combination of those factors. A health carrier shall not deny or restrict coverage of a child based on eligibility for other coverage, except as provided in (b)(1) of this section.  (4) Nothing in this section shall be construed to require a health insurance carrier to make coverage available for the child of a child receiving dependent coverage, unless the grandparent becomes the legal guardian or adoptive parent of that grandchild.  (5) The terms of coverage in a health benefit plan offered by a health insurance carrier providing dependent coverage of children cannot vary based on age except for children who are twenty-six (26) years of age or older.  (b)(1) For plan years beginning before January 1, 2014, a group health plan providing group health insurance coverage that is a grandfathered health plan and makes available dependent coverage of children may exclude an adult child who has not attained twenty-six (26) years of age from coverage only if the adult child is eligible to enroll in an eligible employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of the federal Internal Revenue Code, other than the group health plan of a parent.  (2) For plan years, beginning on or after January 1, 2014, a group health plan providing group health insurance coverage that is a grandfathered health plan shall comply with the requirements of this section.  (c) This section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified diseased indemnity; or (8) Other limited benefit policies.  History of Section.P.L. 2000, ch. 214,  2; P.L. 2002, ch. 292,  37; P.L. 2006, ch. 377,  3; P.L. 2006, ch. 469,  3; P.L. 2012, ch. 256,  5; P.L. 2012, ch. 262,  5. 
 27-19-51. Hearing aids. (a)(1) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide coverage for one thousand five hundred dollars ($1,500) per individual hearing aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall provide coverage for seven hundred dollars ($700) per individual hearing aid per ear, every three (3) years for anyone of the age of nineteen (19) years and older.  (2) Every group health insurance contract or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide, as an optional rider, additional hearing aid coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group policies subject to the small employer health insurance availability act, chapter 50 of this title.  (b) For the purposes of this section, hearing aid means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices, including, but not limited to, FM systems.  (c) It shall remain within the sole discretion of the nonprofit hospital service corporation as to the provider of hearing aids with which they choose to contract. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation. Nothing contained in this section precludes the nonprofit hospital service corporation from conducting managed care, medical necessity, or utilization review.  History of Section.P.L. 2000, ch. 461,  2; P.L. 2004, ch. 539,  2; P.L. 2004, ch. 550,  2; P.L. 2005, ch. 374,  2; P.L. 2005, ch. 395,  2; P.L. 2006, ch. 595,  2; P.L. 2006, ch. 614,  2. 
 27-19-52. Prompt processing of claims. (a) A health care entity or health plan operating in the state shall pay all complete claims for covered health care services submitted to the health care entity or health plan by a health care provider or by a policyholder within forty (40) calendar days following the date of receipt of a complete written claim or within thirty (30) calendar days following the date of receipt of a complete electronic claim. Each health plan shall establish a written standard defining what constitutes a complete claim and shall distribute this standard to all participating providers.  (b) If the health care entity or health plan denies or pends a claim, the health care entity or health plan shall have thirty (30) calendar days from receipt of the claim to notify in writing the health care provider or policyholder of any and all reasons for denying or pending the claim and what, if any, additional information is required to process the claim. No health care entity or health plan may limit the time period in which additional information may be submitted to complete a claim.  (c) Any claim that is resubmitted by a health care provider or policyholder shall be treated by the health care entity or health plan pursuant to the provisions of subsection (a) of this section.  (d) A health care entity or health plan which fails to reimburse the health care provider or policyholder after receipt by the health care entity or health plan of a complete claim within the required timeframes shall pay to the health care provider or the policyholder who submitted the claim, in addition to any reimbursement for health care services provided, interest which shall accrue at the rate of twelve percent (12%) per annum commencing on the thirty-first (31st) day after receipt of a complete electronic claim or on the forty-first (41st) day after receipt of a complete written claim, and ending on the date the payment is issued to the health care provider or the policyholder.  (e) Exceptions to the requirements of this section are as follows:  (1) No health care entity or health plan operating in the state shall be in violation of this section for a claim submitted by a health care provider or policyholder if:  (i) Failure to comply is caused by a directive from a court or federal or state agency;  (ii) The health care provider or health plan is in liquidation or rehabilitation or is operating in compliance with a court-ordered plan of rehabilitation; or  (iii) The health care entity or health plans compliance is rendered impossible due to matters beyond its control that are not caused by it.  (2) No health care entity or health plan operating in the state shall be in violation of this section for any claim: (i) initially submitted more than ninety (90) days after the service is rendered, or (ii) resubmitted more than ninety (90) days after the date the health care provider received the notice provided for in  27-18-61(b); provided, this exception shall not apply in the event compliance is rendered impossible due to matters beyond the control of the health care provider and were not caused by the health care provider.  (3) No health care entity or health plan operating in the state shall be in violation of this section while the claim is pending due to a fraud investigation by a state or federal agency.  (4) No health care entity or health plan operating in the state shall be obligated under this section to pay interest to any health care provider or policyholder for any claim if the director of the department of business regulation finds that the entity or plan is in substantial compliance with this section. A health care entity or health plan seeking such a finding from the director shall submit any documentation that the director shall require. A health care entity or health plan which is found to be in substantial compliance with this section shall after this submit any documentation that the director may require on an annual basis for the director to assess ongoing compliance with this section.  (5) A health care entity or health plan may petition the director for a waiver of the provision of this section for a period not to exceed ninety (90) days in the event the health care entity or health plan is converting or substantially modifying its claims processing systems.  (f) For purposes of this section, the following definitions apply:  (1) Claim means:  (i) A bill or invoice for covered services;  (ii) A line item of service; or  (iii) All services for one patient or subscriber within a bill or invoice.  (2) Date of receipt means the date the health care entity or health plan receives the claim whether via electronic submission or has a paper claim.  (3) Health care 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 described in  23-17.13-2(2), that operates a health plan.  (4) Health care provider means an individual clinician, either in practice independently or in a group, who provides health care services, and referred to as a non-institutional provider.  (5) Health care services include, but are not limited to, medical, mental health, substance abuse, dental and any other services covered under the terms of the specific health plan.  (6) Health plan means a plan operated by a health care entity that provides for the delivery of health care services to persons enrolled in those plans through:  (i) Arrangements with selected providers to furnish health care services; and/or  (ii) Financial incentive for persons enrolled in the plan to use the participating providers and procedures provided for by the health plan.  (7) Policyholder means a person covered under a health plan or a representative designated by that person.  (8) Substantial compliance means that the health care entity or health plan is processing and paying ninety-five percent (95%) or more of all claims within the time frame provided for in  27-18-61(a) and (b).  (g) Any provision in a contract between a health care entity or a health plan and a health care provider which is inconsistent with this section shall be void and of no force and effect.  History of Section.P.L. 2001, ch. 119,  2; P.L. 2001, ch. 380,  2. 
 27-19-53. Mandatory coverage for certain lyme disease treatments. Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2004 shall provide coverage for diagnostic testing and long term antibiotic treatment of chronic lyme disease when determined to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of title 5 entitled lyme disease diagnosis and treatment after making a thorough evaluation of the patients symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as unproven, experimental, or investigational in nature.  History of Section.P.L. 2003, ch. 113,  4; P.L. 2003, ch. 114,  4; P.L. 2004, ch. 34,  3; P.L. 2004, ch. 35,  3. 
 27-19-54. Dental insurance assignment of benefits. Every entity providing a contract of insurance subject to this chapter shall allow, as a provision in a group or individual policy, contract or health benefit plan for coverage of dental services, any person insured by such entity to direct, in writing, that benefits from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by such entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.  History of Section.P.L. 2004, ch. 268,  2; P.L. 2004, ch. 386,  2. 
 27-19-55. Coverage for early intervention services. (a) Every individual or group hospital or medical expense insurance policy or contract providing coverage for dependent children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of early intervention services which coverage shall take effect no later than January 1, 2005. Such coverage shall 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.  1471 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.  History of Section.P.L. 2004, ch. 595, art. 22,  2; P.L. 2004, ch. 598,  3; P.L. 2005, ch. 97,  2; P.L. 2005, ch. 99,  2; P.L. 2008, ch. 475,  83. 
 27-19-56. Post-payment audits. (a) Except as otherwise provided herein, any review, audit, or investigation by a nonprofit hospital service corporation of a healthcare providers 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 payers 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.  History of Section.P.L. 2006, ch. 86,  2; P.L. 2006, ch. 97,  2; P.L. 2013, ch. 251,  2; P.L. 2013, ch. 395,  2; P.L. 2014, ch. 201,  2; P.L. 2014, ch. 214,  2; P.L. 2017, ch. 368,  2; P.L. 2017, ch. 375,  2; P.L. 2022, ch. 157,  2, effective June 27, 2022; P.L. 2022, ch. 158,  2, effective June 27, 2022. 
 27-19-57. Tobacco cessation programs. (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, which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided that if such medical coverage does not include prescription drug coverage, such contract, plan or policy shall not be required to include coverage for FDA approved smoking cessation medications.  (b) As used in this section, smoking cessation treatment includes the use of an over-the-counter (OTC) or prescription U.S. Food and Drug Administration (FDA) approved smoking cessation medication, when used in accordance with FDA approval, for not more than two (2) courses of medication of up to fourteen (14) weeks each, annually, when recommended and prescribed by a prescriber who holds prescriptive privileges in the state in which they are licensed, and used in combination with an annual outpatient benefit of sixteen (16) one-half (12) hour evidence based smoking cessation counseling sessions provided by a qualified practitioner for each covered individual. Smoking cessation treatment may be redefined through regulation promulgated by the health insurance commissioner in accordance with the most current clinical practice guidelines sponsored by the United States department of health and human services or its component agencies.  (c) Health insurance contracts, plans, or policies to which this section applies, may impose copayments and/or deductibles for the benefits mandated by this section consistent with the contracts, plans or policies copayments and/or deductibles for physician services and medications. Nothing contained in this section shall impact the reimbursement, medical necessity or utilization review, managed care, or case management practices of these health insurance contracts, plans or policies.  (d) This section shall not apply to insurance coverage providing benefits for:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Limited benefit health;  (7) Specified disease indemnity;  (8) Sickness or bodily injury or death by accident or both; and  (9) Other limited benefit policies.  History of Section.P.L. 2006, ch. 262,  2; P.L. 2006, ch. 293,  2; P.L. 2008, ch. 475,  83; P.L. 2009, ch. 187,  2; P.L. 2009, ch. 291,  2. 
 27-19-58. Reimbursement for orthotics and prosthetic services. (a) As used in this section:  (1) Federal reimbursement rates means the current listed fee schedule from the Centers for Medicare and Medicaid Services, listing the current Healthcare Common Procedure Coding system (HCPCS) and the corresponding reimbursement rates.  (2) Orthosis means a custom fabricated brace or support that is designed based on medical necessity. Orthosis does not include prefabricated or direct-formed orthotic devices, as defined in this section, or any of the following assistive technology devices: commercially available knee orthoses used following injury or surgery; spastic muscle-tone inhibiting orthoses; upper extremity adaptive equipment; finger splints; hand splints; wrist gauntlets; face masks used following burns; wheelchair seating that is an integral part of the wheelchair and not worn by the patient independent of the wheelchair; fabric or elastic supports; corsets; low-temperature formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; and other similar devices as determined by the director of the department of health, such as those commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility.  (3) Orthotics means the science and practice of evaluating measuring, designing, fabricating, assembling, fitting, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of, an orthosis for the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury or deformity. The practice of orthotics encompasses evaluation, treatment, and consultation; with basic observational gait and postural analysis, orthotists assess and design orthoses to maximize function and provide not only the support but the alignment necessary to either prevent or correct a deformity or to improve the safety and efficiency of mobility or locomotion or both. Orthotic practice includes providing continuing patient care in order to assess its effect on the patients tissues and to assure proper fit and function of the orthotic device by periodic evaluation.  (4) Prosthesis means an artificial limb that is alignable or, in lower-extremity applications capable of weight bearing. Prosthesis means an artificial medical device that is not surgically implanted and that is used to replace a missing limb, appendage, or other external human body part including an artificial limb, hand, or foot. The term does not include artificial eyes, ears, noses, dental appliances, osotmy products, or devices such as eyelashes or wigs.  (5) Prosthetics means the science and practice of evaluation, measuring, designing, fabricating, assembling, fitting, aligning, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of, a prosthesis through the replacement of external parts of a human body lost due to amputation or congenital deformities or absences. The practice of prosthetics also includes the generation of an image, form, or mold that replicates the patients body or body segment and that requires rectification of dimensions, contours and volumes for use in the design and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial appendage that is designed either to support body weight or to improve or restore function or cosmesis, or both. Involved in the practice of prosthetics is observational gait analysis and clinical assessment of the requirements necessary to refine and mechanically fix the relative position of various parts of the prosthesis to maximize function, stability, and safety of the patient. The practice of prosthetics includes providing and continuing patient care in order to assess the prosthetic devices effect on the patients tissues and to assure proper fit and function of the prosthetic device by periodic evaluation.  (6) Private insurance company means any insurance company, or management company hired by an insurance company, who is any of the following:  (i) based in the state of Rhode Island; or  (ii) provides coverage for citizens for the state of Rhode Island; or  (iii) allows subscribing patients to seek prosthetic or orthotic services in the state of Rhode Island.  (b) Every individual or group health insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after January 1, 2006, which provides medical coverage that includes coverage for physician services in a physicians office and every policy, which provides major medical or similar comprehensive type coverage shall provide coverage for benefits for orthotic and prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C. sections 1395K, 13951 and 1395M and 42 CFR 414.202, 414.210, 414.228, and 410.100 as applicable to this section.  (c) A health insurance contract, plan or policy may require prior authorization for orthotic and prosthetic devices in the same manner that prior authorization is required for any other covered benefit.  (d) Covered benefits for orthotic or prosthetic devices shall be limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insureds treating physician.  (e) The repair and replacement of orthotic or prosthetic devices also shall be covered subject to co-payments and deductibles, unless necessitated by misuse or loss.  (f) An insurer may require, if coverage is provided through a managed care plan, that benefits mandated pursuant to this section be covered benefits only if the orthotic or prosthetic devices are provided by a vendor and orthotic or prosthetic services are rendered by a provider who is licensed by the state of Rhode Island to provide orthotics and prosthetics.  History of Section.P.L. 2006, ch. 210,  2; P.L. 2006, ch. 380,  2. 
 27-19-59. Mandatory coverage for scalp hair prosthesis. (a) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2007, which provides coverage for any other prosthesis, shall provide coverage for expenses for scalp hair prosthesis worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia; provided, however, that such coverage shall be subject to the same limitations and guidelines as other prosthesis, and that coverage shall not exceed an amount of three hundred fifty dollars ($350) per covered member per year, exclusive of any deductible.  (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 2006, ch. 538,  2. 
 27-19-6. Rates charged subscribers  Reserves. [Effective until January 1, 2023.] (a) Public hearings: The rates proposed to be charged or a rating formula proposed to be used by any corporation organized under this chapter to employers, the state or any political subdivision of the state, or individuals, shall be filed by the corporation at the office of the health insurance commissioner. Within sixty (60) days after receipt of the application, the commissioner, or his or her designee shall hold a hearing on all rates proposed for health insurance coverage offered in the individual market as defined in  27-18.5-2 upon not less than ten (10) days written notice prior to the hearing. With regard to any other rates subject to the commissioner's jurisdiction the commissioner, or his or her designee, may hold a hearing upon not less than ten (10) days written notice prior to the hearing. The notice shall be published by the commissioner in a newspaper or newspapers having aggregate general circulation throughout the state at least ten (10) days prior to the hearing. The notice shall contain a description of the rates proposed to be charged and a copy of the notice shall be sent to the applicant and to the department of the attorney general. In addition, the applicant shall provide by mail, at least ten (10) days prior to the hearing, notice of the proposed rate increase for health insurance coverage offered in the individual market as defined in  27-18.5-2 to all subscribers subject to the proposed rate increase.  (b) Filings with the Attorney Generals Office: The applicant shall provide a copy of the filing on all rates proposed for health insurance coverage offered in the individual market as defined in  27-18.5-2 to the Insurance Advocacy Unit of the Attorney Generals Office simultaneously with the filing at the office of the health insurance commissioner.  (c) Procedures: At any hearing held under this section, the applicant shall be required to establish that the rates proposed to be charged or the rating formula to be used are consistent with the proper conduct of its business and with the interest of the public.  Rates proposed to be charged by any corporation organized under this chapter shall be sufficient to maintain total reserves in a dollar amount sufficient to pay claims and operating expenses for not less than one month. Those reserves shall be computed as of each December 31st, and a report setting forth the computation shall be submitted to the commissioner together with the corporations Rhode Island annual statement to the commissioner. Any documents presented in support of a filing of proposed rates under this section shall be made available for inspection by any party entitled to participate in a hearing or admitted as an intervenor in a hearing or such conditions as the commissioner may prescribe provided under this section at a time and at a place as the commissioner may deem reasonable. The commissioner, or his or her designee, upon the hearing, may administer oaths, examine and cross-examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence, or other documents which he or she deems relevant. The commissioner shall issue a decision as soon as is reasonably possible following the completion of the hearing. The decision may approve, disapprove, or modify the rates proposed to be charged by the applicant. Applicants requesting changes in rates shall underwrite the reasonable expenses of the commissioner in connection with the hearing, including any costs related to advertisements, stenographic reporting, and expert witnesses fees.  (d) The term designee, as used in this section, shall mean a person who is impartial; a member in good standing of the Rhode Island bar; and a person who is sufficiently acquainted with the rules of evidence as used in the superior court of the state so as to enable that person to conduct a hearing as designee of the commissioner. The reasonable per diem cost of the designee, as appointed by the commissioner, shall be paid by the applicant requesting changes in the rates.  History of Section.P.L. 1939, ch. 719,  3; G.L. 1956,  27-19-6; P.L. 1969, ch. 33,  2; P.L. 1970, ch. 58,  1; P.L. 1976, ch. 156,  1; P.L. 1991, ch. 93,  1; P.L. 1991, ch. 192,  1; P.L. 2000, ch. 200,  20; P.L. 2000, ch. 229,  20; P.L. 2005, ch. 43,  2; P.L. 2005, ch. 86,  2; P.L. 2016, ch. 145,  1; P.L. 2016, ch. 156,  1.   27-19-6. Rates charged subscribers  Reserves. [Effective January 1, 2023.] (a) General: The rates proposed to be charged or a rating formula proposed to be used by any corporation organized under this chapter to employers, the state or any political subdivision of the state, or individuals, shall be filed by the corporation at the office of the health insurance commissioner (the commissioner).  (b) Public hearings: Within ten (10) days after receipt of a filing, the commissioner shall determine, subject to the provisions of subsection (f) of this section, whether they intend to hold a public meeting or a public hearing at which time notice of such determination shall be sent to the insurance advocacy unit of the attorney general. Any such public hearing shall commence within sixty (60) days after receipt of the application, upon not less than ten (10) days written notice prior to the hearing, published by the commissioner in a newspaper or newspapers having aggregate general circulation throughout the state, at least ten (10) days prior to the hearing. The notice shall contain a description of the rates proposed to be charged and a copy of the notice shall be sent to the applicant and to the department of the attorney general. In the event there is a public hearing, the attorney general may engage the services of any expert or consultant necessary to assist in reviewing the filing, including having the ability to seek additional relevant information from the filer. All public hearings held pursuant to this section shall be held in accordance with the provisions of chapter 35 of title 42.  (c) Filings with the attorney generals office: The applicant shall provide a copy of the filing on all rates proposed for health insurance coverage offered in the individual market as defined in  27-18.5-2 to the insurance advocacy unit of the attorney generals office simultaneously with the filing at the office of the health insurance commissioner.  (d) Procedures:(1) The applicant shall be required to establish that the rates proposed to be charged are consistent with the proper conduct of its business and with the interest of the public.  (2) Any documents presented in support of a filing of proposed rates under this section shall be made available for public examination at a time and place that the commissioner may deem reasonable.  (3) If a public hearing is held pursuant to subsection (b) of this section, the commissioner, or designee, upon the hearing, may administer oaths, examine and cross-examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence, or other documents they deem relevant. Any designee who shall conduct a hearing pursuant to this section shall report their findings, in writing, to the commissioner, within a reasonable time following the conclusion of the hearing, with a recommendation for approval, disapproval, or modification of the rates proposed to be charged by the applicant. The commissioner shall make and issue a decision not later than ten (10) days following the issuance of the recommended decision or, if the commissioner hears the application without the appointment of a designee, as soon as is reasonably possible following the completion of the hearing on the proposed rate change. The decision may approve, disapprove, or modify the rates proposed to be charged by the applicant.   (e) The term designee, as used in this section, shall mean a person who is impartial; a member in good standing of the Rhode Island bar; and a person who is sufficiently acquainted with the rules of evidence as used in the superior court of the state so as to enable that person to conduct a hearing as designee of the commissioner. The reasonable per diem cost of the designee, as appointed by the commissioner, shall be paid by the applicant requesting changes in the rates.  (f) Notwithstanding any provision of this section to the contrary, the commissioner shall hold a public hearing in any instance where the applicant covers ten thousand (10,000) or more enrolled individuals in the individual market, and the rates proposed in the filing for the annual rate increase for products offered in the individual market produce an overall average-rate increase of ten percent (10%) or more. The commissioner shall require that any filing for a rate increase for products offered in the individual market shall include the calculation of the overall average-rate increase in order to determine whether a public hearing is required.  (1) For the purposes of this section, the calculation of the overall average-rate increase shall be based on the overall average-increase percent weighted by member premiums, excluding the effects of age scale increases. To calculate the overall average-rate increase, the applicant shall multiply the proposed rate increase by product, times the total monthly renewing premium for each product, and then divide the product by the sum of monthly renewing premiums for all products. The commissioner shall require this calculation to be provided as part of the applicants individual market rate filing.  (g) In the event that subsection (f) of this section, in combination with  42-62-13(b), would result in more than one public hearing in any given calendar year, the commissioner may defer one or more public hearing(s) for an applicant resulting from subsection (f) of this section or  42-62-13(b) until the subsequent calendar year, with the provision that one of the deferred applicants shall be required to have a public hearing in the subsequent year, whether or not the applicants filing satisfies the requirements of subsection (f) of this section or  42-62-13(b) in that subsequent calendar year.  (h) The commissioner shall notify the attorney general of the filing(s) to be deferred and the attorney general shall be given the opportunity to provide written comments and recommendations to the commissioner regarding any such filing(s) deferred in accordance with subsection (g) of this section.  (i) Notwithstanding any other provision of law to the contrary, the filing of proposed rates or a rating formula, and the holding and conducting of any public hearing in connection with these proposed rates or rating formula, shall be held in accordance with the provisions of chapter 35 of title 42.  (j) Public comment. Whether or not a public hearing is held pursuant to subsection (f) of this section, the commissioner shall solicit public comment regarding the rates proposed to be charged. Public comment shall be solicited upon not less than ten (10) days written notice prior to the date that either:  (1) A public meeting at which verbal comments may be provided; or  (2) That written comment must be received by the commissioner.  The notice shall contain a description of the rates proposed to be charged, or the formula proposed to be used, and a copy of the notice shall be sent to the applicant and to the insurance advocacy unit of the department of the attorney general. The attorney general shall be permitted to conduct discovery in relation to the actuarial analysis and actuarial assumptions of the filer regarding any filing in the individual market as defined in  27-18.5-2. Any documents presented in support of the filing under this section shall be made available for public examination at a time and place that the commissioner may deem reasonable.  (k) The applicant shall bear reasonable expenses of the commissioner in connection with a filing made pursuant to this section, including any costs related to advertisements, stenographic reporting, and expert fees, regardless of whether a public hearing is held. The applicant shall bear reasonable expenses of the attorney general in relation to any public hearing conducted pursuant to this section. The applicant shall bear reasonable expenses of the attorney general in relation to any filing in the individual market that is not subject to a public hearing.  History of Section.P.L. 1939, ch. 719,  3; G.L. 1956,  27-19-6; P.L. 1969, ch. 33,  2; P.L. 1970, ch. 58,  1; P.L. 1976, ch. 156,  1; P.L. 1991, ch. 93,  1; P.L. 1991, ch. 192,  1; P.L. 2000, ch. 200,  20; P.L. 2000, ch. 229,  20; P.L. 2005, ch. 43,  2; P.L. 2005, ch. 86,  2; P.L. 2016, ch. 145,  1; P.L. 2016, ch. 156,  1; P.L. 2022, ch. 147,  1, effective January 1, 2023; P.L. 2022, ch. 148,  1, effective January 1, 2023. 
 27-19-60. Licensed ambulance service. (a) No individual or group health insurance contract, plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009 shall provide for a co-payment for ground ambulance services in excess of fifty dollars ($50.00).  (b) As used in this section, the term ground ambulance services shall mean those services provided by an ambulance service licensed to operate in Rhode Island in accordance with  23-4.1-6. The term excludes air and water ambulance services and ambulance services provided outside of Rhode Island.  (c) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 2008, ch. 68,  2; P.L. 2008, ch. 70,  2. 
 27-19-61. Enteral nutrition products. (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and that are medically necessary for the treatment of malabsorption caused by Crohns disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein and shall extend to all recipients regardless of age.  (b) Benefit plans offered by a hospital service corporation may impose a copayment and/or deductible for the benefits mandated by this section, however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for prescription enteral formulas or nutritional aids. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization. Reimbursement shall be provided according to the respective principles and policies of the accident and sickness insurer. Nothing contained in this section precludes the accident and sickness insurer from conducting managed care, medical necessity, or utilization review.  (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited-benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited-benefit policies.  History of Section.P.L. 2008, ch. 253,  2; P.L. 2014, ch. 269,  2; P.L. 2014, ch. 519,  2. 
 27-19-62. Prohibition on rescission of coverage. (a)(1) Coverage under a health plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be rescinded after the individual is covered under the plan, unless:  (A) The individual or a person seeking coverage on behalf of the individual, performs an act, practice or omission that constitutes fraud; or  (B) The individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage.  (2) For purposes of paragraph (1)(A), a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health carrier.  (b) At least thirty (30) days advance written notice shall be provided to each health benefit plan enrollee or, for individual health insurance coverage, primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of, in the case of group health insurance coverage, whether the rescission applies to the entire group or only to an individual within the group.  (c) For purposes of this section, to rescind means to cancel or to discontinue coverage with retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.  (d) This section applies to grandfathered health plans.  History of Section.P.L. 2012, ch. 256,  6; P.L. 2012, ch. 262,  6. 
 27-19-63. Prohibition on annual and lifetime limits. (a) Annual limits.(1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health insurance carrier and health benefit plan subject to the jurisdiction of the commissioner under this chapter may establish an annual limit on the dollar amount of benefits that are essential health benefits provided the restricted annual limit is not less than the following:  (A) For a plan or policy year beginning after September 22, 2011, but before September 23, 2012  one million two hundred fifty thousand dollars ($1,250,000); and  (B) For a plan or policy year beginning after September 22, 2012, but before January 1, 2014  two million dollars ($2,000,000).  (2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier and health benefit plan shall not establish any annual limit on the dollar amount of essential health benefits for any individual, except:  (A) A health flexible spending arrangement, as defined in Section 106(c)(2) of the federal Internal Revenue Code, a medical savings account, as defined in Section 220 of the federal Internal Revenue Code, and a health savings account, as defined in Section 223 of the federal Internal Revenue Code, are not subject to the requirements of subdivisions (1) and (2) of this subsection.  (B) The provisions of this subsection shall not prevent a health insurance carrier and health benefit plan from placing annual dollar limits for any individual on specific covered benefits that are not essential health benefits to the extent that such limits are otherwise permitted under applicable federal law or the laws and regulations of this state.  (3) In determining whether an individual has received benefits that meet or exceed the allowable limits, as provided in subdivision (1) of this subsection, a health insurance carrier and health benefit plan shall take into account only essential health benefits.   (b) Lifetime limits.(1) A health insurance carrier and health benefit plan offering group or individual health insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits for any individual.  (2) Notwithstanding subdivision (1) above, a health insurance carrier and health benefit plan is not prohibited from placing lifetime dollar limits for any individual on specific covered benefits that are not essential health benefits in accordance with federal laws and regulations.   (c)(1) The provisions of this section relating to lifetime limits apply to any health insurance carrier providing coverage under an individual or group health plan, including grandfathered health plans.  (2) The provisions of this section relating to annual limits apply to any health insurance carrier providing coverage under a group health plan, including grandfathered health plans, but the prohibition and limits on annual limits do not apply to grandfathered health plans providing individual health insurance coverage.  (d) This section shall not apply to a plan or to policy years prior to January 1, 2014, for which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant to 45 C.F.R.  147.126(d)(3). This section also shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  (e) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this subsection shall be construed to limit the authority of the Commissioner to regulate health insurance under existing state law.  History of Section.P.L. 2012, ch. 256,  6; P.L. 2012, ch. 262,  6. 
 27-19-64. Coverage for individuals participating in approved clinical trials. (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:  (A) The study or investigation is approved or funded, which may include funding through in-kind contributions, by one or more of the following:  (i) The federal National Institutes of Health;  (ii) The federal Centers for Disease Control and Prevention;  (iii) The federal Agency for Health Care Research and Quality;  (iv) The federal Centers for Medicare & Medicaid Services;  (v) A cooperative group or center of any of the entities described in items (i) through (iv) or the U.S. Department of Defense or the U.S. Department of Veterans Affairs;  (vi) A qualified non-governmental research entity identified in the guidelines issued by the federal National Institutes of Health for center support grants; or  (vii) 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 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.  (B) The study or investigation is conducted under an investigational new drug application reviewed by the U.S. Food and Drug Administration; or  (C) The study or investigation is a drug trial that is exempt from having such an investigational new drug application.  (2) Participant has the meaning stated in section 3(7) of federal ERISA [29 U.S.C.  1002].  (3) 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.  (4) Qualified individual means a participant or beneficiary who meets the following conditions:  (A) 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  (B)(i) The referring healthcare professional is a participating provider and has concluded that the individuals participation in such trial would be appropriate based on the individual meeting the conditions described in subdivision (A) of this subdivision (3); or  (ii) The participant or beneficiary provides medical and scientific information establishing the individuals participation in such trial would be appropriate based on the individual meeting the conditions described in subdivision (A) of this subdivision (3).  (5) 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.  (b)(1) If a health insurance carrier offering group or individual health insurance coverage provides coverage to a qualified individual, the health carrier:  (A) Shall not deny the individual participation in an approved clinical trial.  (B) Subject to subdivision (3) of this subsection, 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  (C) Shall not discriminate against the individual on the basis of the individuals participation in the approved clinical trial.  (2)(A) Subject to subdivision (B) of this subdivision (2), 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.  (B) For purposes of subdivision (B) of this subdivision (2), routine patient costs do not include:  (i) The investigational item, device or service itself;  (ii) 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  (iii) A service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis.  (3) If one or more participating providers are participating in a clinical trial, nothing in subdivision (1) of this subsection shall be construed as preventing a health carrier from requiring that a qualified individual participate in the trial through such a participating provider if the provider will accept the individual as a participant in the trial.  (4) Notwithstanding subdivision (3) of this subsection, subdivision (1) of this subsection shall apply to a qualified individual participating in an approved clinical trial that is conducted outside this state.  (5) This section shall not be construed to require a health carrier offering group or individual health insurance coverage to provide benefits for routine patient care services provided outside of the coverages 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 carriers coverage with respect to clinical trials.  (c) The requirements of this section shall be in addition to the requirements of  27-18-32  27-19-32.2.  (d) The provisions of this section shall apply to grandfathered health plans. This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  (e) This section shall be effective for plan years beginning on or after January 1, 2014.  History of Section.P.L. 2012, ch. 256,  6; P.L. 2012, ch. 262,  6. 
 27-19-65. Medical loss ratio reporting and rebates. (a) A nonprofit hospital service corporation offering group or individual health insurance coverage of a health benefit plan, including a grandfathered health plan, shall comply with the provisions of Section 2718 of the Public Health Service Act as amended by the federal Affordable Care Act [42 U.S.C.  300gg-18], in accordance with regulations adopted thereunder.  (b) Health insurance carriers required to report medical loss ratio and rebate calculations and other medical loss ratio and rebate information to the U.S. Department of Health and Human Services shall concurrently file such information with the commissioner.  History of Section.P.L. 2012, ch. 256,  6; P.L. 2012, ch. 262,  6. 
 27-19-66. Emergency services. (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:  (A) 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  (B) 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 nonprofit hospital service corporation provides any benefits to subscribers with respect to services in an emergency department of a hospital, the plan must cover emergency services consistent with the rules of this section.  (c) A nonprofit hospital service corporation 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:  (A) The exclusion of or coordination of benefits;  (B) An affiliation or waiting period permitted under part 7 of federal ERISA, part A of title XXVII of the federal PHS Act, or chapter 100 of the federal Internal Revenue Code; or  (C) 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. However, 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 insurance carrier is required to pay under subdivision (1) of this subsection. A group health plan or health insurance carrier complies with the requirements of this subsection if it provides benefits with respect to an emergency service in an amount equal to the greatest of the three amounts specified in subdivisions (A), (B), and (C) of this subdivision (1) (which are adjusted for in-network cost-sharing requirements).  (A) 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 subdivision (A) 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 subdivision (A) is disregarded.  (B) The amount for the emergency service shall be 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 subdivision (B) 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. Thus, for example, if a plan generally pays seventy percent (70%) of the usual, customary, and reasonable amount for out-of-network services, the amount in this subdivision (B) for an emergency service is the total, that is, one hundred percent (100%), of the usual, customary, and reasonable amount for the service, not reduced by the thirty percent (30%) coinsurance that would generally apply to out-of-network services (but reduced by the in-network copayment or coinsurance that the individual would be responsible for if the emergency service had been provided in-network).  (C) 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) 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.  History of Section.P.L. 2012, ch. 256,  6; P.L. 2012, ch. 262,  6. 
 27-19-67. Internal and external appeal of adverse benefit determinations. (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 which are not subject to the jurisdiction of the department of health pursuant to R.I. Gen. Laws  23-17.12 et seq. (Utilization Review Act).  (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.  History of Section.P.L. 2012, ch. 256,  6; P.L. 2012, ch. 262,  6. 
 27-19-68. Prohibition on preexisting condition exclusions. (a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title and/or chapter:  (1) Shall not limit or exclude coverage for an individual under the age of nineteen (19) by imposing a preexisting condition exclusion on that individual.  (2) For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude coverage for any individual by imposing a preexisting condition exclusion on that individual.  (b) As used in this section:  (1) Preexisting condition exclusion means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition (whether physical or mental) was present before the effective date of coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, diagnosis, care or treatment was recommended or received before the effective date of coverage.  (2) Preexisting condition exclusion means any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individuals health status before the individuals effective date of coverage, or if the coverage is denied, the date of denial, under the health benefit plan, such as a condition (whether physical or mental) identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period.  (c) This section shall not apply to grandfathered health plans providing individual health insurance coverage.  (d) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  History of Section.P.L. 2012, ch. 256,  6; P.L. 2012, ch. 262,  6. 
 27-19-69. Primary care provider designation requirement. Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2013, shall require that the subscriber and each dependent designate a participating primary care provider and the insurer shall collect the designation from the insured. Designation of a primary care provider shall not be a condition of enrollment and failure to designate a primary care provider shall not constitute grounds for cancellation of coverage. For purposes of this section, primary care provider means the physician, practice or other medical provider considered by the insured to be his or her usual source of medical care.  History of Section.P.L. 2012, ch. 189,  2; P.L. 2012, ch. 202,  2. 
 27-19-7.1. Uniform explanation of benefits and coverage. (a) A nonprofit hospital service corporation shall provide a summary of benefits and coverage explanation and definitions to policyholders and others required by, and at the times and in the format required, by the federal regulations adopted under section 2715 of the Public Health Service Act, as amended by the federal Affordable Care Act [42 U.S.C.  300gg-15]. The forms required by this section shall be made available to the commissioner on request. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.  (b) The provisions of this section shall apply to grandfathered health plans. This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  (c) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.  History of Section.P.L. 2012, ch. 256,  6; P.L. 2012, ch. 262,  6. 
 27-19-7.2. Filing of policy forms. (a) A nonprofit hospital service corporation shall file all policy forms and rates used by it in the state with the commissioner, including the forms of any rider, endorsement, application blank, and other matter generally used or incorporated by reference in its policies or contracts of insurance. No such form shall be used if disapproved by the commissioner under this section, or if the commissioners 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 actuarys 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.  History of Section.P.L. 2012, ch. 256,  6; P.L. 2012, ch. 262,  6. 
 27-19-7. Rates charged by hospitals. (a) The rates charged by contracting hospitals to any nonprofit hospital service corporation for hospital services rendered by the hospitals to the subscribers of the corporation shall be established from time to time by agreement between the contracting hospitals and the corporation.  (b) Upon completion of its services, each contracting hospital shall, upon request, provide a copy of an itemized bill for each patient; provided, that nothing contained in this subsection shall be construed to apply to any hospital operated by the state of Rhode Island, its departments, or agencies.  History of Section.P.L. 1939, ch. 719,  3; G.L. 1956,  27-19-7; P.L. 1985, ch. 529,  1. 
 27-19-70. Discretionary clauses. (a) No new or existing policy or certificate may contain any provision:  (1) Purporting to reserve sole discretion to the insurer or healthcare entity to determine eligibility for benefits or interpret the terms of a policy or certificate; or  (2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.  (b) Any such clause or language included in a contract, policy or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.  (c) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.  History of Section.P.L. 2013, ch. 85,  3; P.L. 2013, ch. 94,  3. 
 27-19-71. Orally administered anticancer medication  Cost-sharing requirement. (a) Every individual or group hospital or medical expense, insurance policy or individual or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued for delivery, or renewed in this state, on or after January 1, 2014, that offers both medical and prescription drug coverage, and provides coverage for intravenously administered anticancer medication, shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section. Notwithstanding the above, the requirements shall not be construed to impose any form of cap on cost-sharing.  (b) This section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  History of Section.P.L. 2013, ch. 323,  2; P.L. 2013, ch. 405,  2. 
 27-19-72. Consumer notification. Every nonprofit hospital service corporation providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a non-duplication of benefits clause: NO DUPLICATION OF BENEFITS.  History of Section.P.L. 2013, ch. 452,  2; P.L. 2013, ch. 479,  2. 
 27-19-73. Opioid antagonists. (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.  History of Section.P.L. 2016, ch. 175,  2; P.L. 2016, ch. 192,  2. 
 27-19-74. Healthcare provider credentialing. (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 providers 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 providers 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 entitys or health plans 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.  History of Section.P.L. 2017, ch. 185,  2; P.L. 2017, ch. 254,  2. 
 27-19-75. Unfair discrimination prohibited. Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services that may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37 of title 5.  History of Section.P.L. 2017, ch. 165,  2; P.L. 2017, ch. 314,  2. 
 27-19-76. Health insurance contracts  Full year coverage for contraception. 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.  History of Section.P.L. 2018, ch. 230,  3; P.L. 2018, ch. 234,  3. 
 27-19-77. Prohibition on discrimination in organ transplants.  Pursuant to chapter 95 of title 23, any nonprofit hospital that provides for anatomical gifts, organ transplants, or related treatment and services shall not:  (1) Deny coverage to a covered person solely on the basis of the persons disability;  (2) Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the health benefit plan, solely for the purpose of avoiding the requirements of this section;  (3) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide monetary or nonmonetary incentives to an attending provider, to induce the provider to provide care to an insured or enrollee in a manner inconsistent with this section; or  (4) Reduce or limit coverage benefits to a patient for the medical services or other services related to organ transplantation performed pursuant to this section as determined in consultation with the attending physician and patient.  History of Section.P.L. 2021, ch. 109,  4, effective June 30, 2021; P.L. 2021, ch. 133,  4, effective June 30, 2021. 
 27-19-78. Health insurance contracts  Copayments exemption for COVID-19 vaccinations. (a) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for COVID-19 related services, including, but not limited to: emergency services, inpatient services, provider office visits, and inpatient hospital stays, as long as the COVID-19 state of emergency remains in effect.  (b) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for the administration of the COVID-19 vaccine or a COVID-19 test.  (c) The health insurance commissioner shall promulgate any rules and regulations as the commissioner deems necessary for the efficient administration and enforcement of this section.  History of Section.P.L. 2021, ch. 145,  2, effective July 3, 2021; P.L. 2021, ch. 161,  2, effective July 3, 2021. 
 27-19-79. Perinatal doulas.  (a) As used in this section, doula or perinatal doula means a trained professional providing continuous physical, emotional, and informational support to a pregnant individual, from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.  (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 July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurers respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas area of professional competence as defined by the doula certification standard developed and maintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other healthcare provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement, except when those requirements are also applicable to other categories of healthcare providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other healthcare provider.  (c) 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 that is required to cover perinatal doula services, as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023, and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.  (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.  History of Section.P.L. 2021, ch. 209,  3, effective July 1, 2022; P.L. 2021, ch. 321,  3, effective July 1, 2022. 
 27-19-8. Annual and quarterly statements. (a) Every nonprofit hospital service corporation shall annually, on or before the first day of March in each year, file in the office of the commissioner of insurance a statement, verified by at least two (2) of the principal officers of the corporation, of its condition on the thirty-first day of December then next preceding, which statement shall be in general form and context as approved by the National Association of Insurance Commissioners and contain any matters the commissioner shall prescribe and shall be available for inspection by the public.  (b) Every nonprofit hospital service corporation shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners guidelines and procedures, and shall be available for inspection by the public.  (c) The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.  History of Section.P.L. 1939, ch. 719,  4; G.L. 1956,  27-19-8; P.L. 1994, ch. 404,  1; P.L. 1996, ch. 188,  9. 
 27-19-80. Gender rating. [Effective January 1, 2023.] (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 physicians office, and no policy that provides major medical or similar comprehensive-type coverage, excluding disability income, long-term care, and insurance supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall vary the premium rate for a health coverage plan based on the gender of the individual policy holders, enrollees, subscribers, or members.  (b) This section shall not apply to insurance coverage providing benefits for any of the following:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Limited benefit health;  (7) Specified disease indemnity;  (8) Sickness of bodily injury or death by accident or both; and  (9) Other limited benefit policies.  History of Section.P.L. 2021, ch. 88,  2, effective January 1, 2023; P.L. 2021, ch. 89,  2, effective January 1, 2023. 
 27-19-81. Coverage for biomarker testing. (a) As used in this section:  (1) Biomarker means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Biomarkers include but are not limited to gene mutations or protein expression.  (2) Biomarker testing is the analysis of a patients tissue, blood, or other biospecimen for the presence of a biomarker. Biomarker testing includes but is not limited to single-analyte tests, multi-plex panel tests, and whole genome sequencing.  (3) Clinical utility means the test result provides information that is used in the formulation of a treatment or monitoring strategy that informs a patients outcome and impacts the clinical decision. The most appropriate test may include both information that is actionable and some information that cannot be immediately used in the formulation of a clinical decision.  (4) Consensus statements as used here are statements developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure and with a conflict of interest policy. These statements are aimed at specific clinical circumstances and base the statements on the best available evidence for the purpose of optimizing the outcomes of clinical care.  (5) Nationally recognized clinical practice guidelines as used here are evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy. Clinical practice guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options and include recommendations intended to optimize patient care.  (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2024, shall provide coverage for the services of biomarker testing in accordance with each health insurers respective principles and mechanisms of reimbursement, credentialing, and contracting. Biomarker testing must be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollees disease or condition to guide treatment decisions, when the test provides clinical utility as demonstrated by medical and scientific evidence, including, but not limited to:  (1) Labeled indications for an FDA-approved or -cleared test or indicated tests for an FDA-approved drug;  (2) Centers for Medicare Services (CMS) national coverage determinations or Medicare Administrative Contractor (MAC) local coverage determinations; or  (3) Nationally recognized clinical practice guidelines and consensus statements.  (c) Coverage as defined in subsection (b) is provided in a manner that limits disruptions in care including the need for multiple biopsies or biospecimen samples.  (d) The patient and prescribing practitioner shall have access to clear, readily accessible, and convenient processes to request an exception to a coverage policy of a health insurer, nonprofit health service plan, and health maintenance organization. The process shall be made readily accessible on the health insurers, nonprofit health service plans, or health maintenance organizations website.  History of Section.P.L. 2022, ch. 151,  2, effective June 27, 2022; P.L. 2022, ch. 152,  2, effective June 27, 2022. 
 27-19-82. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.] (a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobin therapy.  (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall be coded as autoimmune encephalitis until the American Medical Association and the Centers for Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome.  (c) The healthcare benefits outlined in this section apply only to services delivered within the state of Rhode Island; provided, that all health insurance carriers shall be required to provide coverage for those benefits mandated by this section outside of the state of Rhode Island where it can be established through a pre-authorization process that the required services are not available in the state of Rhode Island from a provider in the health insurance carriers network.  (d) Each health insurance carrier shall collect and provide to the office of the health insurance commissioner, in a form and frequency acceptable to the commissioner, information and data reflecting the costs and the savings of adding the benefit coverage provided in this section. On or before January 1, 2025, the office of the health insurance commissioner shall report to the general assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage provided in this section produces a net savings to health insurance carriers and to policy holders.  (e) This section shall sunset and be repealed effective December 31, 2025.  History of Section.P.L. 2022, ch. 422,  2, effective June 30, 2022; P.L. 2022, ch. 423,  2, effective June 30, 2022. 
 27-19-9. Examination of affairs of corporations. It is the duty of the insurance commissioner to make an examination of the financial condition and methods of doing business of every nonprofit hospital service corporation. The examination shall be performed, and the associated costs borne by the company, in accordance with all of the provisions of chapter 13.1 of this title.  History of Section.P.L. 1939, ch. 719,  5; G.L. 1956,  27-19-9; P.L. 1960, ch. 71, art. 1,  10; P.L. 1967, ch. 154,  1; P.L. 1994, ch. 404,  1; P.L. 2002, ch. 292,  37. 
 27-2.1-1. New application fee. Any foreign insurance company applying for licensure within the state of Rhode Island to transact insurance business must upon filing of an application submit to the insurance commissioner a non-refundable application fee of one thousand, two hundred dollars ($1,200).  History of Section.P.L. 1982, ch. 285,  1; P.L. 2009, ch. 68, art. 12,  5; P.L. 2013, ch. 31,  1; P.L. 2013, ch. 36,  1. 
 27-2.1-2. Review of application fee. Whenever any foreign insurance company has made application to transact insurance business within the state, the applicant shall be assessed for the actual time incurred in conducting the analysis in accordance with the expense calculation for examinations under  27-13.1-7(a)(1).  History of Section.P.L. 1982, ch. 285,  1; P.L. 2009, ch. 68, art. 12,  5; P.L. 2013, ch. 31,  1; P.L. 2013, ch. 36,  1. 
 27-2.1-3. Repealed.
 27-2.1-4. Use of fees. Any and all fees as prescribed by this chapter shall be paid to the general treasurer of the state of Rhode Island.  History of Section.P.L. 1982, ch. 285,  1; P.L. 2002, ch. 292,  9. 
 27-2.2-1. Domestication of foreign insurer. Any foreign insurer may become a domestic insurer by complying with all of the requirements of law relative to the organization and licensing of a domestic insurer of the same type, and by filing with the insurance commissioner its articles of association, charter, or other organizational document, together with appropriate amendments to them adopted in accordance with the laws of this state bringing the articles of association, charter, or other organizational document into compliance with the laws of this state. The foreign insurer shall be entitled to the necessary or appropriate certificates and licenses to continue its business and to transact business in this state, and shall be subject to the authority and jurisdiction of this state. In connection with any domestication, the commissioner may waive any and all requirements for public hearings. No insurer domesticating into this state need merge, consolidate, transfer assets, or engage in any other reorganization, other than as specified in this section.  History of Section.P.L. 1992, ch. 24,  1. 
 27-2.2-2. Effects of domestication. Upon domestication in accordance with  27-2.2-1, the foreign insurer shall become a domestic insurer organized under the laws of this state and have all the rights, privileges, immunities, and powers, and be subject to all applicable laws, duties, and liabilities, of domestic insurers of the same type. The domestic insurer shall then and after this possess all rights that obtained prior to the domestication to the extent permitted by the laws of this state, and be responsible and liable for all the liabilities and obligations that obtained prior to the domestication. The certificate of authority, insurance producers, appointments and licenses, rates, and other items that the insurance commissioner allows, in his or her discretion, which are in existence at the time any insurer licensed to transact the business of insurance in this state transfers its corporate domicile to this or any other state or jurisdiction by domestication, shall continue in full force and effect after the transfer if the insurer remains duly qualified to transact the business of insurance in this state. All transferring insurers qualified in this state shall notify the commissioner of the transfer of domicile and shall provide the commissioner any information and documentation that the commissioner may request. All outstanding policies of any transferring insurer shall remain in full force and effect.  History of Section.P.L. 1992, ch. 24,  1. 
 27-2.2-3. Fees. An insurer becoming a domestic insurer through the domestication procedure specified in  27-2.2-1 shall pay to the commissioner the fees that would be payable by a similar domestic insurer organizing and becoming licensed, or transacting business, in this state. An insurer becoming a domestic insurer pursuant to  27-2.2-1 shall pay to the insurance commissioner a filing fee in the amount of one thousand dollars ($1,000) for the filing required.  History of Section.P.L. 1992, ch. 24,  1. 
 27-2.2-4. Conversion to foreign insurer. (a) Any domestic insurer may, upon the approval of, and compliance with any conditions as may be imposed by the insurance commissioner, transfer its domicile, in accordance with the laws of the other state or jurisdiction, to any other state or jurisdiction, and upon the transfer shall cease to be a domestic insurer, and its corporate or other legal existence in this state shall cease upon the filing of proof of the re-domestication with the insurance commissioner and upon payment of a filing fee in the amount of one thousand dollars ($1,000).  (b) The insurer shall be admitted to this state as a foreign insurer if qualified as a foreign insurer, upon compliance with the qualification requirements for foreign insurers pursuant to chapter 2 of this title, to the extent not waived by the commissioner.  History of Section.P.L. 1992, ch. 24,  1. 
 27-2.3-1  27-2.3-22. Repealed.
 27-2.4-1. Purpose and scope. (a) This chapter governs the qualifications and procedures for the licensing of insurance producers. It simplifies and organizes some statutory language to improve efficiency, permits the use of new technology and reduces costs associated with issuing and renewing insurance licenses. This chapter does not apply to excess and surplus lines agents and brokers licensed pursuant to  27-3-38 except as provided in  27-2.4-10 and 27-2.4-17.  (b) Whenever the words agent, solicitor, or broker and their plural construct are used in the context of a licensee pursuant to chapter 3 of this title and occur in this chapter, any general law, public law, act or resolution of the general assembly or department of business regulation, those words mean insurance producer, except for those provisions of law and regulation which govern excess and surplus lines agents or brokers licensed pursuant to  27-3-38.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3. 
 27-2.4-10. Nonresident licensing. (a) Unless denied licensure pursuant to  27-2.4-14, a nonresident person shall receive a nonresident insurance producer license if:  (1) The person is currently licensed as a resident and in good standing in his or her home state;  (2) The person has submitted the proper request for licensure and has paid the fees required by  27-2.4-4;  (3) The person has submitted or transmitted to the insurance commissioner the application for licensure that the person submitted to his or her home state, or in lieu of that application, a completed uniform application; and  (4) The persons home state awards nonresident insurance producer licenses to residents of this state on the same basis.  (b) The insurance commissioner may verify the insurance producers licensing status through the producer database maintained by the NAIC, its affiliates or subsidiaries.  (c) A nonresident insurance producer who moves from one state to another state or a resident insurance producer who moves from this state to another state shall file a change of address and provide certification from the new resident state within thirty (30) days of the change of legal residence. No fee or license application is required.  (d) Notwithstanding any other provision of this chapter, a person licensed as a surplus lines broker in his or her home state shall receive a nonresident surplus lines broker license pursuant to subsection (a) of this section. Except as provided in subsection (a) of this section, nothing in this section amends or supersedes any provision of chapter 3 of this title.  (e) Notwithstanding any other provision of this chapter, a person licensed as a limited line credit insurance or other type of limited lines insurance producer in his or her home state shall receive a nonresident limited lines insurance producer license, pursuant to subsection (a) of this section, granting the same scope of authority as granted under the license issued by the insurance producers home state. For purposes of this section, limited line insurance is any authority granted by the home state which restricts the authority of the insurance producer to less than the total authority prescribed in associated major lines pursuant to  27-2.4-9(a)(1)  (a)(8).  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3. 
 27-2.4-11. Exemption from examination. (a) An individual who applies for an insurance producer license in this state who was previously licensed for the same lines of authority in another state shall not be required to complete any pre-licensing education or examination, but shall be required to certify knowledge of Rhode Island law applicable to insurance producers. This exemption is only available if the person is currently licensed in that state or if the application is received within ninety (90) days of the cancellation of the applicants previous license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state or the states producer database records, maintained by the NAIC, its affiliates or subsidiaries, indicate that the insurance producer is or was licensed in good standing for the line of authority requested.  (b) A person licensed as an insurance producer in another state who moves to this state shall make application within ninety (90) days of establishing legal residence to become a resident insurance producer pursuant to  27-2.4-8. No pre-licensing education or examination shall be required of that person to obtain any line of authority previously held in the prior state except where the insurance commissioner determines otherwise by regulation.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3. 
 27-2.4-12. Assumed names. An insurance producer doing business under any name other than the insurance producers legal name is required to notify the insurance commissioner prior to using the assumed name.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3. 
 27-2.4-13. Temporary licenses. (a) The insurance commissioner may issue a temporary insurance producer license for a period not to exceed one hundred eighty (180) days without requiring an examination if the insurance commissioner deems that the temporary license is necessary for the servicing of an insurance business in the following cases:  (1) To the surviving spouse or court-appointed personal representative of a licensed insurance producer who dies or becomes mentally or physically disabled to allow adequate time for the sale of the insurance business owned by the insurance producer or for the recovery or return of the insurance producer to the business or to provide for the training and licensing of new personnel to operate the insurance producers business; or  (2) To a member or employee of a business entity operated by a licensed insurance producer, upon the death or disability of that individual; or  (3) To the designee of a licensed insurance producer entering active service in the armed forces of the United States of America; or  (4) In any other circumstance where the insurance commissioner deems that the public interest will best be served by the issuance of this license.  (b) The insurance commissioner may by order limit the authority of any temporary insurance producer in any way deemed necessary to protect the insured and the public. The insurance commissioner may require the temporary insurance producer to have a suitable sponsor who is a licensed insurance producer or insurer and who assumes responsibility for all acts of the temporary insurance producer and may impose other similar requirements designed to protect the insured and the public. The insurance commissioner may by order revoke a temporary license if the interest of the insured or the public are endangered. A temporary license may not continue after the owner or the personal representative disposes of the business.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2007, ch. 85,  1; P.L. 2007, ch. 211,  1. 
 27-2.4-14. Licenses  Denial  Nonrenewal  Suspension or revocation. (a) The insurance commissioner may place on probation, suspend, revoke or refuse to issue or renew an insurance producers license or may levy an administrative penalty in accordance with  42-14-16 or any combination of actions, for any one or more of the following causes:  (1) Providing incorrect, misleading, incomplete or materially untrue information in the license application;  (2) Violating any insurance laws, or violating any regulation, subpoena or order of the insurance commissioner or of another states insurance commissioner;  (3) Obtaining or attempting to obtain a license through misrepresentation or fraud;  (4) Improperly withholding, misappropriating or converting any monies or properties received in the course of doing insurance business;  (5) Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance;  (6) Having been convicted of a felony;  (7) Having admitted or been found to have committed any insurance unfair trade practice or fraud;  (8) Using fraudulent, coercive, or dishonest practices or demonstrating incompetence, untrustworthiness or financial irresponsibility in this state or in another place;  (9) Having an insurance producer license, or its equivalent, denied, suspended or revoked in any other state, province, district or territory or administrative action under this section;  (10) Forging anothers name to an application for insurance or to any document related to an insurance transaction;  (11) Cheating on an examination for an insurance license;  (12) Knowingly accepting insurance business from an individual who is not licensed;  (13) Failing to comply with an administrative or court order imposing a child support obligation; or  (14) Failing to pay state income tax or comply with any administrative or court order directing payment of state income tax.  (b) In the event that the action by the insurance commissioner is to non-renew or to deny an application for a license, the insurance commissioner shall notify the applicant or insurance producer and advise, in writing, the applicant or insurance producer of the reason for the denial or non-renewal of the applicants or insurance producers license. The applicant or insurance producer may make written demand upon the insurance commissioner within thirty (30) days for a hearing before the insurance commissioner to determine the reasonableness of the insurance commissioners action. The hearing shall be conducted pursuant to the Administrative Procedures Act, chapter 35 of title 42.  (c) In addition to or in lieu of any applicable denial, suspension or revocation of a license, a person may, after hearing, be subject to an administrative fine in accordance with  42-14-16.  (d) The insurance commissioner shall retain the authority to enforce the provisions of and impose any penalty or remedy authorized by this chapter and this title against any person who is under investigation for or charged with a violation of this chapter or this title even if the persons license or registration has been surrendered or has lapsed by operation of the law.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2007, ch. 85,  1; P.L. 2007, ch. 211,  1. 
 27-2.4-15.1. Compensation disclosure. (a) Where any insurance producer or any affiliate of such producer receives any compensation from the customer for the initial placement of insurance, neither that producer nor the affiliate shall accept or receive any compensation from an insurer or other third-party for that placement of insurance unless the producer has, prior to the customers purchase of insurance:  (1) Obtained the customers documented acknowledgment that such compensation will be received by the producer or affiliate; and  (2) Provided a description of the method and factors utilized for calculating the compensation to be received from the insurer or other third-party for that placement.  (b) This section shall not apply to:  (1) A person licensed as an insurance producer who acts only as an intermediary between an insurer and the customers producer, for example: a managing general agent, a sales manager, or wholesale broker;  (2) The placement of insurance in secondary or residual markets; or  (3) A producer whose sole compensation for the placement is derived from commissions, salaries and other remuneration from the insurer.  (i) Notwithstanding this provision, a producer shall, at the time of sale or no later than the delivery of the policy, disclose that they will be paid a commission by the company and may receive other performance based compensation. This does not apply to salaried employees of an insurance company.  (c) For purposes of this section:  (1) Affiliate means a person that controls, is controlled by or is under common control with the producer.  (2) Compensation from an insurer or other third-party means payments, commissions, fees, awards, overrides, bonuses, contingent commissions, loans, stock options, gifts, prizes or any other form of valuable consideration, whether or not payable pursuant to a written agreement.  (3) Compensation from the customer shall not include any fee or similar expense or any fee or amount collected by or paid to the producer that does not exceed an amount established by the commissioner.  (4) Customer means the person signing the application or submission for insurance or the authorized representative of the insured actually negotiating the placement of insurance with the producer. A person shall not be considered a customer for purposes of this section if the person is:  (i) A participant or beneficiary of an employee benefit plan; or  (ii) Covered by a group or blanket insurance policy or group annuity contract sold, solicited or negotiated by the insurance producer or affiliate.  (5) Documented acknowledgement means the customers acknowledgment obtained prior to the customers purchase of insurance.  (d) An insurance producer may satisfy any requirements imposed by this section directly or through an affiliate.  History of Section.P.L. 2005, ch. 113,  1; P.L. 2005, ch. 116,  1. 
 27-2.4-15. Commissions. (a) No insurer or insurance producer shall pay, directly or indirectly, any commission, service fee, brokerage, or other valuable consideration to any person for services as an insurance producer unless the person performing the service held a valid license regarding the class or classes of insurance as to which the service was rendered at the time the service was performed. No person, other than a person properly licensed in accordance with this chapter at the time the person performs services as an insurance producer, shall accept any commissions, service fee, brokerage, or other valuable consideration for the services. Acceptance of the consideration shall constitute operating without a license. This section shall not prevent payment or receipt of renewal or other deferred commissions to or by any person entitled to the payment or receipt under this chapter.  (b) No person shall accept a commission, service fee, brokerage or other valuable consideration for selling, soliciting or negotiating insurance in this state if that person is required to be licensed under this chapter and is not licensed.  (c) Renewal or other deferred commissions may be paid to a person for selling, soliciting or negotiating insurance in this state if the person was required to be licensed under this chapter at the time of the sale, solicitation or negotiation and was licensed at that time.  (d) An insurer or insurance producer may pay or assign commissions, service fees, brokerages or other valuable consideration to an insurance agency or to persons who do not sell, solicit or negotiate insurance in this state, unless the payment would violate  27-4-6 [repealed], 27-6-46 [repealed], 27-8-7, 27-9-44 [repealed], and 27-29-4 of the general laws of this state.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2006, ch. 84,  2; P.L. 2006, ch. 93,  2. 
 27-2.4-16. Notification to insurance commissioner of termination. (a) Termination for cause. An insurer or authorized representative of the insurer that terminates the employment contract or other insurance business relationship with an insurance producer shall notify the insurance commissioner within thirty (30) days following the effective date of the termination, using a format prescribed by the insurance commissioner, if the reason for termination is one of the reasons set forth in  27-2.4-14 or the insurer has knowledge the insurance producer was found by a court, government body, or self-regulatory organization authorized by law to have engaged in any of the activities in  27-2.4-14. Upon the written request of the insurance commissioner, the insurer shall provide additional information, documents, records or other data pertaining to the termination or activity of the insurance producer.  (b) Ongoing notification requirement. The insurer or the authorized representative of the insurer shall promptly notify the insurance commissioner in a format acceptable to the insurance commissioner if, upon further review or investigation, the insurer discovers additional information that would have been reportable to the insurance commissioner in accordance with subsection (a) of this section had the insurer then known of its existence.  (c) Copy of notification to be provided to the insurance producer. (1) Within fifteen (15) days after making the notification required by subsections (a) and (b) of this section, the insurer shall mail a copy of the notification to the insurance producer at his or her last known address. If the insurance producer is terminated for cause for any of the reasons listed in  27-2.4-14, the insurer shall provide a copy of the notification to the insurance producer at his or her last known address by certified mail, return receipt requested, postage prepaid or by overnight delivery using a nationally recognized carrier.  (2) Within thirty (30) days after the insurance producer has received the original or additional notification, the insurance producer may file written comments concerning the substance of the notification with the insurance commissioner. The insurance producer shall, by the same means, simultaneously send a copy of the comments to the reporting insurer, and the comments shall become a part of the insurance commissioners file and accompany every copy of a report distributed or disclosed for any reason about the insurance producer as permitted under subsection (e) of this section.  (d) Immunities. (1) In the absence of actual malice, an insurer, the authorized representative of the insurer, an insurance producer, the insurance commissioner, or an organization of which the insurance commissioner is a member and that compiles the information and makes it available to other insurance commissioners or regulatory or law enforcement agencies shall not be subject to civil liability, except as provided in this section, and a civil cause of action of any nature shall not arise against these entities or their respective agents or employees, except as provided in this section, as a result of any statement or information required by or provided pursuant to this section or any information relating to any statement that may be requested in writing by the insurance commissioner, from an insurer or insurance producer; or a statement by a terminating insurer or insurance producer to an insurer or insurance producer limited solely and exclusively to whether a termination for cause under subsection (a) of this section was reported to the insurance commissioner, provided that the propriety of any termination for cause under subsection (a) of this section is certified in writing by an officer or authorized representative of the insurer or insurance producer terminating the relationship.  (2) In any action brought against a person that may have immunity under this chapter for making any statement required by this section or providing any information relating to any statement that may be requested by the insurance commissioner, the party bringing the action shall plead specifically in any allegation that subdivision (d)(1) of this section does not apply because the person making the statement or providing the information did so with actual malice.  (3) This chapter shall not abrogate or modify any existing statutory or common law privileges or immunities.  (e) Confidentiality. (1) Any documents, materials or other information in the control or possession of the department that is furnished by an insurer, insurance producer or an employee or agent of the insurer or insurance producer acting on behalf of the insurer or insurance producer, or obtained by the insurance commissioner in an investigation pursuant to this section, shall be confidential by law and privileged, shall not be subject to chapter 2 of title 38, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. The insurance commissioner is authorized to use the documents, materials or other information in the furtherance of any regulatory or legal action brought as a part of the insurance commissioners duties.  (2) Neither the insurance commissioner nor any person who received documents, materials or other information while acting under the authority of the insurance commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to this chapter.  (3) In order to assist in the performance of the insurance commissioners duties under this chapter, the insurance commissioner:  (i) May share documents, materials or other information, including the confidential and privileged documents, materials or information subject to this chapter, with other state, federal, and international regulatory agencies, with the NAIC, its affiliates or subsidiaries, and with state, federal, and international law enforcement authorities, provided that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information;  (ii) May receive documents, materials or information, including confidential and privileged documents, materials or information, from the NAIC, its affiliates or subsidiaries and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information;  (iii) May enter into agreements governing sharing and use of information consistent with this subsection;  (iv) No waiver of any applicable privilege or claim of confidentiality in the documents, materials, or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in this chapter;  (v) Nothing in this chapter shall prohibit the insurance commissioner from releasing final, adjudicated actions including for cause terminations that are open to public inspection pursuant to chapter 2 of title 38 to a database or other clearinghouse service maintained by the NAIC, its affiliates or subsidiaries; and  (vi) If the department releases to an unauthorized third party any documents, materials or other information provided to the department pursuant to this section, then the department shall be subject to a fine not to exceed one thousand dollars ($1,000) after a hearing on this violation brought in the Superior Court.  (f) Penalties for failing to report. An insurer, the authorized representative of the insurer, or insurance producer that fails to report as required under the provisions of this section or that is found to have reported with actual malice by a court of competent jurisdiction may, after notice and hearing, have its license or certificate of authority suspended or revoked and may be fined in accordance with  42-14-16.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2013, ch. 31,  2; P.L. 2013, ch. 36,  2; P.L. 2021, ch. 395,  6, effective July 14, 2021. 
 27-2.4-17. Reciprocity. (a) The insurance commissioner shall waive any requirements for a nonresident license applicant with a valid license from his or her home state, except the requirements imposed by  27-2.4-10, if the applicants home state awards nonresident licenses to residents of this state on the same basis.  (b) A nonresident insurance producers satisfaction of his or her home states continuing education requirements for licensed insurance producers shall constitute satisfaction of this states continuing education requirements if the nonresident insurance producers home state recognizes the satisfaction of its continuing education requirements imposed upon insurance producers from this state on the same basis.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2003, ch. 80,  1; P.L. 2003, ch. 81,  1. 
 27-2.4-18. Reporting of actions. (a) An insurance producer shall report to the insurance commissioner any administrative action taken against the insurance producer in another jurisdiction or by another governmental agency in this state within thirty (30) days of the final disposition of the matter. This report shall include a copy of the order, consent to order or other relevant legal documents.  (b) Within thirty (30) days of the initial pre-hearing date, an insurance producer shall report to the insurance commissioner any criminal prosecution of the insurance producer taken in any jurisdiction. The report shall include a copy of the initial complaint filed, the order resulting from the hearing and any other relevant legal documents.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3. 
 27-2.4-19. Fiduciary capacity of insurance producers  Misappropriation as theft. That portion of all premiums or moneys which a licensed insurance producer collects from a policyholder and which is to be paid to an insurance company, its agents, or his or her employer because of the assumption of liability through the issuance of insurance contracts, or which the insurance producer collects from an insurance company or its agents and which is to be paid to a policyholder or claimant under any contract of insurance, shall be held by the insurance producer in a fiduciary capacity and shall not be misappropriated or converted to the insurance producers own use or illegally withheld by the insurance producer. Any insurance producer who converts or misappropriates these funds shall be held guilty of theft and punishable for theft as provided by law. Nothing contained in this section shall be deemed to require any insurance producer to maintain separate bank accounts or deposits for these funds if and so long as these funds held are reasonably ascertainable from the books of account and records of the insurance producer.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3. 
 27-2.4-2. Definitions. The following definitions apply to this chapter: (1) Business entity means a corporation, association, partnership, limited liability company, limited liability partnership, or other legal entity;  (2) Contracted producer report means the annual report that all insurers contracting with insurance producers must provide to the department on or by March 1 listing each insurance producer to whom the insurer paid one hundred dollars ($100) or more in commissions for the preceding calendar year of January 1 to December 31. The department shall prescribe the form and manner of reporting.  (3) Department means the department of business regulation;  (4) Home state means any state or territory of the United States, or the District of Columbia, in which an insurance producer maintains his or her principal place of residence or principal place of business and is licensed to act as an insurance producer;  (5) Insurance means any of the lines of authority set forth in this title;  (6) Insurance commissioner means the director of the department of business regulation or his or her designee;  (7) Insurance producer means a person required to be licensed under the laws of this state to sell, solicit or negotiate insurance;  (8) Insurer means: (i) any person, reciprocal exchange, interinsurer, Lloyds insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance, including insurance producers; (ii) notwithstanding  27-19-2, 27-20-2, 27-20.1-2, 27-20.2-2, 27-20.3-2, and 27-41-22, all of whom shall be engaged in the business of insurance for the purpose of this chapter, nonprofit hospital and/or medical service corporation, a nonprofit dental service corporation, a nonprofit optometric service corporation, a nonprofit legal service corporation, a health maintenance organization as defined in chapter 41 of this title or as defined in chapter 62 of title 42, or any other entity providing a plan of health benefits subject to state insurance regulation; and (iii) an organization that for consideration assumes certain risks for an insured. Insurer organizations may include corporations, stock companies, mutual companies, risk retention groups, reciprocals, captives, Lloyds associations, and government residual plans.  (9) License means a document issued by this states insurance commissioner authorizing a person to act as an insurance producer for the lines of authority specified in the document. The license itself does not create any authority, actual, apparent or inherent, in the holder to represent or commit an insurance carrier;  (10) Limited line credit insurance includes credit life, credit disability, credit property, credit unemployment, involuntary unemployment, mortgage life, mortgage guaranty, mortgage disability, guaranteed automobile protection (gap) insurance, and any other form of insurance offered in connection with an extension of credit that is limited to partially or wholly extinguishing that credit obligation that the insurance commissioner determines should be designated a form of limited line credit insurance;  (11) Limited line credit insurance producer means a person who sells, solicits or negotiates one or more forms of limited line credit insurance coverage to individuals through a master, corporate, group or individual policy;  (12) Limited lines insurance means those lines of insurance that the insurance commissioner deems necessary to recognize for purposes of complying with subsection 27-2.4-10(e);  (13) Limited lines producer means a person authorized by the insurance commissioner to sell, solicit or negotiate limited lines insurance;  (14) NAIC means National Association of Insurance Commissioners;  (15) Negotiate means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning any of the substantive benefits, terms or conditions of the contract, provided that the person engaged in that act either sells insurance or obtains insurance from insurers for purchasers;  (16) Person means an individual;  (17) Resident means a person who either resides in Rhode Island or maintains an office in Rhode Island where the business of producing insurance is transacted and designates Rhode Island as the residence for purposes of licensure;  (18) Sell means to exchange a contract of insurance by any means, for money or its equivalent, on behalf of an insurance company;  (19) Solicit means attempting to sell insurance or asking or urging a person to apply for a particular kind of insurance from a particular company;  (20) Terminate means the cancellation of the relationship between an insurance producer and the insurer or the termination of an insurance producers authority to transact insurance;  (21) Uniform application means the current version of the NAIC uniform application for resident and nonresident insurance producer licensing.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2007, ch. 85,  1; P.L. 2007, ch. 211,  1; P.L. 2008, ch. 144,  1; P.L. 2008, ch. 198,  1; P.L. 2008, ch. 475,  73. 
 27-2.4-20.1. Revocation or modification of property and casualty insurance producers contract  Procedures. (a) No property and casualty insurance company shall cancel the authority of an insurance producer, having a contract with and placing such insurance with more than one property and casualty insurance company, unless the company gives written notice of its intent to cancel that insurance producer at least fourteen (14) months before the proposed effective date of any cancellation. In such case, no company shall allow the license of that insurance producer to expire unless the company gives written notice of its intent to do so at least fourteen (14) months before the proposed effective date of expiration because of cancellation. In addition, no company shall modify a contract with an insurance producer, unless the company gives written notice of its intent to modify the contract of that insurance producer at least one hundred eighty (180) days before the proposed effective date of the modification.  (b) When a property and casualty insurance company cancels the authority of an insurance producer having a contract with and places such insurance with more than one property and casualty insurance company, under the provisions of this section, the company shall continue to renew the expiring policies of the insurance producer who has received notification of cancellation that meets its underwriting guidelines for a period of fourteen (14) months of the issuance of the notice at a rate of compensation to that insurance producer equal to that provided in the expiring contract.  (c) The provisions of subsections (a) and (b) do not apply to a property and casualty insurance producer:  (1) Convicted of a dishonest act related to his or her occupation as an insurance agent; or  (2) Whose license to engage as an insurance producer was revoked; or  (3) Whose company surrendered its license to do business in the state; or  (4) Who is an employee of the insurance company.  History of Section.P.L. 2012, ch. 211,  2; P.L. 2012, ch. 243,  2. 
 27-2.4-20. Revocation or modification of insurance producers contract  Procedures. (a) No company shall cancel the authority of an insurance producer, if the insurance producer is not an employee of the company, and no company shall modify a contract with that insurance producer unless the company gives written notice of its intent to cancel that insurance producer or its intent to modify the contract at least one hundred eighty (180) days before the proposed effective date of any cancellation or at least one hundred eighty (180) days before the proposed effective date of any modification. No company shall allow the license of that insurance producer to expire unless the company gives written notice of its intent to do so at least one hundred eighty (180) days before the proposed effective date of expiration because of cancellation. Except as otherwise provided in this section, any insurance producer receiving notice of cancellation, modification, or expiration may, within sixty (60) days after receipt of the notice, make a written demand for reference to three (3) referees of the question as to whether or not the cancellation, modification, or expiration will affect the renewal, continuation, or replacement of any policies placed with the company through the efforts of the insurance producer, or the services needed by any policyholder doing business with the company as a result of the efforts of the insurance producer, as to justify renewal or continuation of any policies then in effect having been placed with the company by that insurance producer. In the event the referees find that the cancellation, modification, or expiration will affect the renewal, continuation, or replacement of any policies placed with the company through the efforts of the insurance producer, or the services needed by any policyholders doing business with the company as a result of the efforts of the insurance producer, then the referees shall order continuance or renewal of any policies expiring within a period of twelve (12) months of the issuance of the notice, at a rate of compensation to the insurance producer equal to that as provided in the agreement expiring or being cancelled or modified, for one additional policy period equal in length to the most recent policy period of the expiring policy, but in no event for more than one year. The referees shall not order continuance or renewal of any policies if they find that the reason for the cancellation or expiration of the agreement by the company was legitimately based upon one of the following grounds:  (1) The insurance producer was convicted of a dishonest act related to his or her occupation as an insurance agent;  (2) The insurance producers license to engage as an insurance producer was revoked; or  (3) The company surrendered its license to do business in the state.  (b) An insurance producer making a written demand for a reference shall accompany the written demand with the names and addresses of three (3) persons, where the company shall, within fifteen (15) days, notify the insurance producer of its choice of one of the persons to act as one of the referees and at the same time submit the names and addresses of three (3) persons to the insurance producer, who shall, within fifteen (15) days after receiving these names, notify the company in writing of his her choice of one of the persons to act as a second referee. At the same time the insurance producer shall notify the commissioner, the notice to be on a form prescribed by the commissioner, that both the company and insurance producer have chosen referees. Within ten (10) days of the receipt of this notice the commissioner shall appoint a person to serve as third referee, and shall notify that person, the insurance producer, and the company in writing of this appointment. Each person nominated or appointed as a referee shall be a disinterested person, shall be a resident of the state, and shall be willing to act as a referee. Within ten (10) working days of the appointment of the third referee, who shall serve as chairperson, the three (3) referees shall meet, hear evidence, and reduce their decisions to writing and sign it, and shall deliver a copy of the decision to the insurance producer, to the company, and to the commissioner. In the event any company receiving a written demand for a reference fails to comply with the provisions of this subsection, then the insurance producer shall have the authority to renew or continue any policies placed with that company through the efforts of the insurance producer expiring within a period of thirteen (13) months from the date of the notice of cancellation, modification, or expiration of the agreement, at a rate of compensation to the insurance producer equal to that as provided in the agreement expiring or being cancelled or modified, for one additional policy period equal in length to the most recent policy period of the expiring policy, but in no event for more than one year.  (c) Any insurance company and any insurance producer may by written contract agree to modify the provisions of subsections (a) and (b) of this section other than the requirement of a one hundred eighty (180) day notice in the event of cancellation or a one hundred eighty (180) day notice in the event of modification of a contract or of intent to allow the expiration of a license, by provisions presented to and approved by the commissioner which he or she finds after due hearing and investigation will adequately protect both the right of the policyholder to a continuance of insurance and the services of any insurance producer of his or her own choosing and the right of the insurance producer to fair compensation for the insurance placed with a company as a result of the insurance producers efforts. The commissioner may make reasonable rules of general application regarding these modified provisions.  (d) The decision of the referees may provide for the renewal or continuance of any or all policies expiring within a period of twelve (12) months of the issuance of any notice, at a rate of compensation to the insurance producer equal to that as provided in the agreement expiring or being cancelled or modified, for one additional policy period equal in length to the most recent policy period of the expiring policy, but in no event for more than one year. The decision of the referees may also provide for the continuance of previous contractual provisions, if the referees, or a majority of them, find that the decision will best protect the right of a policyholder to a continuance of insurance and the services of an insurance producer of his or her own choosing and the right of any insurance producer to compensation for the insurance placed with a company as a result of his or her efforts, giving due consideration to the possibility the affected insurance producer has of obtaining similar coverage for policyholders affected from other companies at reasonable compensation. The decisions rendered in accordance with the provisions of this section providing for reference shall be binding on all companies and insurance producer affected by those decisions. If a decision orders the renewal or continuance of any policies, policyholders and the affected insurance producer shall be entitled in all respects to the same services and practices as were in effect prior to reference insofar as amounts and types of coverage, credit terms, commissions paid to the insurance producer, and insurance producer services are also continued.  (e) All policies expiring within twelve (12) months of the notice may be renewed for the policy periods as provided in subsection (d) of this section, but no insurance producer or company relying on this section shall again refer the same issue to referees. Where other provisions of the general laws require notice to policyholders before nonrenewal of any coverage, the company shall, at the request of the insurance producer who is unable to replace any policy which has been renewed for one or more policy periods in accordance with this section, comply with those provisions of law.  (f) An insurance producer initiating reference under this section and the company receiving written demand shall each be liable for the payment of the reasonable charges and expenses of his or her nominee for referee and one-half (12) of the compensation for the reasonable charges and expenses of the third referee. The third referee shall upon the execution of the decision furnish the insurance producer and the company with a written statement specifying in detail his or her charges for compensation and expenses. The insurance producer or the company, if aggrieved by these charges, may petition the commissioner for review. The petition shall set forth with particularity the specific item or charges in dispute. The commissioner shall, within ten (10) days of receipt of the petition, notify the interested parties of the date established for a hearing on the petition and, after the hearing, the commissioner shall approve or disapprove the charges in whole or in part, his or her findings and decisions shall be final and conclusive.  (g) In the event a property and casualty insurance producer has a contract with and places such insurance with more than one property and casualty company, then said insurance producer and the company that contracts to provide such insurance to the insurance producer, shall not be subject to this section but shall be subject to the provisions of  27-2.4-20.1. However, any insurance producer who, by contractual agreement, either represents only one company or group of affiliated insurance companies or is required by contract to submit risks to a specified company or group of affiliated insurance companies prior to submitting them to other insurance companies, then those contracts shall remain subject only to  27-2.4-20.  (h) This section shall not apply to agents of title insurers as defined in chapter 2.6 of this title, or to insurance producers who are employees of the insurance company.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2002, ch. 292,  10; P.L. 2012, ch. 211,  1; P.L. 2012, ch. 243,  1. 
 27-2.4-21. Regulations. The insurance commissioner may, in accordance with Rhode Island law, promulgate reasonable rules and regulations as are necessary or proper to carry out the purposes of this chapter including, but not limited to, prelicensing requirements for applicants for an insurance producer license.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2004, ch. 40,  3; P.L. 2004, ch. 43,  3. 
 27-2.4-22. Severability. If any provisions of this chapter, or the application of a provision to any person or circumstances, shall be held invalid, the remainder of the chapter, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3. 
 27-2.4-23. Errors and omissions insurance required of resident insurance producers. (a) All holders of resident insurance producer licenses issued by the insurance division of the department of business regulation of the state of Rhode Island shall, as a condition for obtaining and retaining such license, carry and maintain errors and omissions insurance covering the business activities contemplated, in an amount not less than two hundred fifty thousand dollars ($250,000) per claim and five hundred thousand dollars ($500,000) annual aggregate limit. Authorized insurance producers of a licensed firm may meet the requirements of this section with a policy in the name of the licensed firm insuring each licensee employed by, or associated with, the firm.  (b) Licensees shall maintain records and keep copies of all errors and omissions policies issued under this subsection.  (c) Failure to carry and maintain errors and omissions insurance may result in the suspension or revocation of the resident insurance producer license.  (d) This section shall not apply to insurance producers that are employed in that capacity directly by insurance companies.  (e) The department of business regulation may grant a written exemption to any producer who shows that he/she is not engaged in the sale, solicitation or negotiation of insurance. Such exemption shall only be valid while the insurance producer is not engaged in the sale, solicitation or negotiation of insurance.  History of Section.P.L. 2006, ch. 92,  1; P.L. 2006, ch. 154,  1; P.L. 2007, ch. 85,  1; P.L. 2007, ch. 211,  1. 
 27-2.4-3. License required. A person shall not sell, solicit or negotiate insurance in this state for any class or classes of insurance unless the person is licensed for that line of authority in accordance with this chapter.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3. 
 27-2.4-4. Fees. (a) Fees required by this chapter shall be as follows:  (1) Initial insurance producer license: $ 55.00;  (2) Annual insurance producer renewal: $ 55.00; and  (3) Annual contracted producer report: $ 30.00 (per producer).  (b) The insurance commissioner may by rule or regulation specify fees for letters of certification, clearance letters, duplicate licenses, and any other documents as well as fees for services and documents provided by or on behalf of the department that are reasonably determined by the insurance commissioner.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2002, ch. 65, art. 13,  24; P.L. 2007, ch. 85,  1; P.L. 2007, ch. 211,  1; P.L. 2008, ch. 144,  1; P.L. 2008, ch. 198,  1. 
 27-2.4-5. Exceptions to licensing. (a) Nothing in this chapter shall be construed to require an insurer to obtain an insurance producer license. In this section, the term insurer does not include an insurers officers, directors, employees, subsidiaries or affiliates.  (b) A license as an insurance producer shall not be required of the following:  (1) An officer, director or employee of an insurer or of an insurance producer, provided that the officer, director or employee does not receive any commission or fees on policies written or sold to insure risks residing, located or to be performed in this state; and:  (i) The officer, director or employees activities are executive, administrative, managerial, clerical or a combination of these, and are only indirectly related to the sale, solicitation or negotiation of insurance; or  (ii) The officer, director or employees function relates to underwriting, loss control, inspection or the processing, adjusting, investigating or settling of a claim on a contract of insurance; or  (2) The officer, director or employee is acting in the capacity of a special agent or agency supervisor assisting insurance producers where the persons activities are limited to providing technical advice and assistance to licensed insurance producers and do not include the sale, solicitation or negotiation of insurance;  (3) A person who secures and furnishes information: (i) for the purpose of group life insurance, group property and casualty insurance, group annuities, group or blanket accident and health insurance; or (ii) for the purpose of enrolling individuals under plans, issuing certificates under plans or assisting in administering plans; or (iii) performs administrative services related to mass marketed property and casualty insurance; where no commission or fee is paid to the person for the service;  (4) An employer or association or its officers, directors, employees, or the trustees of an employee trust plan, to the extent that the employers, officers, employees, director or trustees are engaged in the administration or operation of a program of employee benefits for the employers or associations own employees or the employees of its subsidiaries or affiliates, which program involves the use of insurance issued by an insurer, as long as the employers, associations, officers, directors, employees or trustees are not in any manner compensated, directly or indirectly, by the company issuing the contracts;  (5) Employees of insurers or organizations employed by insurers who are engaging in the inspection, rating or classification of risks, or in the supervision of the training of insurance producers and who are not individually engaged in the sale, solicitation or negotiation of insurance;  (6) A person whose activities in this state are limited to advertising without the intent to solicit insurance in this state through communications in printed publications or other forms of electronic mass media whose distribution is not limited to residents of the state, provided that the person does not sell, solicit or negotiate insurance that would insure risks residing, located or to be performed in this state;  (7) A person who is not a resident of this state who sells, solicits or negotiates a contract of insurance for commercial property and casualty risks to an insured with risks located in more than one state insured under that contract, provided that that person is licensed as an insurance producer to sell, solicit or negotiate that insurance in the state where the insured maintains its principal place of business and the contract of insurance insurers risks located in that state;  (8) A salaried full-time employee who counsels or advises his or her employer relative to the insurance interests of the employer or of the subsidiaries or business affiliates of the employer provided that the employee does not sell or solicit insurance or receive a commission;  (9) A person engaged or employed as an attorney licensed to practice law in Rhode Island and provided those persons do not sell, solicit or negotiate insurance;  (10) An actuary or a certified public accountant engaged or employed in a consulting capacity performing duties incidental to that position and provided those persons do not sell, solicit or negotiate insurance;  (11) A licensed public adjuster acting within the scope of an applicable license and provided those persons do not sell, solicit or negotiate insurance; or  (12) Rental car companies and their employees principally engaged in the rental of motor vehicles and which offer in connection with and incidental to the rental of those motor vehicles various optional insurance coverage during the term of the rental agreement which shall be no more than sixty (60) days.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2003, ch. 411,  1; P.L. 2008, ch. 371,  1. 
 27-2.4-6. Order to cease unlicensed activities. (a) If the department has reason to believe that any person is conducting any activities requiring licensure under this chapter without obtaining a license, or who after the denial, suspension or revocation of a license conducts any activities requiring licensure under this chapter, the department may issue its order to that person commanding them to appear before the department at a hearing after issuance of that order to show cause why the department should not issue an order to that person to cease and desist from the violations of the provisions of this chapter. The order to show cause may be served on any person named in the order in the same manner that summons in a civil action may be served, or by mailing a copy of the order, certified mail, return receipt requested, to that person at any address at which he or she has done business or at which he or she lives. If upon that hearing the department is satisfied that the person is in fact violating any provision of this chapter, then the department may order that person, in writing, to cease and desist from that violation. All hearings shall be governed in accordance with the Administrative Procedures Act, chapter 35 of title 42. If that person fails to comply with an order of the department after being afforded a hearing, the superior court in the county where the insurance transaction took place has jurisdiction upon complaint of the department to restrain and enjoin that person from violating this chapter.  (b) Any person who violates this section by operating without a license shall be guilty of a misdemeanor and fined an amount not exceeding one thousand dollars ($1,000) or imprisoned for a term not exceeding one year, or both. The matter shall be referred to the department of attorney general.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2007, ch. 85,  1; P.L. 2007, ch. 211,  1. 
 27-2.4-7. Application for examination. (a) A resident individual applying for an insurance producer license shall pass a written examination unless exempt pursuant to  27-2.4-11. The examination shall test the knowledge of the individual concerning the lines of authority for which application is made, the duties and responsibilities of an insurance producer and the insurance laws and regulations of this state. Examinations required by this section shall be developed and conducted under rules and regulations prescribed by the insurance commissioner.  (b) The insurance commissioner may make arrangements, including contracting with an outside testing service, for administering examinations and collecting a nonrefundable fee.  (c) Each individual applying for an examination shall remit a nonrefundable fee as prescribed by the department pursuant to rule and regulation.  (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.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3. 
 27-2.4-8. Application for license. (a) A person applying for a resident insurance producer license shall make application to the insurance commissioner on the uniform application and declare under penalty of refusal, suspension or revocation of the license that the statements made in the application are true, correct and complete to the best of the individuals knowledge and belief. Before approving the application, the insurance commissioner shall find that the individual:  (1) Is at least eighteen (18) years of age;  (2) Has not committed any act that is a ground for denial, suspension or revocation set forth in  27-2.4-14;  (3) Has paid the fees set forth in  27-2.4-4; and  (4) Has successfully passed the examinations for the lines of authority for which the person has applied.  (b) A Rhode Island resident business entity acting as an insurance producer may elect to obtain an insurance producer license. Application shall be made using the uniform business entity application. Prior to approving the application, the commissioner shall find both of the following:  (1) The business entity has paid the appropriate fees.  (2) The business entity has designated a licensed producer responsible for the business entitys compliance with the insurance laws and rules of this state.  (c) The insurance commissioner may require any documents reasonably necessary to verify the information contained in an application.  (d) Each insurer that sells, solicits or negotiates any form of limited line credit insurance shall provide to each individual whose duties will include selling, soliciting or negotiating limited line credit insurance a program of instruction that may be approved by the insurance commissioner.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2007, ch. 85,  1; P.L. 2007, ch. 211,  1; P.L. 2008, ch. 144,  1; P.L. 2008, ch. 198,  1; P.L. 2011, ch. 18,  1; P.L. 2011, ch. 25,  1. 
 27-2.4-9. License. (a) Unless denied licensure pursuant to  27-2.4-14, persons who have met the requirements of  27-2.4-7 and 27-2.4-8 shall be issued an insurance producer license. An insurance producer may receive qualification for a license in one or more of the following lines of authority:  (1) Life insurance coverage on human lives including benefits of endowment and annuities, and may include benefits in the event of death or dismemberment by accident and benefits for disability income;  (2) Accident and health or sickness insurance coverage for sickness, bodily injury or accidental death and may include benefits for disability income;  (3) Property insurance coverage for the direct or consequential loss or damage to property of every kind;  (4) Casualty insurance coverage against legal liability, including that for death, injury or disability or damage to real or personal property;  (5) Variable life and variable annuity products insurance coverage provided under variable life insurance contracts and variable annuities;  (6) Personal lines-property and casualty insurance coverage sold to individuals and families for primary noncommercial purposes;  (7) Credit-limited line credit insurance;  (8) Any other line of insurance permitted under state laws or regulations.  (b) An insurance producer license shall remain in effect unless revoked or suspended as long as the fee set forth in  27-2.4-4 is paid and education requirements for resident individual insurance producers are met by the license renewal due date.  (c) An individual insurance producer who allows his or her license to expire may, within twelve (12) months from the due date of the renewal fee, reinstate this license without the necessity of passing a written examination. A penalty in the amount of double the unpaid renewal fee shall be required for any renewal fee received after the due date.  (d) A licensed insurance producer who is unable to comply with license renewal procedures due to military service or some other extenuating circumstance (e.g., a long-term medical disability) may request a waiver of those procedures. The insurance producer may also request a waiver of any examination requirement or any other fine or sanction imposed for failure to comply with renewal procedures.  (e) The license shall contain the insurance producers name, address, license number, license type, lines of authority, and any other information the insurance commissioner deems necessary.  (f) Insurance producers shall inform the insurance commissioner by any means acceptable to the insurance commissioner of a change in legal name or address within thirty (30) days of the change. Failure to timely inform the insurance commissioner of a change in legal name or address may result in a penalty to be determined by the insurance commissioner.  (g) In order to assist in the performance of the insurance commissioners duties, the insurance commissioner may contract with non-government entities, including the NAIC or any affiliates or subsidiaries which the NAIC oversees, to perform any ministerial functions, including the collection of fees, related to insurance producer licensing that the insurance commissioner and the non-governmental entity may deem appropriate.  History of Section.P.L. 2001, ch. 14,  3; P.L. 2001, ch. 15,  3; P.L. 2006, ch. 84,  2; P.L. 2006, ch. 93,  2. 
 27-2.5-1. Short title. This chapter may be cited as the Interstate Compact. History of Section.P.L. 2004, ch. 463,  1. 
 27-2.5-2. Compact enacted. The interstate compact on insurance product regulation is hereby enacted into law and entered into with all other jurisdictions legally joining therein in form substantially as follows:   This act intended to help states join together to establish an interstate compact to regulate designated insurance products.  Pursuant to terms and conditions of this act, the state of Rhode Island seeks to join with other states and establish the Interstate Insurance Product Regulation Compact, and thus become a member of the Interstate Insurance Product Regulation Commission. The Rhode Island Insurance Commissioner is hereby designated to serve as the representative of this state to the commission.  Interstate Insurance Product Regulation Compact     The purposes of this compact are, through means of joint and cooperative action among the compacting states:   (1) To promote and protect the interest of consumers of individual and group annuity, life insurance, disability income and long-term care insurance products;  (2) To develop uniform standards for insurance products covered under the compact;  (3) To establish a central clearinghouse to receive and provide prompt review of insurance products covered under the compact and, in certain cases, advertisements related thereto, submitted by insurers authorized to do business in one or more compacting states;  (4) To give appropriate regulatory approval to those product filings and advertisements satisfying the applicable uniform standard;  (5) To improve coordination of regulatory resources and expertise between state insurance departments regarding the setting of uniform standards and review of insurance products covered under the compact;  (6) To create the Interstate insurance product regulation commission; and  (7) To perform these and such other related functions as may be consistent with the state regulation of the business of insurance.     For purposes of this compact:  (1) Advertisement means any material designed to create public interest in a product, or induce the public to purchase, increase, modify, reinstate, borrow on, surrender, replace or retain a policy, as more specifically defined in the rules and operating procedures of the commission.  (2) Bylaws mean those bylaws established by the commission for its governance, or for directing or controlling the commissions actions or conduct.  (3) Compacting state means any state which has enacted this compact legislation and which has not withdrawn pursuant to Article XIV, Section 1, or been terminated pursuant to Article XIV, Section 2.  (4) Commission means the Interstate Insurance Product Regulation Commission established by this compact.  (5) Commissioner means the chief insurance regulatory official of a state including, but not limited to, commissioner, superintendent, director or administrator.  (6) Domiciliary state means the state in which an insurer is incorporated or organized; or, in the case of an alien insurer, its state of entry.  (7) Insurer means any entity licensed by a state to issue contracts of insurance for any of the lines of insurance covered by this act.  (8) Member means the person chosen by a compacting state as its representative to the commission, or his or her designee.  (9) Noncompacting state means any state which is not at the time a compacting state.  (10) Operating procedures mean procedures promulgated by the commission implementing a rule, uniformed standard or a provision of this compact.  (11) Product means the form of a policy or contract, including any application endorsement, or related from which is attached to and made a part of the policy or contract, and any evidence of coverage of certificate, for an individual or group annuity, life insurance, disability income or long-term care insurance product that an insurer is authorized to issue.  (12) Rule means a statement of general or particular applicability and future effect promulgated by the commission, including a uniform standard developed pursuant to Article VII of this compact, designed to implement, interpret, or prescribe law or policy or describing the organization, procedure, or practice requirements of the commission, which shall have the force and effect of law in the compacting states.  (13) State means any state, district or territory of the United States of America.  (14) Third-party filer means an entity that submits a product filing to the commission on behalf of an insurer.  (15) Uniform standard means a standard adopted by the commission for a product line, pursuant to Article VII of this compact, and shall include all of the product requirements in aggregate; provided, that each uniform standard shall be construed, whether express or implied, to prohibit the use of any inconsistent, misleading or ambiguous provisions in a product and the form of the product made available to the public shall not be unfair, inequitable or against public policy as determined by the commission.      (1) The compacting states hereby create and establish a joint public agency known as the Interstate Insurance Product Regulation Commission. Pursuant to Article IV, the commission will have the power to develop uniform standards for product lines, receive and provide prompt review of products filed therewith, and give approval to those product filings satisfying applicable uniform standards; provided, it is not intended for the commission to be the exclusive entity for receipt and review of insurance product filings. Nothing herein shall prohibit any insurer from filing its product in any state wherein the insurer is licensed to conduct the business of insurance; and any such filing shall be subject to the laws of the state where filed.  (2) The commission is a body corporate and politic, and an instrumentality of the compacting states.  (3) The commission is a not-for-profit entity, separate and distinct from the individual compacting states.  (4) The commission is solely responsible for its liabilities except as otherwise specifically provided in this compact.  (5) Venue is proper and judicial proceedings by or against the commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of the commission is located.     The commission shall have the following powers:  (1) To promulgate rules, pursuant to Article VII of this compact, which shall have the force and effect of law and shall be binding in the compacting states to the extent and in the manner provided in this compact;  (2) To exercise its rule-making authority and establish reasonable uniform standards for products covered under the compact, and advertisement related thereto, which shall have the force and effect of law and shall be binding in the compacting states, but only for those products filed with the commission, provided, that a compacting state shall have the right to opt out of such uniform standard pursuant to Article VII, to the extent and in the manner provided in this compact and, provided, further, that any uniform standard established by the commission for long-term care insurance products may provide the same or greater protections for consumers as, but shall not provide less than, those protections set forth in the National Association of Insurance Commissioners Long-Term Care Insurance Model Act and Long-Term Care Insurance Model Regulation, respectively, adopted as of 2001. The commission shall consider whether any subsequent amendments to the NAIC Long-Term Care Insurance Model Act or Long-Term Care Insurance Model Regulation adopted by the NAIC require amending of the uniform standards established by the commission for long-term care insurance products;  (3) To receive and review in an expeditious manner products filed with the commission, and rate filings for disability income and long-term care insurance products, and give approval of those products and rate filings that satisfy the applicable uniform standard, where such approval shall have the force and effect of law and be binding on the compacting states to the extent and in the manner provided in the compact;  (4) To receive and review in an expeditious manner advertisement relating to long-term care insurance products for which uniform standards have been adopted by the commission, and give approval to all advertisement that satisfies the applicable uniform standard. For any product covered under this compact, other than long-term care insurance products, the commission shall have the authority to require an insurer to submit all or any part of its advertisement with respect to that product for review or approval prior to use, if the commission determines that the nature of the product is such that an advertisement of the product could have the capacity or tendency to mislead the public. The actions of commission as provided in this section shall have the force and effect of law and shall be binding in the compacting states to the extent and in the manner provided in the compact;  (5) To exercise its rule-making authority and designate products and advertisement that may be subject to a self-certification process without the need for prior approval by the commission;  (6) To promulgate operating procedures, pursuant to Article VII of the compact, which shall be binding in the compacting states to the extent and in the manner provided in this compact;  (7) To bring and prosecute legal proceedings or actions in its name as the commission; provided, that the standing of any state insurance department to sue or be sued under applicable law shall not be affected;  (8) To issue subpoenas requiring the attendance and testimony of witnesses and the production of evidence;  (9) To establish and maintain offices;  (10) To purchase and maintain insurance and bonds;  (11) To borrow, accept or contract for services of personnel, including, but not limited to, employees of a compacting state;  (12) To hire employees, professionals or specialists, and elect or appoint officers, and to fix their compensation, define their duties and give them appropriate authority to carry out the purposes of the compact, and determine their qualifications; and to establish the commissions personnel policies and programs relating to, among other things, conflicts of interest, rates of compensation and qualifications of personnel;  (13) To accept any and all appropriate donations and grants of money, equipment, supplies, materials, and services, and to receive, utilize and dispose of the same; provided, that at all times the commission shall strive to avoid any appearance of impropriety;  (14) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold, improve or use, any property, real, personal or mixed; provided, that at all times the commission shall strive to avoid any appearance of impropriety;  (15) To sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of any property, real, personal or mixed;  (16) To remit filing fees to compacting states as may be set forth in the bylaws, rules or operating procedures;  (17) To enforce compliance by compacting states with rules, uniform standards, operating procedures and bylaws;  (18) To provide for dispute resolution among compacting states;  (19) To advise compacting states on issues relating to insurers domiciled or doing business in noncompacting jurisdictions, consistent with the purposes of the compact;  (20) To provide advice and training to those personnel in state insurance departments responsible for product review, and to be a resource for state insurance departments;  (21) To establish a budget and make expenditures;  (22) To borrow money;  (23) To appoint committees including advisory committees comprising members, state insurance regulators, state legislators or their representatives, insurance industry and consumer representatives, and such other interested persons as may be designated in the bylaws;  (24) To provide and receive information from, and to cooperate with law enforcement agencies;  (25) To adopt and use a corporate seal; and  (26) To perform such other functions as may be necessary or appropriate to achieve the purposes of this compact consistent with the state regulation of the business of insurance.      (1) Membership, voting and bylaws.  (a) Each compacting state shall have [be] limited to one member. Each member shall be qualified to serve in that capacity pursuant to applicable law of the compacting state. Any member may be removed or suspended from office as provided by the law of the state from which he or she shall be appointed. Any vacancy occurring in the commission shall be filled in accordance with the laws of the compacting state wherein the vacancy exists. Nothing herein shall be construed to affect the manner in which a compacting state determines the election or appointment and qualification of its own commissioner.  (b) Each member shall be entitled to one vote and shall have an opportunity to participate in the governance of the commission in accordance with the bylaws. Notwithstanding any provision herein to the contrary, no action of the commission with respect to the promulgation of a uniform standard shall be effective unless two-thirds (23) of the members vote in favor thereof.  (c) The commission shall, by a majority of the members, prescribe bylaws to govern its conduct as may be necessary or appropriate to carry out the purposes, and exercise the powers, of the compact, including, but not limited to:  (i) Establishing the fiscal year of the commission;  (ii) Providing reasonable procedures for appointing and electing members, as well as holding meetings, of the management committee;  (iii) Providing reasonable standards and procedures: (i) for the establishment and meetings of other committees; and (ii) governing any general or specific delegation of any authority or function of the commission;  (iv) Providing reasonable procedures for calling and conducting meetings of the commission that consists of a majority of commission members, ensuring reasonable advance notice of each such meeting and providing for the rights of citizens to attend such meeting with enumerated exceptions designed to protect the publics interest, the privacy of individuals, and insurers proprietary information, including trade secrets. The commission may meet in camera only after a majority of the entire membership votes to close a meeting en toto or in part. As soon as practicable, the commission must make public: (i) a copy of the vote to close the meeting revealing the vote of each member with no proxy votes allowed; and (ii) votes taken during such meeting;  (v) Establishing the titles, duties and authority and reasonable procedures for the election of the officers of the commission;  (vi) Providing reasonable standards and procedures for the establishment of the personnel policies and programs of the commission. Notwithstanding any civil service or other similar laws of any compacting state, the bylaws shall exclusively govern the personnel policies and programs of the commission;  (vii) Promulgating a code of ethics to address permissible and prohibited activities of commission members and employees; and  (viii) Providing a mechanism for winding up the operations of the commission and the equitable disposition of any surplus funds that may exist after the termination of the compact after the payment and/or reserving of all of its debts and obligations.  (d) The commission shall publish its bylaws in a convenient form and file a copy thereof and a copy of any amendment thereto, with the appropriate agency or officer in each of the compacting states.  (2) Management committee, officers and personnel.  (a) A management committee comprising no more than fourteen (14) members shall be established as follows:  (i) One member from each of the six (6) compacting states with the largest premium volume for individual and group annuities, life, disability income and long-term care insurance products, determined from the records of the NAIC for the prior year;  (ii) Four (4) members from those compacting states with at least two percent (2%) of the market based on the premium volume described above, other than the six (6) compacting states with the largest premium volume, selected on a rotating basis as provided in the bylaws, and;  (iii) Four (4) members from those compacting states with less than two percent (2%) of the market, based on the premium volume described above, with one selected form [from] each of the four (4) zone regions of the NAIC as provided in the bylaws.  (b) The management committee shall have such authority and duties as may be set forth in the bylaws, including, but not limited to:  (i) Managing the affairs of the commission in a manner consistent with the bylaws and purposes of the commission;  (ii) Establishing and overseeing an organizational structure within, and appropriate procedures for, the commission to provide for the creation of uniform standards and other rules, receipt and review of product filings, administrative and technical support functions, review of decisions regarding the disapproval of a product filing, and the review of elections made by a compacting state to opt out of a uniform standard; provided, that a uniform standard shall not be submitted to the compacting states for adoption unless approved by two-thirds (23) of the members of the management committee;  (iii) Overseeing the offices of the commission; and  (iv) planning, implementing, and coordinating communications and activities with other state, federal and local government organizations in order to advance the goals of the commission.  (c) The commission shall elect annually officers from the management committee, with each having such authority and duties, as may be specified in the bylaws.  (d) The management committee may, subject to the approval of the commission, appoint or retain an executive director for such period, upon such terms and conditions and for such compensation as the commission may deem appropriate. The executive director shall serve as secretary to the commission, but shall not be a member of the commission. The executive director shall hire and supervise such other staff as may be authorized by the commission.  (3) Legislative and advisory committees.  (a) A legislative committee comprising state legislators or their designees shall be established to monitor the operations of, and make recommendations to, the commission, including the management committee; provided, that the manner of selection and term of any legislative committee member shall be as set forth in the bylaws. Prior to the adoption by the commission of any uniform standard, revision to the bylaws, annual budget or other significant matter as may be provided in the bylaws, the management committee shall consult with and report to the legislative committee.  (b) The commission shall establish two (2) advisory committees, one of which shall comprise consume [consumer] representatives independent of the insurance industry, and the other comprising insurance industry representatives.  (c) The commission may establish additional advisory committees as its bylaws may provide for the carrying out of its functions.  (4) Corporate records of the commission.  The commission shall maintain its corporate books and records in accordance with the bylaws.  (5) Qualified immunity, defense and indemnification.  (a) The members, officers, executive director, employees and representatives of the commission shall be immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities; provided, that nothing in this paragraph shall be construed to protect any such person from suit and/or liability for any damage, loss, injury or liability caused by the intentional or willful and wanton misconduct of that person.  (b) The commission shall defend any member, officer, executive director, employee or representative of the commission in any civil action seeking to impose liability arising out of any actual or alleged act, error or omission that occurred within the scope of commission employment, duties or responsibilities, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities; provided, that nothing herein shall be construed to prohibit that person from retaining his or her own counsel; and provided, further, that the actual or alleged act, error or omission did not result form [from] that persons intentional or willful and wanton misconduct.  (c) The commission shall indemnify and hold harmless any member, officer, executive director, employee or representative of the commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error or omission that occurred within the scope of commission employment, duties or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities, provided, that the actual or alleged act, error or omission did not result from the intentional or willful and wanton misconduct of that person.      (1) The commission shall meet and take such actions as are consistent with the provisions of this compact and the bylaws.  (2) Each member of the commission shall have the right and power to cast a vote to which that compacting state is entitle [entitled] and to participate in the business and affairs of the commission. A member shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for members participation in meetings by telephone or other means of communication.  (3) The commission shall meet at least once during each calendar year. Additional meetings shall be held as set forth in the bylaws.      (1) Rulemaking authority. The commission shall promulgate reasonable rules, including uniform standards, and operating procedures in order to effectively and efficiently achieve the purposes of this compact. Notwithstanding the foregoing, in the event the commission exercises its rulemaking authority in a manner that is beyond the scope of the purposes of this act, or the powers granted hereunder, then such an action by the commission shall be invalid and have no force and effect.  (2) Rulemaking procedure. Rules and operating procedures shall be made pursuant to a rulemaking process that conforms to the Model State Administrative Procedure Act of 1981 as amended, as may be appropriate to the operations of the commission. Before the commission adopts a uniform standard, the commission shall give written notice to the relevant state legislative committee(s) in each compacting state responsible for insurance issues of its intention to adopt the uniform standard. The commission in adopting a uniform standard shall consider fully all submitted materials and issue a concise explanation of its decision.  (3) Effective date and opt out of a uniform standard. A uniform standard shall become effective ninety (90) days after its promulgation by the commission or such later date as the commission may determine; provided, however, that a compacting state may opt out of a uniform standard as provided in this Article. Opt out shall be defined as any action by a compacting state to decline to adopt or participate in a promulgated uniform standard. All other rules and operating procedures, and amendments thereto, shall become effective as of the date specified in each rule, operating procedure or amendment.  (4) Opt out procedure. A compacting state may opt out of a uniform standard, either by legislation or regulation duly promulgated by the insurance department under the Compacting States Administrative Procedure Act. If a compacting state elects to opt out of a uniform standard by regulation, it must: (a) give written notice to the commission no later than ten (10) business days after the uniform standard is promulgated, or at the time the state becomes a compacting state; and (b) find that the uniform standard does not provide reasonable protections to the citizens of the state, given the conditions in the state. The commissioner shall make specific findings of fact and conclusions of law, based on a preponderance of the evidence, detailing the conditions in the state which warrant a departure from the uniform standard and determining that the uniform standard would not reasonably protect the citizens of the state. The commissioner must consider and balance the following factors and find that the conditions in the state and needs of the citizens of the state outweigh: (i) the intent of the legislature to participate in, and the benefits of, an interstate agreement to establish national uniform consumer protections for the products subject to this act; and (ii) the presumption that a uniform standard adopted by the commission provides reasonable protections to consumers of the relevant product.  Notwithstanding the foregoing, a compacting state, may, at the time of its enactment of this compact, prospectively opt out of all uniform standards involving long-term care insurance products by expressly providing for such opt out in the enacted compact, and such an opt out shall not be treated as a material variance in the offer or acceptance of any state to participate in this compact. Such an opt out shall be effective at the time of enactment of this compact by the compacting state and shall apply to all existing uniform standards involving long-term care insurance products and those subsequently promulgated.  (5) Effect of opt out. If a compacting state elects to opt out of a uniform standard, the uniform standard shall remain applicable in the compacting state electing to opt out until such time the opt out legislation is enacted into law or the regulation opting out becomes effective.  Once the opt out of a uniform standard by a compacting state becomes effective as provided under the laws of that state, the uniform standard shall have no further force and effect in that state unless and until the legislation or regulation implementing the opt out is repealed or otherwise becomes ineffective under the laws of the state. If a compacting state opts out of a uniform standard after the uniform standard has been made effective in that state, the opt out shall have the same prospective effect as provided under Article XIV for withdrawals.  (6) Stay of uniform standard. If a compacting state has formally initiated the process of opting out of a uniform standard by regulation, and while the regulatory opt out is pending, the compacting state may petition the commission, at least fifteen (15) days before the effective date of the uniform standard, to stay the effectiveness of the uniform standard in that state. The commission may grant a stay if it determines the regulatory opt out is being pursued in a reasonable manner and there is a likelihood of success. If a stay is granted or extended by the commission, the stay or extension thereof may postpone the effective date by up to ninety (90) days, unless affirmatively extended by the commission; provided, a stay may not be permitted to remain in effect for more than one (1) year unless the compacting state can show extraordinary circumstances which warrant a continuance of the stay, including, but not limited to, the existence of a legal challenge which prevents the compacting state from opting out. A stay may be terminated by the commission upon notice that the rulemaking process has been terminated.  (7) Not later than thirty (30) days after a rule or operating procedure is promulgated any person may file a petition for judicial review of the rule or operating procedure; provided, that the filing of such a petition shall not stay or otherwise prevent the rule or operating procedure from becoming effective unless the court finds that the petitioner has a substantial likelihood of success. The court shall give deference to the actions of the commission consistent with applicable law and shall not find the rule or operating procedure to be unlawful if the rule or operating procedure represents a reasonable exercise of the commissions authority.      (1) The commission shall promulgate rules establishing conditions and procedures for public inspection and copying of its information and official records, except such information and records involving the privacy of individuals and insurers trade secrets. The commission may promulgate additional rules under which it may make available to federal and state agencies including law enforcement agencies, records and information otherwise exempt from disclosure and may enter into agreements with such agencies to receive or exchange information or records subject to nondisclosure and confidentiality provisions.  (2) Except as to privileged records, data and information, the laws of any compacting state pertaining to confidentiality or nondisclosure shall not relieve any compacting state commissioner of the duty to disclose any relevant records, data or information to the commission; provided, that disclosure to the commission shall not be deemed to waive or otherwise affect any confidentiality requirement; and further provided, that, except as otherwise expressly provided in this act, the commission shall not be subject to the compacting states laws pertaining to confidentiality and nondisclosure with respect to records, data and information in its possession. Confidential information of the commission shall remain confidential after such information is provided to any commissioner.  (3) The commission shall monitor compacting states for compliance with duly adopted bylaws, rules, including uniform standards, and operating procedures. The commission shall notify any noncomplying compacting state in writing of its noncompliance with commission bylaws, rules or operating procedures. If a noncomplying compacting state fails to remedy its noncompliance within the time specified in the notice of noncompliance, the compacting state shall be deemed to be in default as set forth in Article XIV.  (4) The commissioner of any state in which an insurer is authorized to do business, or is conducting the business of insurance, shall continue to exercise his or her authority to oversee the market regulation of the activities of the insurer in accordance with the provisions of the states law. The commissioners enforcement of compliance with the compact is governed by the state following provisions:  (a) With respect to the commissioners market regulation of a product or advertisement that is approved or certified to the commission, the content of the product or advertisement shall not constitute a violation of the provisions, standards or requirements of the compact except upon a final order of the commission, issued at the request of a commissioner after prior notice to the insurer and an opportunity for hearing before the commission.  (b) Before a commissioner may bring an action for violation of any provision, standard or requirement of the compact relating to the content of an advertisement not approved or certified to the commission, the commission, or an authorized commission officer or employee, must authorize the section. However, authorization pursuant to this paragraph does not require notice to the insurer, opportunity for hearing or disclosure of requests for authorization or records of the commissions action on such requests.     The commission shall attempt, upon the request of a member, to resolve any disputes or other issues that are subject to this compact and which may arise between two (2) or more compacting states, or between compacting states and noncompacting states, and the commission shall promulgate an operating procedure providing for resolution of such disputes.       (1) Insurers and third-party filers seeking to have a product approved by the commission shall file the product with, and pay applicable filing fees to, the commission. Nothing in this act shall be construed to restrict or otherwise prevent an insurer from filing its product with the insurance department in any state wherein the insurer is licensed to conduct the business of insurance, and such filing shall be subject to the laws of the states where filed.  (2) The commission shall establish appropriate filing and review processes and procedures pursuant to commission rules and operating procedures. Notwithstanding any provision herein to the contrary, the commission shall promulgate rules to establish conditions and procedures under which the commission will provide public access to product filing information. In establishing such rules, the commission shall consider the interests of the public in having access to such information, as well as protection of personal medical and financial information and trade secrets, that may be contained in a product filing or supporting information.  (3) Any product approved by the commission may be sold or otherwise issued in those compacting states for which the insurer is legally authorized to do business.      (1) Not later than thirty (30) days after the commission has given notice of a disapproved product or advertisement filed with the commission, the insurer or third party filer whose filing was disapproved may appeal the determination to a review panel appointed by the commission. The commission shall promulgate rules to establish procedures for appointing such review panels and provide for notice and hearing. An allegation that the commission, in disapproving a product or advertisement filed with the commission, acted arbitrarily, capriciously, or in a manner that is an abuse of discretion or otherwise not in accordance with the law, is subject to judicial review in accordance with Article III, Section 5.  (2) The commission shall have authority to monitor review and reconsider products and advertisement subsequent to their filing or approval upon a finding that the product does not meet the relevant uniform standard. Where appropriate, the commission may withdraw or modify its approval after proper notice and hearing, subject to the appeal process in section 1 above.      (1) The commission shall pay or provide for the payment of the reasonable expenses of its establishment and organization. To fund the cost of its initial operations, the commission may accept contributions and other forms of funding from the National Association of Insurance Commissioners, compacting states and other sources. Contributions and other forms of funding from other sources shall be of such a nature that the independence of the commission concerning the performance of its duties shall not be compromised.  (2) The commission shall collect a filing fee from each insurer and third party filer filing a product with the commission to cover the cost of the operations and activities of the commission and its staff in a total amount sufficient to cover the commissions annual budget.  (3) The commissions budget for a fiscal year shall not be approved until it has been subject to notice and comment as set forth in Article VII of this compact.  (4) The commission shall be exempt from all taxation in and by the compacting states.  (5) The commission shall not pledge the credit of any compacting state, except by and with the appropriate legal authority of that compacting state.  (6) The commission shall keep complete and accurate accounts of all its internal receipts, including grants and donations, and disbursements of all funds under its control. The internal financial accounts of the commission shall be subject to the accounting procedures established under its bylaws. The financial accounts and reports including the system of internal controls and procedures of the commission shall be audited annually by an independent certified public accountant. Upon the determination of the commission, but no less frequently than every three (3) years, the review of the independent auditor shall include a management and performance audit of the commission. The commission shall make an annual report to the governor and legislature of the compacting states, which shall include a report of the independent audit. The commissions internal accounts shall not be confidential and such materials may be shared with the commissioner of any compacting state upon request; provided, however, that any work papers related to any internal or independent audit and any information regarding the privacy of individuals and insurers proprietary information, including trade secrets, shall remain confidential.  (7) No compacting state shall have any claim to or ownership of any property held by or vested in the commission or to any commission funds held pursuant to the provisions of this compact.      (1) Any state is eligible to become a compacting state.  (2) The compact shall become effective and binding upon legislative enactment of the compact into law by two compacting states; provided, the commission shall become effective for purposes of adopting uniform standards for, reviewing, and giving approval or disapproval of, products filed with the commission that satisfy applicable uniform standards only after twenty-six (26) states are compacting states, or, alternatively, by states representing greater than forty percent (40%) of the premium volume for life insurance, annuity, disability income and long-term care insurance products, based on records of the NAIC for the prior year. Thereafter, it shall become effective and binding as to any other compacting state upon enactment of the compact into law by that state.  (3) Amendments to the compact may be proposed by the commission for enactment by the compacting states. No amendment shall become effective and binding upon the commission and the compacting states unless and until all compacting states enact the amendment into law.      (1) Withdrawal;  (a) Once effective, the compact shall continue in force and remain binding upon each and every compacting state; provided, that a compacting state may withdraw from the compact (Withdrawing State) by enacting a statute specifically repealing the statute which enacted the compact into law.  (b) The effective date of withdrawal is the effective date of the repealing statute. However, the withdrawal shall not apply to any product filings approved or self-certified, or any advertisement of such products, on the date the repealing statute becomes effective, except by mutual agreement of the commission and the withdrawing state unless the approval is rescinded by the withdrawing state as provided in subsection (e) of the this section.  (c) The commissioner of the withdrawing state shall immediately notify the management committee in writing upon the introduction of legislation repealing this compact in the withdrawing state.  (d) The commission shall notify the other compacting states of the introduction of such legislation within ten (10) days after its receipt of notice thereof.  (e) The withdrawing state is responsible for all obligations, duties and liabilities incurred through the effective date of withdrawal, including any obligations, the performance of which extend beyond the effective date of withdrawal, except to the extent those obligations may have been released or relinquished by mutual agreement of the commission and the withdrawing state. The commissions approval of products and advertisement prior to the effect date of withdrawal shall continue to be effective and be given full force and effect in the withdrawing state, unless formally rescinded by the withdrawing state in the same manner as provided by the laws of the withdrawing state for the prospective disapproval of products or advertisement previously approved under state law.  (f) Reinstatement following withdrawal of any compacting state shall occur upon the effective date of the withdrawing state reenacting the compact.  (2) Default.(a) If the commission determines that any compacting state has at any time defaulted (defaulting state) in the performance of any of its obligations or responsibilities under this compact, the bylaws or duly promulgated rules or operating procedures, then, after notice and hearing as set forth in the bylaws, all rights, privileges and benefits conferred by this compact on the defaulting state shall be suspended from the effective date of default as fixed by the commission. The grounds for default include, but are not limited to, failure of compacting state to perform its obligations or responsibilities, and any other grounds designated in commission rules. The commission shall immediately notify the defaulting state in writing of the defaulting states suspension pending a cure of the default. The commission shall stipulate the conditions and the time period within which the defaulting state must cure its default. If the defaulting state fails to cure the default within the time period specified by the commission, the defaulting state shall be terminated from the compact and all rights, privileges and benefits conferred by this compact shall be terminated from the effective date of termination.  (b) Product approvals by the commission or product self-certifications, or any advertisement in connection with such product, that are in force on the effective date of termination shall remain in force in the defaulting state in the same manner as if the defaulting state had withdrawn voluntarily pursuant to paragraph (1) of the article.  (c) Reinstatement following termination of any compacting state requires a reenactment of the compact.  (3) Dissolution of compact.(a) The compact dissolves effective upon the date of the withdrawal or default of the compacting state which reduces membership in the compact to one compacting state.  (b) Upon the dissolution of this compact, the compact becomes null and void and shall be of no further force or effect, and the business and affairs of the commission shall be wound up and any surplus funds shall be distributed in accordance with the bylaws.      (1) The provisions of this compact shall be severable; and if any phrase, clause, sentence or provision is deemed unenforceable, the remaining provisions of the compact shall be enforceable.  (2) The provisions of this compact shall be liberally construed to effectuate it purposes.      (1) Other laws.(a) Nothing herein prevents the enforcement of any other law of a compacting state, except as provided in paragraph (b) of the article.  (b) For any product approved or certified to the commission, the rules, uniform standards and any other requirements of the commission shall constitute the exclusive provisions applicable to the content, approval and certification of such products. For advertisement that is subject to the commissions authority, any rule, uniform standard or other requirement of the commission which governs the content of the advertisement shall constitute the exclusive provision that a commissioner may apply to the content of the advertisement. Notwithstanding the foregoing, no action taken by the commission shall abrogate or restrict: (i) the access of any person to state courts; (ii) remedies available under state law related to breach of contract, tort, or other laws not specifically directed to the content of the product; (iii) state law relating to the construction of insurance contracts; or (iv) the authority of the attorney general of the state, including, but not limited to, maintaining any actions or proceedings, as authorized by law.  (c) All insurance products filed with individual states shall be subject to the laws of those states.  (2) Binding effect on this compact.(a) All lawful actions of the commission, including all rules and operating procedures promulgated by the commission, are binding upon the compacting states.  (b) All agreements between the commission and the compacting states are binding in accordance with their terms.  (c) Upon the request of a party to a conflict over the meaning or interpretation of commission actions, and upon a majority vote of the compacting states, the commission may issue advisory opinions regarding the meaning or interpretation in dispute.  (d) In the event any provision of this compact exceeds the constitutional limits imposed on the legislature of any compacting state, the obligations, duties, powers or jurisdiction sought to be conferred by that provision upon the commission shall be ineffective as to that compacting state, and those obligations, duties, powers or jurisdiction shall remain in the compacting state and shall be exercised by the agency thereof to which those obligations, duties, powers or jurisdiction are delegated by law in effect at the time this compact becomes effective.  History of Section.P.L. 2004, ch. 463,  1; P.L. 2005, ch. 173,  1. 
 27-2.6-1. Title and purpose. (a) This chapter shall be known and may be cited as the Rhode Island Title Insurers Act.  (b) The purpose of this chapter is to provide for the effective regulation and supervision of title insurance and title insurers licensed to write title insurance in this state.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-10. Liquidation, dissolution or insolvency. (a) Chapter 14.3 of this title shall apply to all title insurers subject to the Title Insurance Act, except as otherwise provided in this section. In applying the provisions of chapter 14.3 of this title, the court shall consider the unique aspects of title insurance and shall have broad authority to fashion relief that provides for the maximum protection of the title insurance policyholders.  (b) Security and escrow funds held by or on behalf of the title insurer shall not become general assets and shall be administered as secured creditor claims defined in chapter 14.3 of this title.  (c) Title insurance policies that are in force at the time an order of liquidation is entered shall not be canceled except upon a showing to the court of good cause by the liquidator. The determination of good cause shall be within the discretion of the court. In making this determination, the court shall consider the unique aspects of title insurance and all other relevant circumstances.  (d) The court may set appropriate dates that potential claimants must file their claims with the liquidator. The court may set different dates for claims based upon the title insurance policy than for all other claims. In setting dates, the court shall consider the unique aspects of title insurance and all other relevant circumstances.  (e) As of the date of the order of insolvency or liquidation, all premiums paid, due or to become due under policies of the title insurers, shall be fully earned. It shall be the obligation of agents, insureds or representatives of the title insurer to pay fully earned premium to the liquidator or rehabilitator.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-11. Diversification requirement. (a) Without the prior written approval of the commissioner, a domestic title insurer shall not accept:  (1) Additional business from a title insurance agent that is not an affiliated company with the insurer if, when added to other business written through the title insurance agent during the same calendar year, that agents aggregate premiums written on behalf of the title insurer will exceed twenty percent (20%) of the title insurers gross premiums written during the prior calendar year, as shown on the title insurers most recent annual statement on file with the commissioner; or  (2) Additional direct operations business from a single source if, when added to other direct operations business from the single source during the same calendar year, the aggregate premiums written on the direct operations business of the single source will exceed twenty percent (20%) of the title insurers gross premiums written during the prior calendar year as shown on the title insurers most recent annual statement on file with the commissioner. For purposes of this section a single source means a person that refers business to the title insurer and any other person that controls, is controlled by, or is under common control with, that person.  (b) In determining whether prior approval may be given, the commissioner shall consider:  (1) The potential that the acceptance of more business from the title agent or source may adversely affect the financial solvency of the title insurer;  (2) The availability of competing title agents or additional sources in the territories in which the title insurer accepts risks;  (3) The number of years the title insurer has been in business;  (4) Reinsurance arrangements mitigating the concentration of business from the agent or source;  (5) The comparative profitability of the agents or sources book of business;  (6) The degree of oversight of the agents operations exercised by the title insurer; and  (7) Any other circumstances deemed by the commissioner to be appropriate.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-12. Policyholder treatment. (a) When a title insurance report includes an offer to issue an owners policy covering the resale of owner-occupied residential property, the report shall be furnished to the purchaser-mortgagor or its representative as soon as reasonably possible prior to closing. If the report cannot be delivered prior to the day of closing, the title insurer or agent shall document the reasons for the delay. The report furnished to the purchaser-mortgagor shall incorporate the following statement on the first page in bold type:  Please read the exemptions and the terms shown or referred to herein carefully. The exemptions are meant to provide you with notice of matters which are not covered under the terms of the title insurance policy and should be carefully considered.  It is important to note that this form is not a written representation as to the condition of title and may not list all liens, defects, and encumbrances affecting title to the land.  (b) A title insurer issuing a lenders title insurance policy in conjunction with a mortgage loan made simultaneously with the purchase of all or part of the real estate securing the loan, where no owners title insurance policy has been requested, shall give written notice to the purchaser-mortgagor at the time the commitment is prepared. The notice shall explain that a lenders title insurance policy is to be issued protecting the mortgage-lender, and that the policy does not provide title insurance protection to the purchaser-mortgagor as the owner of property being purchased. The notice shall explain what title policy insures against and what possible exposures exist for the purchaser-mortgagor that could be insured against through the purchase of an owners policy. The notice shall also explain that the purchaser-mortgagor may obtain an owners title insurance policy protecting the property owner at a specified cost or approximate cost, if the proposed coverages or amount of insurance is not then known. A copy of the notice, signed by the purchaser-mortgagor, shall be retained in the relevant underwriting file at least five (5) years after the effective date of the policy.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-13. Duties of title insurers utilizing the services of title insurance agents. (a) The title insurer shall not accept business from a title insurance agent unless there is in force a written contract between the parties that sets forth the responsibilities of each party and, where both parties share responsibility for a particular function, specifies the division of responsibilities.  (b) The title insurer shall, on at least a biennial basis, conduct an on-site review of the underwriting, claims, and escrow practices of the agent that shall include a review of the agents policy blank inventory and processing operations.  (1) If the title insurance producer is also an attorney, and asserts that any documents requested in connection with the review provided in subsection (b) are prohibited from disclosure by an ethical requirement, the producer shall identify in writing the particular document, the applicable privilege, and provide a redacted copy to the title insurer.  (c) A domestic title insurer shall not appoint to its board of directors an officer, director, employee, or controlling shareholder or any title insurance agent who wrote one percent (1%) or more of the title insurers direct premiums written during the previous calendar year as shown on the tile insurers most recent annual statement on file with the commissioner. This subsection shall not apply to relationships governed by  27-35-1 et seq.  (d) The title insurer shall maintain an inventory of all policy forms or policy numbers allocated to each title insurance agent.  (e) The title insurer shall have on file proof that the title insurance agent is licensed by this state.  (f) The title insurer shall establish the underwriting guidelines and, where applicable, limitations on title claims settlement authority to be incorporated into contracts with its title insurance agents.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1; P.L. 2014, ch. 488,  1; P.L. 2014, ch. 521,  1. 
 27-2.6-14. Prohibition of rebate and fee splitting. A title insurer or other person shall not give or receive, directly or indirectly, any consideration for the referral of title insurance business or escrow or other service provided by a title insurer. This section does not affect a title insurers ability to pay consideration to persons or entities who provide core services, as defined by the Real Estate Settlement Procedures Act (RESPA), 12 U.S.C.  2607, as amended.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-15. Favored agent of title insurer. A title insurer shall not participate in any transaction in which it has actual knowledge that a producer or other person requires, directly or indirectly, or through any trustee, director, officer, agent, employee or affiliate, as a condition, agreement or understanding to selling or furnishing any other person a loan, or loan extension, credit, sale, property, contract, lease or service, that the other person shall place a title insurance policy of any kind with the title insurer or through a particular title insurance agent.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-16. Premium rate filings and standards. No title insurer may charge any rates regulated by the state after the effective date of this act, except in accordance with the premium rate schedule and manuals filed with and approved by the commissioner in accordance with the provisions of chapter 44 of this title.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-17. Form filing. (a) A title insurer or authorized rate service organization shall not deliver or issue for delivery or permit any of its authorized title insurance agents to deliver in this state, any policy form, in connection with title insurance written, unless it has been filed with and approved by the commissioner.  (b) Forms covered by this section shall include:  (1) Title insurance policies, including standard form endorsements; and  (2) Title insurance commitments issued prior to the issuance of a title insurance policy;  (3) An insurer may use American Land Title Association (ALTA) approved checklists on endorsements.  (c) After notice and opportunity to be heard are given to the insurer or rate service organization which submitted a form for approval, the commissioner may withdraw approval of the form on finding that the use of the form is contrary to the legal requirements applicable at the time of withdrawal. The effective date of withdrawal of approval shall not be less than ninety (90) days after notice of withdrawal is given.  (d) Any term or condition related to an insurance coverage provided by an approved title insurance policy or any exception to the coverage, except those ascertained from a search and examination of records relating to a title or inspection or survey of a property to be insured, may only be included in the policy after the term, condition or exception has been filed with the commissioner and approved.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-18. Filing by rating bureaus. (a) A title insurer may satisfy its obligation to file premium rates, rating manuals and forms as required by this chapter by becoming a member of, or a subscriber to, a rate service organization, organized and licensed under the provisions of this code, where the organization makes the filing, and by authorizing the commissioner in writing to accept the filings on the insurers behalf.  (b) Nothing in this chapter shall be construed as requiring a title insurer to become a member of, or a subscriber to, any rate service organization. Nothing in this chapter shall be construed as prohibiting the filing of deviations from rate service organization filings by any member or subscriber.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-19. Penalties and liabilities. (a) If the commissioner determines that the title insurer has violated this chapter, or any regulation or order promulgated thereunder, after notice and opportunity to be heard, the commissioner may order:  (1) A penalty pursuant to  42-14-16 for each violation; and  (2) Revocation or suspension of the title insurers license.  (b) Nothing contained in this section shall affect the right of the commissioner to impose any other penalties provided for in the insurance code.  (c) Nothing contained in this chapter is intended to or shall in any manner limit or restrict the rights of policyholders, claimants and creditors.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-2. Application of act and construction with other laws. (a) This chapter shall apply to all persons engaged in the business of title insurance in this state.  (b) Except where the context otherwise requires, all provisions of the Rhode Island general laws applying to insurance and insurance companies shall apply to title insurance insurers.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-20. Violations of the Real Estate Settlement Procedures Act (RESPA). The commissioner or attorney general may bring an action in a court of competent jurisdiction to enjoin violations of RESPA, 12 U.S.C.  2607, as amended.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-21. Severability. If any provision of this chapter, or the application of the provision to any person or circumstances shall be held invalid, the remainder of the chapter and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-3. Definitions. As used in this chapter: (1) Abstract of title or abstract means a written history, synopsis or summary of the recorded instruments affecting the title to real property.  (2) Affiliate means a specific person that directly, or indirectly through one or more intermediaries, controls, or is controlled by or is under common control with the person specified.  (3) Bona fide employee of the title insurer or title insurance agent means an individual who devotes substantially all of his or her time to performing services on behalf of a title insurer or title insurance agent and whose compensation for those services is in the form of salary or its equivalent paid by the title insurer or title insurance agent.  (4) Commissioner means the director of the department of business regulation, or his or her designee or the commissioner, director or superintendent of insurance in any other state.  (5) Control (including the terms controlling, controlled by and under common control with) means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position or corporate office held by the person. Control shall be presumed to exist if a person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing, ten percent (10%) or more of the voting securities of another person. This presumption may be rebutted by a showing that control does not exist in fact. The commissioner may determine, after furnishing all persons in interest notice and opportunity to be heard and making specific findings of fact to support the determination, that control exists in fact, notwithstanding the absence of a presumption to that effect.  (6) Direct operations means that portion of a title insurers operations which are attributable to business written by a bona fide employee.  (7) Escrow means written instruments, money or other items deposited by one party with a depository, escrow agent or escrowee for delivery to another party upon the performance, of a specified condition or the happening of a certain event.  (8) Escrow, settlement or closing fee means the consideration for supervising or handling the actual execution, delivery or recording of transfer and lien documents and for disbursing funds.  (9) Foreign title insurer means any title insurer incorporated or organized under the laws of any other state of the United States, the District of Columbia, or any other jurisdiction of the United States.  (10) Net retained liability means the total liability retained by a title insurer for a single risk, after taking into account any ceded liability and collateral, acceptable to the commissioner, maintained by the insurer.  (11) Non-U.S. title insurer means any title insurer incorporated or organized under the laws of any foreign nation or any province or territory.  (12) Person means any natural person, partnership, association, cooperative, corporation, trust or other legal entity.  (13) Producer means any person, including any officer, director or owner of five percent (5%) or more of the equity or capital of any person, engaged in this state in the trade, business, occupation or profession of:  (i) Buying or selling interests in real property;  (ii) Making loans secured by interests in real property; or  (iii) Acting as broker, agent, representative or attorney or a person who buys or sells any interest in real property or who lends or borrows money with the interest as security.  (14) Qualified financial institution means an institution that is:  (i) Organized or (in the case of a United States branch or agency office of a foreign banking organization) licensed under the laws of the United States or any state and has been granted authority to operate with fiduciary powers;  (ii) Regulated, supervised and examined by federal or state authorities having regulatory authority over banks and trust companies;  (iii) Insured by the appropriate federal entity; and  (iv) Qualified under any additional rules established by the commissioner.  (15) Security or security deposit means funds or other property received by the title insurer as collateral to secure an indemnitors obligation under an indemnity agreement pursuant to which the insurer is granted a perfected security interest in the collateral in exchange for agreeing to provide coverage in a title insurance policy for a specific title exception to coverage.  (16) Subsidiary means an affiliate controlled by a person directly or indirectly through one or more intermediaries.  (17) Title insurance agent or agent means an authorized person, other than a bona fide employee of the title insurer who, on behalf of the title insurer, performs the following acts, in conjunction with the issuance of a title insurance report or policy:  (i) Determines insurability and issues title insurance reports or policies, or both, based upon the performance or review of a search or abstract of title; and  (ii) Performs one or more of the following functions:  (A) Collects or disburses premiums, escrow or security deposits or other funds;  (B) Handles escrows, settlements or closings;  (C) Solicits or negotiates title insurance business; or  (D) Records closing documents.  (18) Title insurance business or business of title insurance means:  (i) Issuing as insurer or offering to issue as insurer, a title insurance policy;  (ii) Transacting or proposing to transact by a title insurer any of the following activities when conducted or performed in contemplation of, or in conjunction with, the issuance of a title insurance policy:  (A) Soliciting or negotiating the issuance of a title insurance policy;  (B) Guaranteeing, warranting or otherwise insuring the correctness of title searches for all instruments affecting titles to real property, any interest in real property, cooperative units and proprietary leases and for all liens or charges affecting the same;  (C) Handling of escrows, settlements or closings;  (D) Executing title insurance policies;  (E) Effecting contracts of reinsurance.  (iii) Guaranteeing, warranting or insuring searches or examination of title to real property or any interest in real property;  (iv) Guaranteeing or warranting the status of title as to ownership of or liens on real property and personal property by any person other than the principals to the transaction; or  (v) Doing or proposing to do any business substantially equivalent to any of the activities listed in this subsection in a manner designed to evade the provisions of this chapter.  (19) Title insurance policy or policy means a contract insuring or indemnifying owners of, or other persons lawfully interested in, real or personal property or any interest in real property, against loss or damage arising from any or all of the following conditions existing and not excepted or excluded:  (i) Defects in or liens or encumbrances on the insured title;  (ii) Unmarketability of the insured title;  (iii) Invalidity, lack of priority or unenforceability of liens or encumbrances on the stated property;  (iv) Lack of legal right of access to the land; or  (v) Unenforceability of rights in title to the land.  (20) Title insurer or insurer means a company organized under laws of this state for the purpose of transacting the business of title insurance and any foreign or non-United States title insurer licensed in this state to transact the business of title insurance.  (21) Title plant means a set of records consisting of documents, maps, surveys or entries affecting title to real property or any interest in or encumbrance on the property, which have been filed or recorded in the jurisdiction for which the title plant is established or maintained.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-4. Corporate form required. No person other than a domestic, foreign or non-United States title insurer organized on the stock plan licensed under title 27 as a title insurer shall issue a title insurance policy or otherwise transact the business of title insurance in this state.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-5. Authorized activities of title insurers. Subject to the exceptions and restrictions contained in this chapter, a title insurer shall have the power to:  (1) Do only title insurance business;  (2) Reinsure title insurance policies; and  (3) Perform ancillary activities, unless prohibited by the commissioner by regulation, including, examining titles to real property and any interest in real property and procuring and furnishing related information and information about relevant personal property, when not in contemplation of, or in conjunction with, the issuance of a title insurance policy.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-6. Limitations on powers. (a) No insurer that transacts any class, type, or kind of business other than title insurance shall be eligible for the issuance or renewal of a license to transact the business of title insurance in this state, nor shall title insurance be transacted, underwritten, or issued by any insurer transacting or licensed to transact any other class, type, or kind of business.  (b) A title insure shall not engage in the business of guaranteeing payment of the principal or the interest of bonds or mortgages.  (c)(1) Notwithstanding subsection (a) of this section, and to the extent such coverage is lawful within this state, a title insurer is expressly authorized to issue closing or settlement protection to a proposed insured upon request if the title insurer or its title agent issues a preliminary report, binder, or title insurance policy. Such closing or settlement protection must be provided in connection with the issuance of any loan policy insuring a lenders interest in residential property intended for residential occupancy containing four (4) or less units. Nothing in this section shall prohibit the title insurer from providing such closing or settlement protection in connection with the issuance of any loan policy insuring a lenders interest in any other type of residential or commercial property. The closing or settlement protection shall conform to the terms of coverage and form of instrument as approved by the commissioner and may indemnify a proposed insured solely against loss of settlement funds only because of the following acts of a title insurers named title insurance agent:  (i) Theft of settlement funds; and  (ii) Failure to comply with written closing instructions by the proposed insured when agreed to by the title insurance agent relating to title insurance coverage.  (2) The fee charged by a title insurer for each party receiving closing protection coverage shall be filed with, and approved by, the commissioner pursuant to  27-2.6-16. The fee shall not be subject to any agreement requiring a division of fees or premiums collected on behalf of the title insurer. The single fee shall be for the protection of all parties receiving the benefit of closing protection, to wit: The buyer(s) or borrower(s) and the lender(s) in connection with the real property transaction giving rise to the issuance of the closing or settlement protection.  (3) A title insurer shall not provide any other coverage that purports to indemnify against improper acts or omissions of a person with regard to escrow, settlement, or closing services, except for an insured closing letter in a form approved by the department.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1; P.L. 2014, ch. 354,  1; P.L. 2014, ch. 393,  1. 
 27-2.6-7. Minimum capital and surplus requirements. Before being licensed to do insurance business in this state, a title insurer shall establish and maintain a minimum paid-in capital of not less than five hundred thousand dollars ($500,000) and, in addition, paid-in initial surplus of at least five hundred thousand dollars ($500,000).  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-8. Admitted asset standards. In determining the financial condition of a title insurer doing business under this chapter, the investment provisions of chapters 11 and 11.1 of this title shall apply, except that an investment in a title plant or plants in an amount equal to the actual cost shall be allowed as an admitted asset for title insurers. The aggregate amount of the investment shall not exceed the lesser of twenty percent (20%) of admitted assets or forty percent (40%) of surplus to policyholders, as shown on the most recent annual statement of the title insurer on file with the commissioner.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.6-9. Reserves. In determining the financial condition of a title insurer doing business under this chapter, the Rhode Island general laws requiring the establishment of reserves sufficient to cover all known and unknown liabilities including allocated and unallocated loss adjustment expense, shall apply, except that a title insurer shall establish and maintain additional reserves in accordance with regulations promulgated by the insurance commissioner.  History of Section.P.L. 2010, ch. 58,  1; P.L. 2010, ch. 66,  1. 
 27-2.7-1. Definitions. For purposes of this section, the following terms shall have the following meanings: (1) Customer means a person who purchases portable electronics or services;  (2) Department means the department of business regulation;  (3) Enrolled customer means a customer who elects coverage under a portable electronics insurance policy issued by a vendor of portable electronics;  (4) Insurance commissioner means the director of the department of business regulation or his/her designee;  (5) Location means any physical location in the state of Rhode Island or any website, call center site or similar location directed to residents of the state of Rhode Island;  (6) Portable electronics means electronic devices that are portable in nature, their accessories and services related to the use of the device;  (7)(i) Portable electronics insurance means insurance providing coverage for the repair or replacement of portable electronics which may provide coverage for portable electronics against any one or more of the following causes of loss: loss, theft, inoperability due to mechanical failure, malfunction, damage or other similar causes of loss.  (ii) Portable electronics insurance does not include:  (A) A service contract or extended warranty providing coverage limited to the repair, replacement or maintenance of property for the operational or structural failure of property due to a defect in materials, workmanship, accidental damage from handling, power surges, or normal wear and tear;  (B) A policy of insurance covering a sellers or a manufacturers obligations under a warranty; or  (C) A homeowners renters, private passenger automobile, commercial multi-peril, or similar policy;  (8) Portable electronics transaction means:  (i) The sale or lease of portable electronics by a vendor to a customer; or  (ii) The sale of a service related to the use of portable electronics by a vendor to a customer.  (9) Supervising entity means a business entity that is a licensed insurer or insurance producer that is authorized by an insurer to supervise the administration of a portable electronics insurance program.  (10) Vendor means a person in the business of engaging in portable electronics transactions directly or indirectly.  History of Section.P.L. 2012, ch. 136,  1; P.L. 2012, ch. 247,  1. 
 27-2.7-2. Licensure of vendors. (a) A vendor is required to hold a portable electronics insurance vendor license to sell or offer coverage under a policy of portable electronics insurance.  (b) A portable electronics insurance vendor license issued under this chapter shall authorize any employee or authorized representative of the vendor to sell or offer coverage under a policy of portable electronics insurance to a customer at each location at which the entity engages in portable electronics transactions.  (c) The supervising entity shall maintain a registry of vendor locations which are authorized to sell or solicit portable electronics insurance coverage in this state. Upon request by the insurance commissioner and with ten (10) days notice to the supervising entity, the registry shall be open to inspection and examination by the insurance commissioner during regular business hours of the supervising entity.  (d) Notwithstanding any other provision of law, a license issued pursuant to this section shall authorize the licensee and its employees or authorized representatives to engage in those activities that are permitted in this section.  History of Section.P.L. 2012, ch. 136,  1; P.L. 2012, ch. 247,  1. 
 27-2.7-3. Requirements for sale of portable electronics insurance. (a) At every location where portable electronics insurance is offered to customers, brochures or other written materials must be made available to a prospective customer which:  (1) Disclose that portable electronics insurance may provide a duplication of coverage already provided by a customers homeowners insurance policy, renters insurance policy or other source of coverage;  (2) State that the enrollment by the customer in a portable electronics insurance program is not required in order to purchase or lease portable electronics or services;  (3) Summarize the material terms of the insurance coverage, including:  (i) The identity of the insurer;  (ii) The identity of the supervising entity;  (iii) The amount of any applicable deductible and how it is to be paid;  (iv) Benefits of the coverage; and  (v) Key terms and conditions of coverage such as whether portable electronics may be repaired or replaced with similar make and model reconditioned or non-original manufacturer parts or equipment.  (4) Summarize the process for filing a claim, including a description of how to return portable electronics and the maximum fee applicable in the event the customer fails to comply with any equipment return requirements; and  (5) State that an enrolled customer may cancel enrollment for coverage under a portable electronics insurance policy at any time and the person paying the premium shall receive a refund of any applicable unearned premium.  (b) Portable electronics insurance may be offered on a month-to-month or other periodic basis as a group or master commercial inland marine policy issued to a vendor of portable electronics for its enrolled customers.  (c) Eligibility and underwriting standards for customers electing to enroll in coverage shall be established for each portable electronics insurance program.  History of Section.P.L. 2012, ch. 136,  1; P.L. 2012, ch. 247,  1. 
 27-2.7-4. Authority of vendors of portable electronics. (a) The employees and authorized representatives of vendors may sell or offer portable electronics insurance to customers and shall not be subject to licensure as an insurance producer under this title provided that:  (1) The vendor obtains a portable electronics insurance vendor license to authorize its employees or authorized representatives to sell or offer portable electronics insurance pursuant to this section;  (2) The insurer issuing the portable electronics insurance either directly supervises or appoints a supervising entity to supervise the administration of the program including development of a training program for employees and authorized representatives of the vendors. The training required by this subdivision shall comply with the following:  (i) The training shall be delivered to employees and authorized representatives of vendors who are directly engaged in the activity of selling or offering portable electronics insurance;  (ii) The training may be provided in electronic form. However, if conducted in an electronic form, the supervising entity shall implement a supplemental education program regarding the portable electronics insurance product that is conducted and overseen by licensed employees of the supervising entity; and  (iii) Each employee and authorized representative shall receive basic instruction about the portable electronics insurance offered to customers and the disclosures required under  27-2.7-3.  (3) No employee or authorized representative of a vendor of portable electronics shall advertise, represent or otherwise hold himself or herself out as a licensed insurance producer.  (b) Notwithstanding any other provision of law, employees or authorized representatives of a vendor of portable electronics shall not be compensated based primarily on the number of customers enrolled for portable electronics insurance coverage but may receive compensation for activities under the limited lines license which is incidental to their overall compensation.  (c) The charges for portable electronics insurance coverage may be billed and collected by the vendor of portable electronics. Any charge to the enrolled customer for coverage that is not included in the cost associated with the purchase or lease of portable electronics or related services shall be separately itemized on the enrolled customers bill. If the portable electronics insurance coverage is included with the purchase or lease of portable electronics or related services the vendor shall clearly and conspicuously disclose to the enrolled customer that the portable electronics insurance coverage is included with the portable electronics or related services. Vendors billing and collecting such charges shall not be required to maintain such funds in a segregated account provided that the vendor is authorized by the insurer to hold such funds in an alternative manner and remits such amounts to the supervising entity within sixty (60) days of receipt. All funds received by a vendor from an enrolled customer for the sale of portable electronics insurance shall be considered funds held in trust by the vendor in a fiduciary capacity for the benefit of the insurer. Vendors may receive compensation for billing and collection services.  History of Section.P.L. 2012, ch. 136,  1; P.L. 2012, ch. 247,  1. 
 27-2.7-5. Suspension or revocation of license. If a portable electronics insurance vendor or its employee or authorized representative violates any provision of this section, the insurance commissioner may do any of the following:  (1) After notice and hearing, impose fines not to exceed five hundred dollars ($500) per violation or five thousand dollars ($5,000) in the aggregate for such conduct.  (2) After notice and hearing, impose other penalties that the commissioner deems necessary and reasonable to carry out the purposes of this chapter including:  (i) Suspending the privilege of transacting portable electronics insurance pursuant to this section at specific business locations where violations have occurred; and  (ii) Suspending or revoking the ability of individual employees or authorized representatives to act under the license; and  (3) Any other penalties appropriate under  42-14-16.  History of Section.P.L. 2012, ch. 136,  1; P.L. 2012, ch. 247,  1. 
 27-2.7-6. Termination of portable electronics insurance. Notwithstanding any other provision of law: (1) An insurer may terminate or otherwise change the terms and conditions of a policy of portable electronics insurance only upon providing the vendor and its enrolled customers with at least thirty (30) days notice. An insurer may not change the terms and conditions of a policy of portable electronics insurance more than once in any six (6) month period.  (2) If the insurer changes the terms and conditions, then the insurer shall provide the vendor with a revised policy or endorsement and each enrolled customer with a revised certificate, endorsement, updated brochure, or other evidence indicating a change in the terms and conditions has occurred and a summary of material changes.  (3) Notwithstanding subdivision (1) of this section, an insurer may terminate an enrolled customers enrollment under a portable electronics insurance policy upon fifteen (15) days notice for discovery of fraud or material misrepresentation in obtaining coverage or in the presentation of a claim thereunder.  (4) Notwithstanding subdivision (1) of this section, an insurer may immediately terminate an enrolled customers enrollment under a portable electronics insurance policy:  (i) For nonpayment of premium;  (ii) If the enrolled customer ceases to have an active service with the vendor of portable electronics; or  (iii) If an enrolled customer exhausts the aggregate limit of liability, if any, under the terms of the portable electronics insurance policy and the insurer sends notice of termination to the enrolled customer within thirty (30) calendar days after exhaustion of the limit. However, if notice is not timely sent, enrollment shall continue notwithstanding the aggregate limit of liability until the insurer sends notice of termination to the enrolled customer.  (5) When a portable electronics insurance policy is terminated by a vendor, the vendor shall mail or deliver written notice to each enrolled customer advising the enrolled customer of the termination of the policy and the effective date of termination. The written notice shall be mailed or delivered to the enrolled customer at least thirty (30) days prior to the termination.  (6) Whenever notice or correspondence with respect to a policy of portable electronics insurance is required pursuant to this section or is otherwise required by law, it shall be in writing and sent within the notice period, if any, specified within the statute or regulation requiring the notice or correspondence. Notwithstanding any other provision of law, notices and correspondence may be sent either by mail or by electronic means as set forth in this subdivision. If the notice or correspondence is mailed, it shall be sent to the vendor of portable electronics at the vendors mailing address specified for such purpose and to its affected enrolled customers last known mailing addresses on file with the insurer. The insurer or vendor of portable electronics, as the case may be, shall maintain proof of mailing in a form authorized or accepted by the United States postal service or other commercial mail delivery service. If the notice or correspondence is sent by electronic means, it shall be sent to the vendor of portable electronics at the vendors electronic mail address specified for such purpose and to its affected enrolled customers last known electronic mail address as provided by each enrolled customer to the insurer or vendor of portable electronics, as the case may be. For purposes of this subdivision, an enrolled customers provision of an electronic mail address to the insurer or vendor of portable electronics, as the case may be, shall be deemed consent to receive notices and correspondence by electronic means. The insurer or vendor of portable electronics, as the case may be, shall maintain proof that the notice or correspondence was sent.  (7) Notice or correspondence required by this section or otherwise required by law may be sent on behalf of an insurer or vendor, as the case may be, by the supervising entity appointed by the insurer.  History of Section.P.L. 2012, ch. 136,  1; P.L. 2012, ch. 247,  1. 
 27-2.7-7. Application for license and fees. (a) A sworn application for a license under this chapter shall be made to and filed with the department on forms prescribed and furnished by the department in accordance with the provisions of  27-2.4-9(a)(8).  (b) The application shall:  (1) Provide the name, residence address, and other information required by the department for an employee or officer of the vendor that is designated by the applicant as the person responsible for the vendors compliance with the requirements of this chapter. However, if the vendor derives more than fifty percent (50%) of its revenue from the sale of portable electronics insurance the information noted above shall be provided for all officers, directors, and shareholder of record having beneficial ownership of ten percent (l0%) or more of any class of securities registered under the federal securities law; and  (2) The location of the applicants home office.  (c) Any license under this chapter is subject to all applicable provisions of chapter 2.4 of this title, including, but not limited to, notification of change of address, lapse of license, notification of administrative actions, assumed names and basis for suspension or revocation of license; provided however, in the event there is a conflict between the provisions of this chapter and chapter 2.4 of this title, this chapter shall prevail.  (d) Any vendor engaging in portable electronics insurance transactions on or before the effective date of this chapter must apply for licensure within ninety (90) days of the application being made available by the department. Any applicant commencing operations after the effective date of this chapter must obtain a license prior to offering portable electronics insurance.  (e) Initial licenses issued pursuant to this chapter shall be valid for a period of two (2) calendar years expiring on May 31 of the second (2nd) renewal year. Applicants for an initial license shall pay the full two (2) year fee regardless of the number of months of the initial licensure. Renewal licenses shall be effective for twenty-four (24) months effective and expiring on May 31.  (f) Each vendor of portable electronics licensed under this chapter shall pay to the department a fee of two hundred dollars ($200) for an initial license and for each renewal thereof. The department is authorized to institute miscellaneous fees for this license type in accordance with  27-2.4-4.  History of Section.P.L. 2012, ch. 136,  1; P.L. 2012, ch. 247,  1. 
 27-2.8-1. Definitions. [Effective January 1, 2023.] For purposes of this chapter, the following terms shall have the following meanings: (1) Commissioner means the definition prescribed by  42-14-5.  (2) Location means any physical location in the state of Rhode Island or any website, call center site, or similar location directed to residents of the state of Rhode Island.  (3) Occupant means a person, or his or her sublessee, successor, or assign, who is entitled to the use of storage space at a self-service storage facility under a rental agreement, to the exclusion of others.  (4) Owner means a person or business entity, whether a resident or nonresident of this state, who or that is the proprietor, operator, lessor, or sublessor of a self-service storage facility, an agent of any of the foregoing, or any other person or business entity authorized to manage the facility or to receive rent from an occupant under a rental agreement.  (5) Personal property means movable property not affixed to land.  (6) Rental agreement means any written agreement or lease that establishes or modifies the terms, conditions, rules, or any other provisions concerning the use and occupancy of storage space at a self-service storage facility.  (7) Self-service storage facility means any real property designed and used for the purpose of renting or leasing individual storage space to occupants who are to have access to the space for the purpose of storing and removing personal property.  (8) Self-service storage insurance means personal property insurance offered in connection with and incidental to the rental of storage space at a self-service storage facility and that provides coverage to occupants for the loss of or damage to personal property occurring at the facility or when the property is in transit to or from the facility during the period of the rental agreement.  (9) Supervising entity means a business entity that is a licensed insurer or insurance producer that is authorized by an insurer to supervise the administration of a self-service storage insurance program.  History of Section.P.L. 2022, ch. 342,  1, effective January 1, 2023; P.L. 2022, ch. 343,  1, effective January 1, 2023. 
 27-2.8-2. Licensure exemption for owners. [Effective January 1, 2023.] (a) An owner and its authorized representatives and employees may sell, solicit, and offer self-service storage insurance coverage without obtaining an insurance producer license pursuant to the requirements set forth in  27-2.8-3 and 27-2.8-4.  (b) The supervising entity shall maintain a registry of owner locations at which self-service storage insurance is sold, solicited, or offered in this state. Upon request by the commissioner and with ten (10) days notice to the supervising entity, the registry shall be open to inspection and examination by the commissioner during regular business hours of the supervising entity.  History of Section.P.L. 2022, ch. 342,  1, effective January 1, 2023; P.L. 2022, ch. 343,  1, effective January 1, 2023. 
 27-2.8-3. Requirements for sale of self-service storage insurance. [Effective January 1, 2023.] (a) At every location where self-service storage insurance is offered to occupants, brochures or other written or electronic materials must be made available that:  (1) Disclose that self-service storage insurance may provide a duplication of coverage already provided by a homeowners insurance policy, renters insurance policy, or other source of coverage;  (2) State that the enrollment in the self-service storage insurance program offered by the owner is not required in order to lease storage space at the self-service storage facility;  (3) Provide the actual terms of the insurance coverage, or summarize the material terms of the insurance coverage, including:  (i) The identity of the insurer;  (ii) The identity of the supervising entity;  (iii) The amount of any applicable deductible and how it is to be paid;  (iv) Benefits of the coverage; and  (v) Key terms and conditions of coverage;  (4) Summarize the process for filing a claim; and  (5) State that an occupant may cancel enrollment for self-service storage insurance coverage at any time and the person paying the premium shall receive a refund of any applicable unearned premium.  (b) Self-service storage insurance may be provided under a commercial, corporate, group, or master policy.  History of Section.P.L. 2022, ch. 342,  1, effective January 1, 2023; P.L. 2022, ch. 343,  1, effective January 1, 2023. 
 27-2.8-4. Authority of owners. [Effective January 1, 2023.] (a) The employees and authorized representatives of owners may sell, solicit, and offer self-service storage insurance and shall not be subject to licensure as an insurance producer under this title; provided that:  (1) The insurer issuing the self-service storage insurance either directly supervises or appoints a supervising entity to supervise the administration of the program including development and implementation of a training program for employees and authorized representatives of the owners who are directly engaged in the activity of selling, soliciting, or offering self-service storage insurance. The training required by this subdivision shall comply with the following:  (i) The training shall be delivered to employees and authorized representatives of owners who are directly engaged in the activity of selling, soliciting, or offering self-service storage insurance;  (ii) The training may be provided in electronic form. The supervising entity shall implement a system to monitor whether the electronic training has been taken by all relevant employees; and  (iii) Each employee and authorized representative shall receive basic instruction about the self-service storage insurance offered and the disclosures required under  27-2.8-3(a).  (2) No employee or authorized representative of an owner shall advertise, represent or otherwise hold himself or herself out as a licensed insurance producer, unless so licensed.  (b) Notwithstanding any other provision of law, employees or authorized representatives of an owner shall not be compensated based primarily on the number of occupants enrolled for self-service storage insurance coverage but may receive compensation for self-service storage insurance which is incidental to their overall compensation.  (c) The charges for self-service storage insurance coverage may be billed and collected by the owner. Any charge for the self-service storage insurance coverage that is not included in the cost associated with the lease of storage space at the self-service storage facility shall be separately itemized on the occupants bill. If the self-service storage insurance coverage is included in the cost associated with the lease of storage space at the self-service storage facility, the owner shall clearly and conspicuously disclose to the occupant that the self-service storage insurance coverage is included in the cost associated with the lease of storage space at the self-service storage facility. Owners billing and collecting these charges shall not be required to maintain these funds in a segregated account; provided that, the owner is authorized by the insurer or supervising entity to hold these funds in an alternative manner and remits the premiums to the insurer or supervising entity within sixty (60) days of receipt. All premiums received by an owner from an occupant for the sale of self-service storage insurance shall be considered funds held by the owner in a fiduciary capacity for the benefit of the insurer. Owners may receive compensation for billing and collection services.  History of Section.P.L. 2022, ch. 342,  1, effective January 1, 2023; P.L. 2022, ch. 343,  1, effective January 1, 2023. 
 27-2.8-5. Penalties. [Effective January 1, 2023.] If an owner or its employee or authorized representative violates any provision of this chapter, the commissioner, after notice and opportunity for a hearing, may impose any penalty as appropriate pursuant to  42-14-16.  History of Section.P.L. 2022, ch. 342,  1, effective January 1, 2023; P.L. 2022, ch. 343,  1, effective January 1, 2023. 
 27-2-1.1. Telephone number  Toll free or collect. Every insurer doing business within this state shall have a toll free telephone number or provide collect charge telephone service for use by the general public when calling the insurer from any location within the state.  History of Section.P.L. 1987, ch. 229,  2; P.L. 1993, ch. 180,  3. 
 27-2-1. Compliance by foreign insurance companies required. No insurance company, unless incorporated by the general assembly, shall make any insurance on property within this state or contract for insurance with any party resident in this state until the insurance company shall have complied with the provisions of this chapter.  History of Section.G.L. 1896, ch. 182,  1; G.L. 1909, ch. 220,  1; G.L. 1923, ch. 256,  1; G.L. 1938, ch. 151,  1; G.L. 1956,  27-2-1. 
 27-2-10. Filing of accident and health policy forms. Any insurance company authorized to transact an accident and health insurance business within this state in accordance with the provisions of this chapter shall file all policy forms used by it with the insurance commissioner. The commissioner may also require any company to file the forms of any rider, endorsement, application blank, and other matter generally used or incorporated by reference in its policies or contracts of insurance. Any organization, bureau, or association of which the company is a member may, on behalf of the company, make the filings required by this section. If the commissioner finds from an examination of any of these filed forms that it is contrary to the public interest, the commissioner shall forbid its use.  History of Section.G.L. 1938, ch. 151,  1; P.L. 1948, ch. 2134,  1; G.L. 1956,  27-2-10. 
 27-2-11. License required  Expiration date. No company shall transact any business of insurance in this state until it has obtained from the insurance commissioner of this state a license stating that it has complied with the laws of this state and specifying the kinds of business it is authorized to transact. The insurance commissioner may refuse to issue the license if he or she is of the opinion that the refusal will be in the public interest. Every license shall be continuous unless revoked or suspended as provided in chapter 13 of this title.  History of Section.G.L. 1938, ch. 151,  3; P.L. 1953, ch. 3174,  3; G.L. 1956,  27-2-11; P.L. 1987, ch. 289,  1. 
 27-2-12. Review of refusal to issue or renew license. A company aggrieved by the refusal of the insurance commissioner to issue or renew a license may within ten (10) days from the date of the refusal file a petition in superior court for the county of Providence for a review of the action, which shall be heard and determined in the same manner as is provided under chapter 13 of this title in the case of a petition filed after the revocation or suspension of a license.  History of Section.G.L. 1938, ch. 151,  3; P.L. 1953, ch. 3174,  3; G.L. 1956,  27-2-12. 
 27-2-13. Commissioner as attorney to receive process. No insurance company not incorporated under the authority of this state shall directly or indirectly issue policies, take risks, or transact business in this state until it has first appointed, in writing, the insurance commissioner of this state to be the true and lawful attorney of the company in and for this state, upon whom all lawful process in any action or proceeding against the company may be served with the same effect as if the company existed in this state; provided, that if the insurance company shall make no appointment, the issuance or delivery of a policy or contract of insurance to, the taking of a risk for, or the transacting of business with a citizen of this state or a resident of the state or a corporation authorized to do business in this state by the company shall be equivalent to an appointment for the service of all lawful process in any action or proceeding arising out of the policy or contract. The written power of attorney shall stipulate and agree on the part of the company that any lawful process against the company which is served on the attorney shall be of the same legal force and validity as if served on the company, and that the authority shall continue in force so long as any liability remains outstanding against the company in this state. A certificate of the written appointment, duly certified and authenticated, shall be filed in the office of the insurance commissioner, and copies certified by him or her shall be received in evidence in all of the courts in this state. Service upon the attorney shall be deemed sufficient service upon the principal; service of process may also be effectuated in accordance with the procedures set forth in Rule 4 of the Rules of Civil Procedure.  History of Section.G.L. 1896, ch. 182,  3; G.L. 1909, ch. 220,  3; G.L. 1923, ch. 256,  3; G.L. 1938, ch. 151,  3; P.L. 1940, ch. 856,  1; P.L. 1953, ch. 3174,  3; G.L. 1956,  27-2-13; P.L. 1985, ch. 163,  1. 
 27-2-14. Forwarding of process by commissioner. (a) Whenever lawful process against a foreign insurance company shall be served upon the insurance commissioner, the commissioner shall forward a copy of the process served on him or her, to the person appointed by the insurance company to accept service of process on behalf of the company. The manner of forwarding shall be at the discretion of the insurance commissioner.  (b) Service upon the insurance commissioner shall be accomplished by regular mail or by whatever alternative method is designated by the commissioner.  (c) For each copy of process the insurance commissioner shall collect, for the use of the state, the sum of twenty-five dollars ($25.00), which shall be paid by the plaintiff at the time of the service; the fee is to be recovered by the plaintiff as part of the taxable costs, if he or she prevails in the suit.  History of Section.G.L. 1896, ch. 182,  4; G.L. 1909, ch. 220,  4; G.L. 1923, ch. 256,  4; G.L. 1938, ch. 151,  4; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-2-14; P.L. 1960, ch. 71, art. 1,  1; P.L. 2004, ch. 595, art. 30,  9; P.L. 2009, ch. 303,  1; P.L. 2009, ch. 304,  1; P.L. 2017, ch. 196,  1; P.L. 2017, ch. 322,  1. 
 27-2-15. Provisions against actions in state courts. If any foreign insurance company, of any name, kind, or description, authorized to do business in this state shall provide in its charter or bylaws, or in the policies or contracts of insurance issued by it, that no action shall be brought against the company in any court of competent jurisdiction within this state, the insurance commissioner shall revoke all licenses and certificates of authority granted to it or to its insurance producers to do business in this state.  History of Section.G.L. 1896, ch. 182,  5; G.L. 1909, ch. 220,  5; G.L. 1923, ch. 256,  5; G.L. 1938, ch. 151,  5; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-2-15. 
 27-2-16. Filing fees  Certificates of compliance. (a) Every insurance company not incorporated in this state applying for admission to transact business in the state shall pay to the insurance commissioner, for the use of the state, for filing a copy of its charter or deed of settlement, the sum of thirty dollars ($30.00), and for filing a statement preliminary to admission, and for filing each annual statement after admission payable prior to April 1 of each year, the sum of one hundred dollars ($100).  (b) A certificate of compliance issued under this chapter shall continue in force as long as the insurer is entitled to it under this chapter and until suspended, revoked, or terminated at the request of the insurer; subject, to continuance of the certificate by the insurer each year by:  (1) Payment prior to April 1 of an annual license fee of one hundred dollars ($100); and  (2) Due filing by the insurer of its annual statement for the preceding calendar year as required under this section.  (c) If not continued in this manner by the insurer, its certificate of compliance shall expire at midnight on June 1 next following the failure of the insurer to continue it in force.  (d) The commissioner may, in his or her discretion, reinstate a certificate of compliance which the insurer has inadvertently permitted to expire, after the insurer has fully cured all its failures which resulted in the expiration, and upon payment by the insurer of the fee in the amount provided in subdivision (b)(1). Otherwise, the insurer shall be granted another certificate of compliance only after filing an application and meeting all other requirements as for an original certificate of compliance in this state.  (e) The commissioner may amend a certificate of compliance at any time to accord with changes in the insurers charter or insuring powers.  (f) The commissioner may assess a late fee of one hundred dollars ($100) per day for each day the insurer is late in filing its annual statement, and ten dollars ($10.00) per day for each day the insurer is late in remitting its annual license fee, except that the insurer may request and receive an extension of the filing date without penalty.  History of Section.G.L. 1896, ch. 182,  25; G.L. 1909, ch. 220,  25; G.L. 1923, ch. 256,  25; G.L. 1938, ch. 151,  25; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-2-16; P.L. 1960, ch. 71, art. 1,  1; P.L. 1971, ch. 283; P.L. 1979, ch. 174, art. 7,  1; P.L. 1987, ch. 289,  1; P.L. 1993, ch. 102,  1; P.L. 1993, ch. 138, art. 62,  9. 
 27-2-17. Reciprocal fees and charges. (a) Whenever, by the laws of any other state of the United States, any fees, charges, taxes, deposits of money or of securities, or other obligations or prohibitions are imposed on insurance companies incorporated or organized under the laws of this state or on the insurance producers of the insurance companies, so long as the laws continue in force, the fees, charges, taxes, deposits, and obligations shall be imposed on the insurance companies doing business in this state which are incorporated or organized under the laws of the other state and on their insurance producers.  (b) Whenever, by the laws of any other state of the United States, insurance companies incorporated or organized under the laws of this state are required to provide a countersignature as a precondition to the issuance, delivery, or making of any contract of insurance in the other state, and whenever the insurance producer of the company is required to pay any fee or commission for placing any insurance coverage in the other state, then the same requirements for countersignatures and fee or commission shall be imposed upon the insurance companies doing business in this state which are incorporated and organized under the laws of the other states and/or their insurance producers.  (c) Whenever insurance companies that are authorized to do business in this state issue, deliver, or make any contract of insurance on a person or property in this state, the companies shall place the business through a licensed resident insurance producer or licensed nonresident insurance producer as permitted under  27-2-3 or any other provision of Rhode Island law; provided, if the insurance to be issued in this state is part of an insurance contract written on a risk whose principal place of business is located in another state, and the insurance contract is placed through an insurance producer of the domiciliary state of the primary insured, it shall be permitted only if that state allows the placement of the business by a licensed nonresident insurance producer of Rhode Island in similar circumstances.  (d) The provisions of this section shall not apply to insurance companies incorporated or organized under the laws of a state or country whose laws do not impose retaliatory taxes or other charges or which grant, on a reciprocal basis, exemptions from those taxes or other charges to insurance companies incorporated or organized under the laws of this state.  History of Section.G.L. 1896, ch. 181,  23; G.L. 1909, ch. 219,  23; P.L. 1914, ch. 1063,  1; G.L. 1923, ch. 255,  23; G.L. 1938, ch. 150,  22; G.L. 1956,  27-2-17; P.L. 1983, ch. 170,  2; P.L. 1984, ch. 346,  1; P.L. 1988, ch. 131,  1; P.L. 1994, ch. 432,  2. 
 27-2-18. Life insurance companies offices. Every life insurance company doing business in this state, and whose premium income received from the inhabitants of this state in any one year shall exceed twenty-five thousand dollars ($25,000), shall equip and maintain an office in this state, satisfactory to the insurance commissioner, for the transaction of business in this state.  History of Section.G.L. 1896, ch. 182,  22; G.L. 1909, ch. 220,  22; P.L. 1909, ch. 382,  1; G.L. 1923, ch. 256,  22; G.L. 1938, ch. 151,  22; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-2-18; P.L. 2006, ch. 84,  1; P.L. 2006, ch. 93,  1. 
 27-2-19. Inquiries as to financial condition. The insurance commissioner may inquire of any life, fire, marine, or fire and marine, or other insurance company, of any name or kind, doing business in this state, or of its secretary, in relation to its financial condition and management, and the inquiry shall be promptly answered.  History of Section.G.L. 1896, ch. 182,  14; G.L. 1909, ch. 220,  14; G.L. 1923, ch. 256,  14; G.L. 1938, ch. 151,  14; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-2-19. 
 27-2-2. Applicability. The general provisions of law relating to the duties, obligations, prohibitions, or penalties which appertain to insurance companies not incorporated under the authority of this state, and defining the powers and duties of the insurance commissioner in reference to those companies, shall be and are applicable to all corporations, companies, and associations not incorporated under the authority of this state, and to all partnerships and individuals, doing, as principals or otherwise, in this state, any insurance business of any name, kind, or description.  History of Section.G.L. 1896, ch. 182,  2; G.L. 1909, ch. 220,  2; G.L. 1923, ch. 256,  2; G.L. 1938, ch. 151,  2; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-2-2. 
 27-2-20. Validity of contracts of non-complying companies  Penalty on insurance producers  Actions by company. If any insurance company, cooperative or otherwise, makes insurance without complying with the provisions of this chapter, the contract shall be valid, but every person acting within this state as an insurance producer of the company within the meaning of chapter 2.4 of this title, respecting the effecting of any insurance, shall be fined not less than three hundred dollars ($300) nor more than one thousand dollars ($1,000). No action at law or suit in equity shall be maintained or recovery had by any insurance company, cooperative or otherwise, or by any assignee of the company or by any person claiming under the assignee or the company, except a domestic receiver of the company, on any contract in any of the courts of this state, so long as the company fails to comply with the provisions of this chapter.  History of Section.G.L. 1896, ch. 182,  17; G.L. 1909, ch. 220,  17; G.L. 1923, ch. 256,  17; G.L. 1938, ch. 151,  17; P.L. 1940, ch. 856,  1; G.L. 1956,  27-2-20. 
 27-2-21. Report and prosecution of violations. The insurance commissioner shall report to the attorney general any violation of the provisions of this chapter that shall come to his or her knowledge. The attorney general shall institute the proper legal proceedings, in the name of the state, against any person violating any provision.  History of Section.G.L. 1896, ch. 182,  24; G.L. 1909, ch. 220,  24; G.L. 1923, ch. 256,  24; G.L. 1938, ch. 151,  24; impl. am. P.L. 1953, ch. 3174,  5: G.L. 1956,  27-2-21. 
 27-2-22. Companies owned or controlled in whole or in part by foreign state or government. No license or certificate of authority to transact any kind of insurance business in this state shall be issued, renewed, or continued in effect to any domestic, foreign, or alien insurance company or other insurance entity which is owned or financially controlled in whole or in part by another state of the United States or by a foreign government or by any political subdivision, instrumentality, or agency of either, or which is an agency or instrumentality of any state government or subdivision, unless the company or entity was owned in this way, controlled, or constituted prior to January 1, 1955, and was authorized to do business in this state on or prior to January 1, 1955.  History of Section.R.P.L. 1957, ch. 162,  1. 
 27-2-23. Discrimination in rates prohibited. (a) No foreign insurance company licensed to do or doing business in this state shall make any distinction or discrimination as to the premiums or rates charged for policies of casualty, fire, home owners, accident and health, or marine insurance, nor shall any company make or permit the rejection of an individuals application for insurance coverage, and the determination of the rate class for the individual, solely on the basis of a disability unless the disability is relevant to the risk of loss, nor shall any company make or require any rebate, diminution, or discount upon the sum to be paid on any policy based on any disability discrimination, nor insert in the policy any condition, nor make any stipulation, where the person insured shall bind himself or herself, his or her heirs, executors, administrators, and assigns, to accept any less sum than the full value or amount of the policy in case of a claim accruing on the policy by reason of the claim of the person insured, other than conditions or stipulations as are imposed upon all persons in similar cases, and any stipulation or condition made in this manner or inserted shall be void.  (b) No foreign insurance company licensed to do or doing business in this state shall make any distinction or discrimination as to the premiums or rates charged for automobile insurance policies, nor shall the company make or permit the rejection of an individuals application for insurance coverage, and the determination of the rate class of the individual, solely on the basis of a disability or the modification of the automobile with specialized equipment that permits an individual with a disability to operate the automobile, unless the disability or modification of the automobile is relevant to the risk of loss, nor shall any insurance company make or require any rebate, diminution, or discount upon the sum to be paid on any policy based on any disability discrimination, nor insert in the policy any condition, nor make any stipulation, where the person insured shall bind himself or herself, his or her heirs, executors, administrators, and assigns, to accept any less sum than the full value or amount of the policy in case of a claim accruing on the policy by reason of the claim of the person insured, other than conditions or stipulations as are imposed upon all persons in similar cases, and any stipulation or condition made or inserted shall be void. The department of business regulation shall enforce the provisions of this section.  History of Section.P.L. 1981, ch. 216,  2; P.L. 1993, ch. 127,  2; P.L. 1993, ch. 285,  2; P.L. 1999, ch. 83,  61; P.L. 1999, ch. 130,  61. 
 27-2-24. Revocation or suspension of license of foreign company. Whenever it appears to the insurance commissioner from the statements, or from an examination of the affairs, of any life, fire, marine, fire and marine, casualty, or other insurance company not incorporated under the authority of this state, that the company is insolvent, or is in an unsound financial condition, or that its business policies are unsound or improper, or that its condition or management is such as to render its further transaction of business hazardous to the public or its policyholders, or that the amount of its funds, net cash, or contingent assets is deficient, or that its capital is impaired, or that it is conducting its business fraudulently or refuses or neglects to comply with the laws of the state relating to insurance companies, it shall be the duty of the insurance commissioner, after notice and hearing, to revoke the license issued to the company and the licenses issued to all of its insurance producers, or the commissioner may revoke those licenses or suspend them for a period not exceeding their unexpired terms.  History of Section.P.L. 1992, ch. 445,  3. 
 27-2-25. Notice of revocation or suspension of license. The insurance commissioner shall give written notice to the company specifying the date on which any revocation or suspension shall be effective, the term of any suspension, and the ground for the revocation or suspension; provided, that if the ground for revocation or suspension is that the company has violated any provision of law or has failed to comply with its charter, the effective date of the revocation or suspension shall be not less than ten (10) days from the date of issue of the notice, and the particulars of the violation or failure to comply with its charter shall be specified in the notice. The notice shall be served by registered or certified mail, sent postage prepaid, and addressed to the company at its last home office address, or in the case of a company of a foreign country, sent to its resident manager in the United States or at his last address appearing on the records of the insurance commissioner. An affidavit of the insurance commissioner in any form as the commissioner may prescribe, or of anyone authorized by him or her to give notice, appended to a copy of the notice, that the notice has been mailed as provided in this section shall be prima facie evidence that the notice has been duly given. The insurance commissioner shall also cause notice of the revocation or suspension to be published in any manner, as the commissioner may deem necessary for the protection of the public.  History of Section.P.L. 1992, ch. 445,  3; P.L. 2002, ch. 292,  8. 
 27-2-26. Business prohibited during suspension or revocation. Any insurance company or its insurance producers shall not make any contracts or issue any policies of insurance in the state after its revocation or suspension is effective or until its license is restored by the insurance commissioner.  History of Section.P.L. 1992, ch. 445,  3. 
 27-2-27. Appeal from revocation or suspension. 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.  History of Section.P.L. 1992, ch. 445,  3. 
 27-2-28. Determination of premium tax rate. The department of business regulation may participate in proceedings under  44-17-1(d) to implement guidelines, directives, criteria, and may promulgate additional resulting rules and regulations pursuant to chapter 35 of title 42 as are necessary to implement  44-17-1(d).  History of Section.P.L. 2016, ch. 538,  3. 
 27-2-3. Reciprocal privileges of nonresident insurance producers. (a) Any commission received by a Rhode Island licensed resident insurance producer may be shared with another licensed resident insurance producer, or with a licensed nonresident insurance producer; provided, that if the nonresident insurance producer resides in, or is a licensed insurance producer in, a state which requires the retention of a stipulated percentage of the commission on risks placed in the state by nonresident insurance producers, then and in that event the Rhode Island resident insurance producer shall require the same percentage of the commission as would be required if a Rhode Island insurance producer should place similar insurance in the state of the residence of the nonresident insurance producer; provided, that if the nonresident insurance producer resides in a state, county, or municipality which by statute or ordinance prohibits the division of commissions on insurance covering property or risks in the city, county, or state of the nonresident insurance producer, then and in that event, it shall be unlawful for the Rhode Island resident insurance producer to pay the nonresident insurance producer any share or portion of the commission on insurance on property or risks in the state of Rhode Island.  (b) This section shall not apply to bid bonds issued by any admitted surety insurer in connection with any public or private contract.  (c) An insurance producer that has been a licensed nonresident insurance producer prior to June 30, 1989, for twelve (12) years or more but whose company is no longer licensed to do business in a reciprocal state after June 30, 1989, may be licensed in Rhode Island as a special nonresident insurance producer.  History of Section.P.L. 1984, ch. 45,  1; P.L. 1989, ch. 383,  1; P.L. 1989, ch. 513,  1; P.L. 1992, ch. 445,  7. 
 27-2-4. Penalty for unlawful business. Any company, officer, or insurance producer violating any of the provisions of  27-2-3 shall be punished by a fine of not less than one hundred dollars ($100) nor more than five hundred dollars ($500) for each offense.  History of Section.G.L. 1896, ch. 182,  7; G.L. 1909, ch. 220,  7; G.L. 1923, ch. 256,  7; G.L. 1938, ch. 151,  7; G.L. 1956,  27-2-4. 
 27-2-5. Minimum capital and surplus requirements  Maximum amount of single risk. No insurance company not incorporated under the authority of this state shall make any contract of insurance with any person in this state unless the capital stock of the company is at least equal to one million dollars ($1,000,000) and the gross paid in and contributed surplus of the company is at least equal to two million dollars ($2,000,000) or, if a mutual company, its net assets over all liabilities amount to not less than three million dollars ($3,000,000), nor unless the company, if other than a life insurance company, shall be restricted, by its charter or otherwise, so that it cannot lawfully incur in any one risk a greater hazard than one-tenth (1/10) part of its capital and surplus if a stock company or of its net assets if a mutual company; provided, that no fire, marine, or fire and marine insurance company of any foreign country shall make any contract of insurance with any person in this state unless the company has two million dollars ($2,000,000) paid-in capital stock and four million dollars ($4,000,000) surplus, or if a foreign mutual company its net assets over all liabilities amount to not less than six million dollars ($6,000,000) and 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 be at all times at or above par and in trust for the benefit of its policyholders in the United States, or if a mono-line business company as defined in this title, has a combined capital and surplus of two million dollars ($2,000,000). Nothing contained in this section shall be construed to apply to foreign insurance companies licensed prior to May 13, 1977.  History of Section.G.L. 1896, ch. 182,  8; P.L. 1906, ch. 1324,  1; G.L. 1909, ch. 220,  8; G.L. 1923, ch. 256,  8; G.L. 1938, ch. 151,  8; P.L. 1953, ch. 3174,  4; G.L. 1956,  27-2-5; P.L. 1977, ch. 278,  1; P.L. 1992, ch. 415,  1; P.L. 2001, ch. 122,  2. 
 27-2-6.1. Special deposit for benefit of policyholders. (a) The insurance commissioner may require any insurance company, association, or society incorporated by or organized under the laws of any other state or government which seeks to make within this state any contract of insurance to make a special deposit as a condition to licensing. The special deposit shall be held in trust and on deposit for the benefit of all Rhode Island policyholders of the company, association, or society. The special deposit may be in any amount and form acceptable to the insurance commissioner. The special deposit shall be deposited with the insurance commissioner or with the general treasurer of this state.  (b) The special deposit shall be held exclusively for the benefit of the Rhode Island policyholders and claimants of the company, notwithstanding the source of the special deposit, and in any agreement entered pursuant to this section the insurer shall grant to the director an interest in the deposit to secure all present and future obligations of the insurer to the policyholders and claimants of the insurer in the state of Rhode Island. The directors interest shall continue until the insurers obligations are fully satisfied or until the deposit is released by the director.  History of Section.P.L. 1998, ch. 71,  1. 
 27-2-6. Certificate of deposit for benefit of policyholders. 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.  History of Section.G.L. 1896, ch. 182,  9; G.L. 1909, ch. 220,  9; P.L. 1915, ch. 1257,  1; G.L. 1923, ch. 256,  9; G.L. 1938, ch. 151,  9; P.L. 1953, ch. 3174,  4; G.L. 1956,  27-2-6; P.L. 1977, ch. 278,  1; P.L. 1978, ch. 120,  1. 
 27-2-7. Charter to be filed. Every insurance company not incorporated under the authority of this state shall, before making any contract of insurance with any person in this state, deposit with the insurance commissioner a copy of the charter of the company.  History of Section.G.L. 1896, ch. 182,  11; G.L. 1909, ch. 220,  11; G.L. 1923, ch. 256,  11; G.L. 1938, ch. 151,  11; P.L. 1953, ch. 3174,  4; G.L. 1956,  27-2-7. 
 27-2-8. Statement as to type of company, investments, and risks. Every company, before making any contract of insurance, shall deposit with the insurance commissioner a statement, signed and sworn to by the president and secretary of the company, specifying that the company is a fire, marine, or fire and marine, life, health, accident, or other insurance company, stating the amount of its capital and the manner of its investment, designating the amount invested respectively in mortgages, public securities, and in the stock of incorporated companies, stating what companies, and also the amount invested in other securities, particularizing each item of investment, the amount of marine risks not terminated and the premium paid on those risks, the amount of fire risks not terminated and the premium paid on those risks, and the amount of liabilities, specifying the amount of outstanding claims adjusted or unadjusted, due or not due. In case the company is incorporated on the mutual principle, the statement shall set forth, in addition to this information, the amount of risks insured by the company, the amount of premium on the risks, what portion of it has been paid in cash, what security has been taken for the remainder, and what is the largest sum insured in any one risk. The statement required to be made in this section, so far as applicable, shall be made of each class in companies authorized to take risks in classes, and in all cases the returns may be varied by the insurance commissioner to obtain more definite information of the company; provided, that not more than one statement needs to be filed on behalf of the company.  History of Section.G.L. 1896, ch. 182,  12; G.L. 1909, ch. 220,  12; G.L. 1923, ch. 256,  12; G.L. 1938, ch. 151,  12; P.L. 1953, ch. 3174,  4; G.L. 1956,  27-2-8. 
 27-2-9. Statement as to capital, assets, and investments. Every life insurance company, health insurance company, livestock, or other insurance company, cooperative, or assessment, shall before making any contract of insurance, deposit with the insurance commissioner a statement signed and sworn to by the president and secretary of the company, specifying the amount of its capital and all of its assets and the manner of its investment, designating the amount invested in mortgages, public securities, and in stock of incorporated companies, stating what companies, and also the amount invested in other securities, particularizing each item of investment, the amount insured by existing policies, the amount of liabilities, specifying the amount of outstanding claims, adjusted or unadjusted, due or not due, and the largest sum insured in any one risk; provided, that no more than one statement needs to be filed on behalf of the company.  History of Section.G.L. 1896, ch. 182,  13; G.L. 1909, ch. 220,  13; G.L. 1923, ch. 256,  13; G.L. 1938, ch. 151,  13; P.L. 1953, ch. 3174,  4; G.L. 1956,  27-2-9. 
 27-20.1-1. Definitions. As used in this chapter: (1) Dental service means the professional services rendered by persons duly licensed under the laws of this state to practice dentistry, and prosthetic dentures, bridges, appliances, or other structures to be used and worn as substitutes for natural teeth, prosthetic appliances, orthodontic appliances, precious metal, and ceramic restorations, necessary in connection with the services and supplied by licensed persons, and drugs, medicines, supplies, and nursing care necessary in connection with the services, or expense indemnity for the services, prosthetic dentures, bridges, appliances, or other structures to be used and worn as substitutes for natural teeth, prosthetic appliances, orthodontic appliances, precious metal and ceramic restorations, drugs, medicines, supplies, and care, as may be specified in any nonprofit dental service plan. Dental service shall not be construed to include hospital services;  (2) Nonprofit dental service corporation means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit dental service plan;  (3) Nonprofit dental service plan means a plan by which specified dental service is provided to subscribers to the plan by a nonprofit dental service corporation; and  (4) Subscribers means those persons or groups of persons who contract with a nonprofit dental service corporation for dental service pursuant to a nonprofit dental service plan.  History of Section.P.L. 1959, ch. 183,  1. 
 27-20.1-10. Nonprofit dental service corporation assessment. (a) Notwithstanding any other provisions of law, each domestic nonprofit dental service corporation shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.  (b) The minimum assessment charged shall be one thousand dollars ($1,000).  History of Section.P.L. 1990, ch. 65, art. 29,  4; P.L. 1993, ch. 180,  18; P.L. 2002, ch. 292,  133. 
 27-20.1-11. Rehabilitation, liquidation, or conservation. (a) Any rehabilitation, liquidations, administrative supervision or conservation of a nonprofit dental service corporation organized under this chapter shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director of business regulation to rehabilitate, liquidate, or conserve a nonprofit dental service corporation upon any one or more of the following grounds:  (1) That the nonprofit dental service corporation is insolvent; for the purposes of this section, the term insolvent means the inability of the nonprofit dental service corporation to meet its debts and financial obligations as they become due;  (2) That the nonprofit dental service corporation fails or refuses to comply with a lawful order of the director of business regulation reasonably designed to correct unsound business policies or practices which, if uncorrected, could reasonably lead to insolvency as defined in subdivision (1) of this subsection; or  (3) That the nonprofit dental service corporations financial condition is such as to render its further transaction of business hazardous to the public or its subscribers or members.  (b) A claim by a health care provider shall not be asserted against any subscriber or member of the nonprofit dental service corporation in the event of the rehabilitation, liquidation, conservation, or administrative supervision of the nonprofit dental service corporation.  History of Section.P.L. 1993, ch. 180,  19. 
 27-20.1-12.1. No derogation of attorney general. 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.  History of Section.P.L. 1998, ch. 90,  8. 
 27-20.1-12. Holding company systems. All of the provisions of chapter 35 of this title apply to corporations organized or licensed pursuant to this chapter. Any approval granted by the director pursuant to chapter 35 of this title do not supersede any other approval under Rhode Island law relative to mergers or other acquisitions of nonprofit dental service corporations in their capacity as Rhode Island charitable nonprofit corporations.  History of Section.P.L. 1993, ch. 180,  19; P.L. 1998, ch. 90,  3; P.L. 2000, ch. 178,  5; P.L. 2000, ch. 200,  15; P.L. 2000, ch. 229,  15. 
 27-20.1-13. Regulations. The director of the department of business regulation may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.  History of Section.P.L. 1993, ch. 180,  19. 
 27-20.1-14. Reserves. Any corporation organized under this title shall maintain total reserves for dental services, separate and distinct from reserves for other health services, in a dollar amount sufficient to pay claims for dental services and operating expenses for not less than one month. Those reserves shall be computed as of each March 31, June 30, September 30 and December 31, and a report setting forth the computation shall be submitted to the director of the department of business regulation together with the corporations Rhode Island quarterly or annual statement to the insurance commissioner of the state of Rhode Island.  History of Section.P.L. 1995, ch. 264,  1. 
 27-20.1-15.1. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies. (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 pharmacys 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 Administrations 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 pharmacys 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.  History of Section.P.L. 2016, ch. 166,  4; P.L. 2016, ch. 168,  4. 
 27-20.1-15. Drug coverage. (a) Any nonprofit dental-service corporation that utilizes a formulary of medications for which coverage is provided under an individual or group plan master contract shall require any physician or other person authorized by the department of health to prescribe medication to prescribe from the formulary. A physician or other person authorized by the department of health to prescribe medication shall be allowed to prescribe medications previously on, or not on, the nonprofit dental-service corporations formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. A nonprofit dental-service corporation shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the nonprofit dental-service corporations medical-exception criteria for the coverage of that medication.  (b) A nonprofit dental-service corporations medical-exception criteria for the coverage of non-formulary medications shall be developed in accordance with  23-17.13-3(c)(3) [repealed].  (c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23 [repealed].  (d) Prior to removing a prescription drug from its plans formulary or making any change in the preferred or tiered, cost-sharing status of a covered prescription drug, a nonprofit dental-service corporation must provide at least thirty (30) days notice to authorized prescribers by established communication methods of policy and program updates and by updating available references on web-based publications. All adversely affected members must be provided at least thirty (30) days notice prior to the date such change becomes effective by a direct notification:  (i) The written or electronic notice must contain the following information:  (A) The name of the affected prescription drug;  (B) Whether the plan is removing the prescription drug from the formulary, or changing its preferred or tiered, cost-sharing status; and  (C) The means by which subscribers may obtain a coverage determination or medical exception, in the case of drugs that will require prior authorization or are formulary exclusions respectively.  (ii) A nonprofit dental-service corporation may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the nonprofit dental-service corporation or the Food and Drug Administration, or removed from the market by their manufacturer, without meeting the requirements of this section.  History of Section.P.L. 1998, ch. 290,  4; P.L. 2016, ch. 541,  4; P.L. 2017, ch. 274,  4; P.L. 2017, ch. 361,  4. 
 27-20.1-16. Magnetic resonance imaging  Quality assurance standards. A magnetic resonance imaging examination eligible for reimbursement by a nonprofit dental services corporation licensed pursuant to this chapter shall be reimbursed only if the provider at which the examination has been conducted and processed, and the licensed physician interpreting the results of the magnetic resonance imaging examination, both meet state approved quality assurance standards for taking, processing, and interpreting magnetic resonance imaging examinations. The director of health has the authority to promulgate rules and regulations necessary to carry out the provisions of this section. The rules and regulations are based upon the most current standards of the American College of Radiology, and approved by the director.  History of Section.P.L. 1999, ch. 169,  5. 
 27-20.1-17. Termination of childrens benefits. (a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive type coverage, except for supplemental policies which only provide coverage for specified diseases and other supplemental policies, shall include a provision that policyholders shall receive no less than thirty (30) days notice from the nonprofit dental service corporation that a child covered as a dependent by the policyholder is about to lose his or her coverage as a result of reaching the maximum age for a dependent child and that the child will only continue to be covered upon documentation being provided of current college enrollment, or that the child may purchase a conversion policy if he or she is not a college student.  (b) Nothing in this section prohibits a nonprofit dental service corporation from requiring a policyholder to annually provide proof of a childs current college enrollment in order to maintain the childs coverage. Provided, nothing in this section requires coverage inconsistent with the membership criteria in effect under the policyholders health benefits coverage.  History of Section.P.L. 2000, ch. 214,  4; P.L. 2002, ch. 292,  40. 
 27-20.1-18. Dental insurance assignment of benefits. Every entity providing nonprofit dental service plan as defined in this chapter shall allow, as a provision in a group or individual policy, contract or health benefit plan for coverage of dental services, any person insured by such entity to direct, in writing, that benefits from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by such entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.  History of Section.P.L. 2004, ch. 268,  4; P.L. 2004, ch. 386,  4. 
 27-20.1-19. Post-payment audits. (a) Except as otherwise provided herein, any review, audit, or investigation by a nonprofit dental service corporation of a healthcare providers claims which 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. 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 specialty, are related to coordination of benefits, 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 payers 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 otherwise referred to as a non-institutional provider.  History of Section.P.L. 2006, ch. 86,  4; P.L. 2006, ch. 97,  4; P.L. 2017, ch. 368,  5; P.L. 2017, ch. 375,  5. 
 27-20.1-2. Organization. (a) Five (5) or more dentists duly licensed to practice under the laws of this state who are members of the Rhode Island State Dental Society and who first obtain authorization to do so by the Rhode Island State Dental Society, as evidenced by an affidavit of the president and secretary of the society, may associate themselves by written articles of association for the incorporation of a nonprofit dental service corporation. The laws of this state relative to insurance companies or to the business of insurance, and acts in amendment of or in addition to them, shall not apply to any nonprofit dental service corporation unless expressly so provided in those laws.  (b) The directors of a nonprofit dental service corporation, other than a corporation organized pursuant to chapter 19 of this title, shall consist of a majority of members of the public not associated with the profession of dentistry and a minority of dentists duly licensed to practice under the laws of this state.  (c) Each nonprofit dental service corporation shall have, in addition to all other powers granted under this chapter and the laws of the state, the power directly or through corporations in which the nonprofit dental service corporation invests or causes to be organized and established and subscribes for all of the capital stock of, the power:  (1) To operate as a nonprofit hospital service corporation, subject to all the requirements of chapter 19 of this title and all of regulatory requirements ancillary to it; and specifically the provisions of  27-19-6; provided, they shall not be subject to  27-19-14 and 27-19-15;  (2) To operate as a nonprofit medical service corporation, subject to all of the requirements of chapter 20 of this title and all of the regulatory requirements ancillary to it; and specifically the provisions of  27-20-6; and  (3) To provide administrative, data processing, consulting, utilization review, systems review, and related services relating to the administration of health care services and health care insurance programs.  (d) Any limitation on investments or holdings provided in  27-20.1-7 and any other provisions of the general laws shall not apply with respect to investments or holdings under this section; provided, that the value of any investment shall not exceed twenty percent (20%) of the assets of the dental service corporation, measured at the time the investment is initially made or added to excluding appreciation or such greater percentage as may be approved in writing by the director of the department of business regulation and the attorney general.  (e) To the extent that the combined value of all investments in subsidiary or other affiliated entities exceeds fifty percent (50%) of the total reserves and unassigned funds of the dental service corporation, the amount in excess of fifty percent (50%) shall be deemed a non admitted asset.  (f) Each nonprofit dental service corporation shall be deemed to be an insurer for the purposes of compliance with chapter 44-17.  History of Section.P.L. 1959, ch. 183,  1; P.L. 1983, ch. 83,  1; P.L. 1993, ch. 47,  1; P.L. 1993, ch. 437,  1; P.L. 2004, ch. 58,  1; P.L. 2004, ch. 88,  1; P.L. 2008, ch. 100, art. 32,  1. 
 27-20.1-20. Plan change notices. Every entity providing a nonprofit dental service plan as defined in this chapter shall notify all dentists providing services under a group or individual policy, contract or health benefit plan for coverage of dental services, in writing, of any changes to its rules and regulations, guidelines, policies or procedures concerning coverage of or payment for dental services. Said notice of changes in terms shall be communicated to the participating dentists by the dental plan in electronic mail format or, in addition, beginning January 1, 2012, and upon the written request of the dentist, received by the nonprofit dental service plan on or before December 31, 2011, by U.S. mail, showing the changes in redline format and shall be provided to the participating dentists no later than fifteen (15) days before the effective date of said changes.  History of Section.P.L. 2011, ch. 236,  1; P.L. 2011, ch. 255,  1. 
 27-20.1-21. Discretionary clauses. (a) No new or existing policy or certificate may contain any provision:  (1) Purporting to reserve sole discretion to the insurance company to determine eligibility for benefits or interpret the terms of a policy or certificate; or  (2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.  (b) Any such clause or language included in a contract, policy or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.  (c) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.  History of Section.P.L. 2013, ch. 85,  5; P.L. 2013, ch. 94,  5. 
 27-20.1-22. Consumer notification. Every nonprofit dental service corporation providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a non-duplication of benefits clause: NO DUPLICATION OF BENEFITS.  History of Section.P.L. 2013, ch. 452,  4; P.L. 2013, ch. 479,  4. 
 27-20.1-3. Contracts. (a) Each nonprofit dental service corporation may contract with its subscribers for a dental service as may be provided under any nonprofit dental service plan adopted by the corporation.  (b) The rates charged by the nonprofit dental service corporation to its subscribers shall be consistent with the proper conduct of its business and the interests of the public and shall at all times be subject to the approval of the director of business regulation.  (c) Nothing contained in this chapter or in any nonprofit dental service plan shall affect the ordinary professional relationship between the person rendering dental services under the plan and the subscriber to whom the services are rendered; and no action based upon or arising out of the relationship or relating to dental services rendered pursuant to a nonprofit dental service plan shall be maintained against the nonprofit dental service corporation operating the plan.  (d) No contract between a nonprofit dental service corporation and a dentist for the provisions of services to patients may require that the dentist indemnify or hold harmless the nonprofit dental service corporation for any expenses and liabilities, including without limitation, judgments, settlements, attorneys fee, court costs, and any associated charges, incurred in connection with any claim or action brought against the nonprofit dental service corporation based on the nonprofit dental service corporations management decisions, or utilization review provisions for any patient.  History of Section.P.L. 1959, ch. 183,  1; P.L. 1999, ch. 481,  4. 
 27-20.1-4. Annual and quarterly statements. (a) Every nonprofit dental service corporation and any nonprofit dental service plan operated by a nonprofit hospital service corporation shall annually, on or before the first day of March in each year, file in the office of the commissioner of insurance a statement, verified by at least two (2) of the principal officers of the corporation, of the condition of the nonprofit dental service corporation or plan on the 31st day of December then next preceding, which statement shall be in general form and context as approved by the National Association of Insurance Commissioners and contain any matters as the director of business regulation shall prescribe including, but not limited to, premiums earned, claims expense, operating expenses, other income and expenses, net gain or loss, reserves, enrollment and enrollment changes separately for dental business for the corporations and shall be available for inspection by the public.  (b) Every nonprofit dental service corporation shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners guidelines and procedures and contain any matters as the director of business regulation shall prescribe, including, but not limited to, premiums earned, claims expense, operating expenses, other income and expenses, net gain or loss, reserves, enrollment and enrollment changes separately for dental business for the corporations and shall be available for inspection by the public.  (c) The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.  History of Section.P.L. 1959, ch. 183,  1; P.L. 1994, ch. 396,  1; P.L. 1994, ch. 404,  3; P.L. 1996, ch. 188,  11. 
 27-20.1-5. Examination of affairs of corporation. It is the duty of the director of business regulation at least every five (5) years to make an examination of the financial condition and methods of doing business of every nonprofit dental service corporation. The examination shall be performed, and the associated costs shall be borne by the company, in accordance with all provisions of chapter 13.1 of this title.  History of Section.P.L. 1959, ch. 183,  1; P.L. 1960, ch. 71, art. 3,  35; P.L. 1994, ch. 404,  3; P.L. 2009, ch. 303,  5; P.L. 2009, ch. 304,  5. 
 27-20.1-6. Commission plans for solicitors or insurance producers. No person shall be engaged to solicit subscribers to any nonprofit dental service plan upon a commission basis or upon any other basis by which the payment of the compensation or expenses of that person shall be conditioned upon the enrollment of subscribers, unless the method of solicitation and rate of compensation shall have had the prior written approval of the director of business regulation.  History of Section.P.L. 1959, ch. 183,  1. 
 27-20.1-7. Investment standards. (a) All nonprofit dental 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 medical 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 are not considered admitted assets.  History of Section.P.L. 1959, ch. 183,  1; P.L. 1999, ch. 45,  3. 
 27-20.1-8. Corporation deemed public charitable institution. Every nonprofit dental service corporation is declared to be, and shall be deemed to be, a charitable institution and shall be subject to the provisions of chapter 6 of title 7, except as otherwise expressly provided in this chapter, and to this chapter.  History of Section.P.L. 1959, ch. 183,  1. 
 27-20.1-9. Adoption of chapter by hospital service corporation. Any nonprofit hospital service corporation organized pursuant to the provisions of chapter 19 of this title, which first obtains authorization to do so by the Rhode Island State Dental Society as evidenced by the affidavit of the president and secretary of the society, may amend its articles of association to adopt the provisions of this chapter, and upon the adoption the corporation shall have and exercise all of the powers and be subject to all of the duties and responsibilities of a nonprofit dental service corporation to the same extent as though it had been incorporated as a nonprofit dental service corporation.  History of Section.P.L. 1959, ch. 183,  1. 
 27-20.10-1. Definitions. For purposes of this chapter, the following definitions shall apply: (1) Contracting entity means any person or entity that enters into direct contracts with providers for the delivery of healthcare services in the ordinary course of business.  (2) Control and under common control with shall mean possession, directly or indirectly, of the power to direct or cause the direction of the management and policies of an entity through the ownership of fifty percent (50%) or more of the voting securities of the entity.  (3) Covered individual means an individual who is covered under a health insurance plan.  (4) Department means the department of business regulation.  (5) Direct notification is a written or electronic communication from a contracting entity to a provider documenting a third-party access to a provider network.  (6) Healthcare services means services for the diagnosis, prevention, treatment or cure of a health condition, illness, injury or disease.  (7)(i) Health insurance plan means any hospital and medical expense incurred policy, nonprofit healthcare service plan contract, health maintenance organization subscriber contract, or any other healthcare plan or arrangement that pays for or furnishes medical or healthcare services, whether by insurance or otherwise.  (ii) Health insurance plan shall not include one or more, or any combination of, the following: coverage only for accident, or disability income insurance; coverage issued as a supplement to liability insurance; liability insurance, including general liability insurance and automobile liability insurance; workers compensation or similar insurance; automobile medical payment insurance; credit-only insurance; coverage for on-site medical clinics; coverage similar to the foregoing as specified in federal regulation issued pursuant to P.L. No. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits; dental or vision benefits; benefits for long-term care, nursing home care, home health care, or community-based care; specified disease or illness coverage, hospital indemnity or other fixed indemnity insurance, or such other similar, limited benefits as are specified in regulations; Medicare supplemental health insurance as defined under  1882(g)(1) of the Social Security Act [42 U.S.C.  1395ss]; coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code; or other similar limited benefit supplemental coverages.  (8)(i) Provider means a physician, a physician organization, or a physician hospital organization that is acting exclusively as an administrator on behalf of a provider to facilitate the providers participation in healthcare contracts.  (ii) Provider does not include a physician organization or physician hospital organization that leases or rents the physician organizations or physician hospital organizations network to a third-party.  (9) Provider network contract means a contract between a contracting entity and a provider specifying the rights and responsibilities of the contracting entity and provider for the delivery of and payment for healthcare services to covered individuals.  (10) Third-party means an organization that enters into a contract with a contracting entity or with another third-party to gain access to a provider network contract.  History of Section.P.L. 2009, ch. 190,  1; P.L. 2009, ch. 209,  1. 
 27-20.10-2. Scope. (a) This chapter shall apply to health insurance corporations subject to chapter 1 of this title, nonprofit hospital or medical service corporations subject to chapters 19 or 20 of this title, and health maintenance organizations incorporated or resident in the state of Rhode Island.  (b) This chapter shall not apply to provider network contracts for services provided to Medicaid, Medicare or state childrens health insurance program (SCHIP) beneficiaries.  (c) This chapter shall not apply in circumstances where access to the provider network contract is granted to an entity operating under common control with or under the same brand licensee program as the contracting entity (affiliate entities). Contracting entities shall, however, make the list of such affiliate entities available on a website or by other means. The affiliate entities shall have the same rights and responsibilities under the provider network contracts as the contracting entities.  (d) This chapter shall not apply to a contract between a contracting entity and a discount medical plan organization.  (e) This chapter shall not apply to any entity, such as employers, church plans or government plans, receiving administrative services from the contracting entity or an affiliate entity. Such exempt entities shall have the same rights and responsibilities under the provider network contracts as the contracting entities, except the exempt entities shall not grant access to a providers healthcare services and contractual discounts to any other entity.  History of Section.P.L. 2009, ch. 190,  1; P.L. 2009, ch. 209,  1. 
 27-20.10-3. Registration. (a) Any person that commences business as a contracting entity shall register with the department within thirty (30) days of commencing business in the state of Rhode Island unless such person is licensed by the department as an insurer. Upon passage of this chapter, each person not licensed by the department as a contracting entity shall register with the department within ninety (90) days of the effective date of this chapter.  (1) Registration shall consist of the submission of the following information:  (i) The official name of the contracting entity, including and d/b/a designations used in this state;  (ii) The mailing address and main telephone number for the contracting entitys main headquarters; and  (iii) The name and telephone number of the contracting entitys representative who shall serve as the primary contact with the department.  (2) The information required by this section shall be submitted in written or electronic format, as prescribed by the department.  (b) The department may collect a reasonable fee for the purpose of administering the registration process.  History of Section.P.L. 2009, ch. 190,  1; P.L. 2009, ch. 209,  1. 
 27-20.10-4. Contracting entity rights and responsibilities. (a) A contracting entity may not grant access to a providers healthcare services and contractual discounts pursuant to a provider network contract unless:  (1) The provider network contract specifically states that the contracting entity may enter into an agreement with a third-party allowing the third-party to obtain the contracting entitys rights and responsibilities under the provider network contract as if the third-party were the contracting entity; and  (2) The third-party accessing the provider network contract is contractually obligated to comply with all applicable terms, limitations and conditions of the provider network contract.  (b) A contracting entity that grants access to a providers healthcare services and contractual discounts pursuant to a provider network contract shall:  (1) Identify and provide to the provider, upon request at the time a provider network contract is entered into with a provider, a written or electronic list of all third-parties known at the time of contracting, to which the contracting entity has or will grant access to the providers healthcare services and contractual discounts pursuant to a provider network contract;  (2) Maintain an Internet website or other readily available mechanism, such as a toll-free telephone number, through which a provider may obtain a listing, updated at least every ninety (90) days, of the third-parties to which the contracting entity or another third-party has executed contracts to grant access to such providers healthcare services and contractual discounts pursuant to a provider network contract;  (3) Provide each third-party who contracts with the contracting entity to gain access to the provider network contract with a summary of the contracting entitys current standard provider contract terms;  (4) Require that the third-party who contracts with the contracting entity to gain access to the provider network contract identify the source of the contractual discount taken by the third-party on each remittance advice (RA) or explanation of payment (EOP) form furnished to a healthcare provider when such discount is pursuant to the contracting entitys provider network contract;  (5)(i) Notify the third-party who contracts with the contracting entity to gain access to the provider network contract of the termination of the provider network contract no later than ten (10) days after receipt of notice of the termination of the provider network contract;  (ii) Require those that are by contract eligible to claim the right to access a providers discounted rate to cease claiming entitlement to those rates or other contracted rights or obligations for services rendered after termination of the provider network contract; and  (iii) The notice required under paragraph (i) above can be provided through any reasonable means, including, but not limited to: written notice, electronic communication, or an update to electronic database or other provider listing.  (c) Subject to any applicable continuity of care requirements, agreements, or contractual provisions:  (1) A third-partys right to access a providers healthcare services and contractual discounts pursuant to a provider network contract shall terminate on the date the provider network contract is terminated;  (2) Claims for healthcare services performed after the termination date of the provider network contract are not eligible for processing and payment in accordance with the provider network contract; and  (3) Claims for healthcare services performed before the termination date of the provider network contract, but processed after the termination date, are eligible for processing and payment in accordance with the provider network contract.  (d)(1) All information made available to provider in accordance with the requirements of this chapter shall be confidential and shall not be disclosed to any person or entity not involved in the providers practice or the administration thereof without the prior written consent of the contracting entity.  (2) Nothing contained in this chapter shall be construed to prohibit a contracting entity from requiring the provider to execute a reasonable confidentiality agreement to ensure that confidential or proprietary information disclosed by the contracting entity is not used for any purpose other than the providers director practice management or billing activities.  History of Section.P.L. 2009, ch. 190,  1; P.L. 2009, ch. 209,  1. 
 27-20.10-5. Third-party rights and responsibilities. (a) A third-party, having itself been granted access to a providers healthcare services and contractual discounts pursuant to a provider network contract, that subsequently grants access to another third-party is obligated to comply with the rights and responsibilities imposed on contracting entities under  27-20.10-4 and 27-20.10-6.  (b) A third-party that enters into a contract with another third-party to access a providers healthcare services and contractual discounts pursuant to a provider network contract is obligated to comply with the rights and responsibilities imposed on third-parties under this  27-20.10-5.  (c)(1) A third-party will provide to the contracting entity the location of a website, or identify another readily available mechanism such as a toll-free telephone number, which the contracting entity will make available to the providers under the provider network contract accessed through the contracting entity. The website or other readily available mechanism will identify the name of the person or entity to which the third-party subsequently grants access to the providers healthcare services and contractual discounts pursuant to the provider network contract.  (2) The website will allow the providers under the contracting entitys provider network contract access to the information referenced in subsection (c)(1) above, and will be updated on a routine basis as additional persons or entities are granted access. The website must be updated to reflect all current persons and entities with access every ninety (90) days. Upon request, a contracting entity shall make updated access information available to a provider via telephone or through direct notification.  History of Section.P.L. 2009, ch. 190,  1; P.L. 2009, ch. 209,  1. 
 27-20.10-6. Unauthorized access to provider network contracts. (a) It is an unfair insurance practice for the purposes of chapter 29 of this title to knowingly access or utilize a providers contractual discount pursuant to a provider network contract without a contractual relationship with the provider, contracting entity, or third-party, as specified in this chapter;  (b) Contracting entities and third-parties are obligated to comply with  27-20.10-4(b)(2) or  27-20.10-5(c)(1) and (2) concerning the services referenced on a remittance advice (RA) or explanation of payment (EOP). A provider may refuse the discount taken on the (RA) or (EOP) if the discount is taken without a contractual basis or in violation of these sections. However, an error in the (RA) or (EOP) may be corrected within thirty (30) days following notice by the provider.  (c) A contracting entity may not lease, rent, or otherwise grant to a third-party, access to a provider network contract unless the third-party accessing the healthcare contract is:  (1) A payer or third-party administrator or another entity that administers or processes claims on behalf of the payer;  (2) A preferred provider organization or preferred provider network, including a physician organization or physician-hospital organization; or  (3) An entity engaged in the electronic claims transport between the contracting entity and the payer that does not provide access to the providers services and discount to any other third-party.  History of Section.P.L. 2009, ch. 190,  1; P.L. 2009, ch. 209,  1. 
 27-20.10-7. Enforcement. Enforcement of this model will follow that of chapter 29 of this title, Unfair Competition and Practices.  History of Section.P.L. 2009, ch. 190,  1; P.L. 2009, ch. 209,  1. 
 27-20.11-1. Mandatory coverage for Autism spectrum disorders. (a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2012, shall provide coverage for autism spectrum disorders; provided, however, the provisions of this chapter shall not apply to contracts, plans or group policies subject to the Small Employer Health Insurance Availability Act, chapter 50 of this title, Medical Assistance, chapter 8 of title 40, or subject to the Individual Health Insurance Coverage Act, chapter 18.5 of this title.  History of Section.P.L. 2011, ch. 159,  1; P.L. 2011, ch. 175,  1; P.L. 2012, ch. 371,  1; P.L. 2012, ch. 397,  1. 
 27-20.11-2. Definitions. As used in this chapter: (1) Applied behavior analysis means the design, implementation and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvements in human behavior, including the use of direct observation, measurement and functional analysis of the relationship between environment and behavior.  (2) Autism spectrum disorders means any of the pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association.  (3) Health insurance carrier or carrier means any entity subject to the insurance laws and regulations of this state, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including, without limitation, an insurance company offering accident and sickness insurance, a health maintenance organization, a nonprofit hospital, medical service corporation, or any other entity subject to chapter 18, 19, 20 or 41 of this title, providing a plan of health insurance, health benefits, or health services.  History of Section.P.L. 2011, ch. 159,  1; P.L. 2011, ch. 175,  1. 
 27-20.11-3. Scope of coverage. (a) Benefits under this section shall include coverage for pharmaceuticals, applied behavior analysis, physical therapy, speech therapy, psychology, psychiatric and occupational therapy services for the treatment of Autism spectrum disorders, as defined in the most recent edition of the DSM. Provided, however:  (1) Coverage for physical therapy, speech therapy and occupational therapy and psychology, psychiatry and pharmaceutical services shall be, to the extent such services are a covered benefit for other diseases and conditions under such policy; and  (2) Applied behavior analysis.  (b) Benefits under this section shall continue until the covered individual reaches age fifteen (15).  (c) The healthcare benefits outlined in this chapter apply only to services delivered within the state of Rhode Island; provided, that all health insurance carriers shall be required to provide coverage for those benefits mandated by this chapter outside of the state of Rhode Island where it can be established through a pre-authorization process that the required services are not available in the state of Rhode Island from a provider in the health insurance carriers network.  History of Section.P.L. 2011, ch. 159,  1; P.L. 2011, ch. 175,  1; P.L. 2012, ch. 371,  1; P.L. 2012, ch. 397,  1; P.L. 2015, ch. 141, art. 5,  5. 
 27-20.11-4. Medical necessity and appropriateness of treatment. (a) Upon request of the reimbursing health insurance carrier, all providers shall furnish medical records or other necessary data which substantiates that initial or continued treatment is at all times medically necessary and appropriate.  (b) Medical necessity criteria may be based in part on evidence of continued improvement as a result of treatment. When the provider cannot establish the medical necessity and/or appropriateness of the treatment modality being provided, neither the health insurer nor the patient shall be obligated to reimburse for that period or type of care that was not established. The exception to the preceding can only be made if the patient has been informed of the provisions of this subsection and has agreed in writing to continue to receive treatment at his or her own expense.  (c) Any subscriber who is aggrieved by a denial of benefits provided under this chapter may appeal a denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23 [repealed].  (d) A health insurance carrier may require submission of a treatment plan, including the frequency and duration of treatment, signed by a child psychiatrist, a behavioral developmental pediatrician, a child neurologist or a licensed psychologist with training in child psychology, that the treatment is medically necessary for the patient and is consistent with nationally recognized treatment standards for the condition such as those set forth by the American Academy of Pediatrics. An insurer may require an updated treatment plan no more frequently than on a quarterly basis.  History of Section.P.L. 2011, ch. 159,  1; P.L. 2011, ch. 175,  1. 
 27-20.11-5. Limits on cost sharing. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each health insurance carrier. Except as otherwise provided in this section, any policy, contract or certificate that provides coverage for services under this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are no more extensive than coverage provided for other conditions or illnesses. Coverage for autism spectrum disorders is otherwise subject to the same terms and conditions of the policy as any other condition or illness.  History of Section.P.L. 2011, ch. 159,  1; P.L. 2011, ch. 175,  1. 
 27-20.11-6. Educational and other services provided to children diagnosed with Autism spectrum disorders. Nothing in this section shall be construed to alter any obligation of a school district or the state of Rhode Island to provide services to an individual under an individualized family service plan or an individualized education program, as required under the federal Individuals with Disabilities Education Act, or the provision of services to an individual under any other federal or state law. A health insurance carrier assessed for services provided under  42-12-29, childrens health account, shall not be required to provide duplicative coverage for the same beneficiary for the same or similar services mandated under this section.  History of Section.P.L. 2011, ch. 159,  1; P.L. 2011, ch. 175,  1. 
 27-20.11-7. Credentials. (a) Any individual providing or supervising applied behavior analysis treatment under this section shall be:  (1) Individually licensed by the department of health as a licensed applied behavior analyst; or a licensed applied behavior assistant analyst acting under supervision; or  (2) Licensed by the department of health as a psychologist with equivalent experience or a psychologist practicing within their scope of practice.  (b) Nothing in this chapter shall be construed to require a change in the credentialing or contracting practices of health insurers for mental health or substance abuse providers.  History of Section.P.L. 2011, ch. 159,  1; P.L. 2011, ch. 175,  1; P.L. 2012, ch. 371,  1; P.L. 2012, ch. 397,  1. 
 27-20.11-8. Exclusions. This chapter 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.  History of Section.P.L. 2011, ch. 159,  1; P.L. 2011, ch. 175,  1. 
 27-20.2-1. Definitions. As used in this chapter: (1) Nonprofit optometric service corporation means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit optometric service plan;  (2) Nonprofit optometric service plan means a plan by which specified optometric service is provided to subscribers to the plan by a nonprofit optometric service corporation;  (3) Optometric service means the professional services rendered by persons duly licensed under the laws of this state to practice optometry or the expense indemnity for the services, appliances, supplies, and care as may be specified in any nonprofit optometric service plan. Optometric service shall not be construed to include hospital services; and  (4) Subscribers means those persons or groups of persons who contract with a nonprofit optometric service corporation for optometric service pursuant to a nonprofit optometric service plan.  History of Section.P.L. 1960, ch. 69,  1. 
 27-20.2-10. Nonprofit optometric service corporation assessment. (a) Notwithstanding any other provisions of law, each domestic nonprofit optometric service corporation shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.  (b) The minimum assessment charged shall be one thousand dollars ($1,000).  History of Section.P.L. 1990, ch. 65, art. 29,  5; P.L. 1993, ch. 180,  20; P.L. 2002, ch. 292,  134. 
 27-20.2-11. Rehabilitation, liquidation, or conservation. (a) Any rehabilitation, liquidation, administrative supervision, or conservation of a nonprofit optometric service corporation organized under this chapter shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director of business regulation to rehabilitate, liquidate, or conserve a nonprofit optometric service corporation upon any one or more of the following grounds:  (1) That the nonprofit optometric service corporation is insolvent; for the purposes of this section, the term insolvent means the inability of the nonprofit optometric service corporation to meet its debts and financial obligations as they become due;  (2) That the nonprofit optometric service corporation fails or refuses to comply with a lawful order of the director of business regulations reasonably designed to correct unsound business policies or practices which, if uncorrected, could reasonably lead to insolvency as defined in subdivision (1) of this subsection; or  (3) That the nonprofit optometric service corporations financial condition is such as to render its further transaction of business hazardous to the public or its subscribers or members.  (b) A claim by a health care provider shall not be asserted against any subscriber or member of the nonprofit optometric service corporation in the event of the rehabilitation, liquidation, conservation, or administrative supervision of the nonprofit optometric service corporation.  History of Section.P.L. 1993, ch. 180,  21. 
 27-20.2-12.1. No derogation of attorney general. 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.  History of Section.P.L. 1998, ch. 90,  9. 
 27-20.2-12. Holding company systems. All of the provisions of chapter 35 of this title apply to corporations organized or licensed pursuant to this chapter. Any approval granted by the director pursuant to chapter 35 of this title do not supersede any other approval under Rhode Island law relative to mergers or other acquisitions of nonprofit optometric service corporations in their capacity as Rhode Island charitable nonprofit corporations.  History of Section.P.L. 1993, ch. 180,  21; P.L. 1998, ch. 90,  4; P.L. 2000, ch. 178,  6; P.L. 2000, ch. 200,  16; P.L. 2000, ch. 229,  16. 
 27-20.2-13. Regulations. The director of business regulation may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.  History of Section.P.L. 1993, ch. 180,  21. 
 27-20.2-14. Termination of childrens benefits. (a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive type coverage, except for supplemental policies which only provide coverage for specified diseases and other supplemental policies, shall include a provision that policyholders shall receive thirty (30) days notice from the nonprofit optometric service corporation that a child covered as a dependent by the policyholder is about to lose his or her coverage as a result of reaching the maximum age for a dependent child and that the child will only continue to be covered upon documentation being provided of current college enrollment, or that the child may purchase a conversion policy if he or she is not a college student.  (b) Nothing in this section prohibits a nonprofit optometric service corporation from requiring a policyholder to annually provide proof of a childs current college enrollment in order to maintain the childs coverage. Provided further, nothing in this section requires coverage inconsistent with the membership criteria in effect under the policyholders health benefits coverage.  History of Section.P.L. 2000, ch. 214,  5; P.L. 2002, ch. 292,  41. 
 27-20.2-2. Organization. (a) Five (5) or more optometrists duly licensed to practice under the laws of this state who are members of the Rhode Island Optometric Association and who first obtain authorization to do so by the Rhode Island Optometric Association, as evidenced by an affidavit of the president and secretary of the association, may associate themselves by written articles of association for the incorporation of a nonprofit optometric service corporation under the provisions of chapter 6 of title 7.  (b) The laws of this state relative to insurance companies or to the business of insurance, and acts in amendment of or in addition to them, shall not apply to any nonprofit optometric service corporation unless expressly so provided in the laws.  (c) A majority of the directors of a nonprofit optometric service corporation, other than a corporation organized pursuant to the provisions of chapter 19 of this title, must at all times be optometrists duly licensed to practice under the laws of this state.  History of Section.P.L. 1960, ch. 69,  1. 
 27-20.2-3. Contracts. (a) Each nonprofit optometric service corporation may contract with its subscribers for an optometric service under any nonprofit optometric service plan adopted by the corporation.  (b) The rates charged by the nonprofit optometric service corporation to its subscribers shall be consistent with the proper conduct of its business and the interests of the public, and shall at all times be subject to the approval of the director of business regulation.  (c) Nothing contained in this chapter or in any nonprofit optometric service plan shall affect the ordinary professional relationship between the person rendering optometric services under the plan and the subscriber to whom the services are rendered; and no action based upon or arising out of the relationship or relating to optometric services rendered pursuant to a nonprofit optometric service plan shall be maintained against the nonprofit optometric service corporation operating the plan.  History of Section.P.L. 1960, ch. 69,  1. 
 27-20.2-4. Annual and quarterly statements. (a) Every nonprofit optometric service corporation shall annually, on or before the first day of March in each year, file in the office of the commissioner of insurance a statement, verified by at least two (2) of the principal officers of the corporation, of its condition on the 31st day of December then next preceding, which statement shall contain any matters the director of business regulation shall prescribe and shall be available for inspection by the public.  (b) Every nonprofit optometric service corporation shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners guidelines and procedures, and shall be available for inspection by the public.  (c) The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.  History of Section.P.L. 1960, ch. 69,  1; P.L. 1994, ch. 404,  4; P.L. 1996, ch. 188,  12. 
 27-20.2-5. Examination of affairs of corporation. It shall be the duty of the director of business regulation to make an examination of the financial condition and methods of doing business of every nonprofit optometric service corporation. The examination shall be performed, and the associated costs shall be borne by the company, in accordance with all provisions of chapter 13.1 of this title.  History of Section.P.L. 1960, ch. 69,  1; P.L. 1994, ch. 404,  4. 
 27-20.2-6. Commission plans for solicitors or insurance producers. No person shall be engaged to solicit subscribers to any nonprofit optometric service plan upon a commission basis or upon any other basis by which the payment of the compensation or expenses of the person shall be conditioned upon the enrollment of subscribers, unless the method of solicitation and rate of compensation shall have had the prior written approval of the director of business regulation.  History of Section.P.L. 1960, ch. 69,  1. 
 27-20.2-7. Investment standards. (a) All nonprofit optometric 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 optometric 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 are not considered admitted assets.  History of Section.P.L. 1960, ch. 69,  1; P.L. 1999, ch. 45,  4. 
 27-20.2-8. Corporation deemed public charitable institution. Every nonprofit optometric service corporation is declared to be, and shall be deemed to be, a charitable institution and an incorporated public charitable institution and shall be subject to the provisions of chapter 6 of title 7, except as otherwise expressly provided in this chapter, and to this chapter.  History of Section.P.L. 1960, ch. 69,  1. 
 27-20.2-9. Adoption of chapter by hospital service corporation. Any nonprofit hospital service corporation organized pursuant to the provisions of chapter 19 of this title, which first obtains authorization to do so by the Rhode Island Optometric Association as evidenced by the affidavit of the president and secretary of the association, may amend its articles of association to adopt the provisions of this chapter, and upon that adoption the corporation shall have and exercise all of the powers and be subject to all of the duties and responsibilities of a nonprofit optometric service corporation to the same extent as though it had been incorporated as a nonprofit optometric service corporation.  History of Section.P.L. 1960, ch. 69,  1; P.L. 2002, ch. 292,  41. 
 27-20.3-1. Definitions. As used in this chapter: (1) Legal service means the professional services rendered by persons duly licensed under the laws of this state to engage in the practice of law who have agreed to perform services as may be specified under any nonprofit prepaid legal service plan, and to accept payment for the services on the basis provided in the plan. The plan shall assure that every subscriber will be able to choose any attorney he or she desires who has agreed to participate as a member of a nonprofit prepaid legal service plan, and if a subscriber has no preference, a fair method shall be available to insure that every attorney who has agreed to participate as a member of a nonprofit prepaid legal service plan is given an equal opportunity to be selected for legal service;  (2) Nonprofit prepaid legal service corporation means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit prepaid legal services plan;  (3) Nonprofit prepaid legal services plan means any plan by which reimbursement for specified legal services is provided to participating attorneys or subscribers to the plan by a nonprofit prepaid legal service corporation, and the plan shall be open for participation to all qualified, practicing members of the Rhode Island Bar Association; and  (4) Subscribers means those persons or groups of persons who shall contract with a nonprofit legal service corporation for reimbursement for specified legal services pursuant to a nonprofit legal services plan.  History of Section.P.L. 1976, ch. 179,  1. 
 27-20.3-10. Nonprofit legal service corporation assessment. (a) Notwithstanding any other provisions of law, each domestic nonprofit legal service corporation shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.  (b) The minimum assessment charged shall be one thousand dollars ($1,000).  History of Section.P.L. 1990, ch. 65, art. 29,  6; P.L. 1993, ch. 180,  22; P.L. 2002, ch. 292,  135. 
 27-20.3-11. Rehabilitation, liquidation, or conservation. (a) Any rehabilitation, liquidation, administrative supervision, or conservation of a nonprofit legal service corporation organized under this chapter shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director of business regulation to rehabilitate, liquidate, or conserve a nonprofit legal service corporation upon any one or more of the following grounds:  (1) That the nonprofit legal service corporation is insolvent; for the purposes of this section, the term insolvent means the inability of the nonprofit legal service corporation to meet its debts and financial obligations as they become due;  (2) That the nonprofit legal service corporation fails or refuses to comply with a lawful order of the director of business regulation reasonably designed to correct unsound business policies or practices which, if uncorrected, could reasonably lead to insolvency as defined in subdivision (1) of this subsection; or  (3) That the nonprofit legal service corporations financial condition is such as to render its further transaction of business hazardous to the public or its subscribers or members.  (b) A claim by a health care provider shall not be asserted against any subscriber or member of the nonprofit legal service corporation in the event of the rehabilitation, liquidation, conservation, or administrative supervision of the nonprofit legal service corporation.  History of Section.P.L. 1993, ch. 180,  23. 
 27-20.3-12. Holding company systems. All provisions of chapter 35 of this title apply to corporations organized or licensed pursuant to this chapter. Any approval granted by the director pursuant to chapter 35 of this title shall not supersede any other approval under Rhode Island law relative to mergers or other acquisitions of nonprofit legal service corporations in their capacity as Rhode Island charitable nonprofit corporations.  History of Section.P.L. 1993, ch. 180,  23; P.L. 2000, ch. 178,  7; P.L. 2000, ch. 200,  17; P.L. 2000, ch. 229,  17. 
 27-20.3-13. Regulations. The director of business regulation may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.  History of Section.P.L. 1993, ch. 180,  23. 
 27-20.3-2. Organization. (a) Five (5) or more lawyers duly licensed to practice under the laws of this state who are members of the Rhode Island Bar Association and who first obtain authorization to do so by the Rhode Island Bar Association, as evidenced by an affidavit of the president and secretary of the association, may associate themselves by written articles of association for the incorporation of a nonprofit prepaid legal service corporation. The laws of this state relative to insurance companies or to the business of insurance, and acts in amendment of or in addition to them, shall not apply to any nonprofit prepaid legal service corporation unless expressly so provided in the laws. Nonprofit prepaid legal service corporations shall have all of the corporate powers of nonbusiness corporations as specified in chapter 6 of title 7.  (b) The directors of any nonprofit prepaid legal service corporation shall consist of an equal number of attorneys duly licensed to practice under the laws of this state and of persons representing the public who are not attorneys.  History of Section.P.L. 1976, ch. 179,  1. 
 27-20.3-3. Contracts. (a) A nonprofit prepaid legal service corporation may contract with its subscribers for legal services that may be provided under any nonprofit prepaid legal services plan adopted by the corporation.  (b) Every nonprofit prepaid legal service corporation shall, before accepting applications for participation in a nonprofit prepaid legal services plan, establish a reserve fund of not less than ten percent (10%) of the claims and expenses projected by the board of directors of the corporation for its first fiscal year of operation. At the time or times that the corporation shall adjust its rates, it shall include a factor for the protection of its subscribers projected to produce a reserve fund at the end of the rating period applied for of not less than ten percent (10%) of the most recent twelve (12) months of claims and operating expenses available at the time of filing its request for approval of the rates.  (c) The rates charged by the nonprofit prepaid legal service corporation to its subscribers shall be consistent with the proper conduct of its business and the interests of the public, and shall at all times be subject to the approval of the director of business regulation.  (d) Nothing contained in this chapter or in any nonprofit prepaid legal service plan shall affect the ordinary professional relationship between the person rendering legal services under the plan and the subscriber to whom the services are rendered; and no action based upon or arising out of the relationship or relating to legal services rendered pursuant to a nonprofit prepaid legal services plan shall be maintained against the nonprofit prepaid legal service corporation operating the plan.  History of Section.P.L. 1976, ch. 179,  1. 
 27-20.3-4. Annual and quarterly statements. (a) Every nonprofit prepaid legal service corporation shall annually, on or before the first day of March in each year, file in the office of the commissioner of insurance a statement, verified by at least two (2) of the principal officers of the corporation, of its condition on the thirty-first day of December then next preceding, which statement shall contain any matters relating to its financial operation, financial condition, and reserves as the director of business regulation shall prescribe, and shall be available for inspection by the public.  (b) Every nonprofit prepaid legal service corporation shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners guidelines and procedures, and shall be available for inspection by the public.  (c) The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.  History of Section.P.L. 1976, ch. 179,  1; P.L. 1994, ch. 404,  5; P.L. 1996, ch. 188,  13. 
 27-20.3-5. Examination of affairs of corporation. It shall be the duty of the director of business regulation to make an examination of the financial condition and methods of doing business of every nonprofit prepaid legal service corporation. The examination shall be performed, and the associated costs shall be borne by the company, in accordance with all provisions of chapter 13.1 of this title.  History of Section.P.L. 1976, ch. 179,  1; P.L. 1994, ch. 404,  5. 
 27-20.3-6. Commission plans for solicitors or insurance producers. No person shall be engaged to solicit subscribers to any nonprofit prepaid legal services plan upon a commission basis or upon any other basis by which the payment of the compensation or expenses of the person shall be conditioned upon the enrollment of subscribers, unless the method of solicitation and rate of compensation shall have had the prior written approval of the director of business regulation.  History of Section.P.L. 1976, ch. 179,  1. 
 27-20.3-7. Investment standards. (a) All nonprofit prepaid legal 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 prepaid legal 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 are not considered admitted assets.  History of Section.P.L. 1976, ch. 179,  1; P.L. 1999, ch. 45,  5. 
 27-20.3-8. Corporation deemed public charitable institution. Every nonprofit prepaid service corporation is declared to be, and shall be deemed to be, a charitable institution and shall be subject to the provisions of chapter 6 of title 7, except as otherwise expressly provided in this chapter, and to this chapter.  History of Section.P.L. 1976, ch. 179,  1. 
 27-20.3-9. Operational agreements. (a) Any nonprofit hospital service corporation, organized pursuant to provisions of chapter 19 of this title, is authorized to enter into administrative agreements with nonprofit prepaid legal service corporations organized pursuant to the provisions of this chapter.  (b) Nonprofit prepaid legal service corporations, organized pursuant to the provisions of this chapter, are authorized to enter into administrative agreements with any nonprofit hospital service corporation organized pursuant to the provisions of chapter 19 of this title or commercial insurance companies duly licensed and authorized to conduct business in this state.  (c) In the event a nonprofit prepaid legal service corporation, organized pursuant to the provisions of this chapter, enters into an administrative agreement with a commercial insurance company duly licensed and authorized to conduct business in this state, nothing contained in this chapter shall be construed to exempt the commercial insurance company from the laws of this state regulating insurance companies or the regulations of the director of business regulation applicable to the company.  History of Section.P.L. 1976, ch. 179,  1. 
 27-20.4-1. Continuation of health plan coverage for former spouse. (a) In the event of a final judgment of divorce, whether absolute or otherwise, where one party to the divorce was at the time of the entry of the judgment for divorce a member of a health plan providing family coverage regulated under chapters 18, 19, 20, or 20.1 of this title and  42-62-13, or a member of a health maintenance organization as defined in  42-62-4(5), or any similar health plan whether regulated under these chapters and sections or not, the person who was the spouse of the party prior to the entry of judgment for divorce may remain eligible for continuing benefits under the plan and health maintenance organization without additional premium or examination if the order is included in the judgment when entered. The eligibility shall continue as long as the original member is a participant in the plan or health maintenance organization and until either one of the following shall take place: (1) the remarriage of either party to the divorce, or (2) until a time as provided by the judgment for divorce. If the person who was the spouse of a member of a plan or health maintenance organization as set forth in this subsection becomes eligible to participate in a comparable plan or health maintenance organization through his or her own employment, the continuation of the original plan coverage shall cease. Any final decree continuing family health insurance shall require both the member and the spouse to notify the insurer promptly of any remarriage.  (b) The person who was the spouse and remains eligible for continuing benefits under the provisions of this section or any custodial guardian of an insured minor child of the original member, having paid for covered medical costs subject to reimbursement, shall be reimbursed directly by the insurer upon the filing of the claim. The insurer shall not require that the claim be filed through the insured member, but must allow for direct filing.  History of Section.P.L. 1983, ch. 148,  1; P.L. 1984, ch. 32,  1; P.L. 1993, ch. 276,  1. 
 27-20.4-2. Effect of remarriage on continuation of plan coverage. If a member of a health plan or health maintenance organization as set forth in  27-20.4-1 shall be excluded from coverage by the remarriage of his or her former spouse, the person excluded shall have the right to purchase within thirty (30) days without evidence of insurability an individual policy from the health plan or health maintenance organization previously insuring that person.  History of Section.P.L. 1983, ch. 148,  1. 
 27-20.4-3. Definitions. As used in this chapter, the following terms have the following meaning: (1) Director means the director of the department of business regulation;  (2) Individual contract means any health benefit contract that is not a group contract;  (3) Insurer means every medical service corporation, hospital service corporation, health maintenance organization licensed under chapter 41 of this title or as defined in  42-62-4, or insurance company offering and/or insuring health services;  (4) Late enrollee means a person who requests enrollment in a group plan following the initial enrollment period provided under the terms of the plan, except that a person is not a late enrollee if:  (i) The request for enrollment is made within thirty (30) days after the termination of coverage under a prior contract or policy and the individual did not request coverage initially under the succeeding contract because that individual was covered under a prior contract and coverage under that contract ceased due to termination of employment, death of a spouse, or divorce; or  (ii) A court has ordered that coverage be provided for a spouse or minor child under a covered employees plan and the request for coverage is made within thirty (30) days after issuance of the court order;  (5) Prior contract means the group or individual health benefit contract or health benefit plan that previously covered the person;  (6) Replacement contract means a total group health benefit contract which replaces another total group health benefit contract;  (7) Succeeding contract means the group health benefit contract under which the person is seeking coverage or a different health benefit plan under the same group health benefit contract; and  (8) Total group contract means a health benefit contract for the coverage of all eligible members of the employer health plan.  History of Section.P.L. 1991, ch. 321,  1; P.L. 1992, ch. 387,  1. 
 27-20.4-4. Continuity on replacement of total group contract. (a) Notwithstanding any other provision of law, this section applies to all health plans providing coverage regulated by chapters 18, 19, 20, 20.1 and 41 of this title and to all total group contracts, except group long term care policies issued by an insurer to contract holders who are obtaining coverage to replace coverage under a different contract or policy issued by any insurer.  (b) This section provides continuity of coverage to eligible persons under the succeeding contract who were covered under a total group contract at any time during the ninety (90) days before the discontinuance of the total group contract, when that contract is replaced by another total group contract.  (c) In a replacement contract subject to this section, an insurer may not, for any person described in subsection (b) of this section:  (1) Request that the person provide or seek to obtain evidence of insurability other than to:  (i) Determine whether the group as a whole is insurable;  (ii) Determine rates for the whole group; and  (iii) Make reinsurance decisions;  (2) Decline to enroll the person on the basis of evidence of insurability if the person is eligible for coverage; or  (3) Impose a period during which benefits are excluded or limited with respect to preexisting conditions on that person, except as provided in this section.  (d) Notwithstanding subsection (c) of this section, any person who was covered under the replaced total group contract for fewer than ninety (90) continuous days may be subject to a preexisting condition exclusion or waiting period in the replacement contract, provided the period is not longer than ninety (90) days and credit is given for satisfaction or partial satisfaction of any preexisting condition exclusions or limitations under the replaced total group contract.  (e) The insurer that issued the replaced contract or policy is liable after the discontinuance of that contract or policy only to the extent of its accrued liability and any extensions of benefits provided in its contract.  History of Section.P.L. 1991, ch. 321,  1; P.L. 1992, ch. 387,  1; P.L. 1994, ch. 381,  1. 
 27-20.4-5. Continuity of coverage for individual who changes groups, changes insurers within the same group, or changes benefit plans provided by the same insurer. (a) This section applies to all health benefit group contracts issued by an insurer when a member of the group changes from one group to another group due to a change in employment, or when due to the action of the employer or insurer is: (1) forced to change from one benefit plan to another; or (2) forced to change from one insurer to another.  (b) Except as provided in subsection (c) of this section, this section provides continuity of coverage for a person who seeks coverage under a succeeding contract if coverage under the prior contract is terminated within three (3) months before the date the person enrolls or is eligible to enroll in the succeeding contract. No period of ineligibility for any health plan imposed by terms of employment may be considered in determining whether the coverage ended within three (3) months of the date the person enrolls or would be eligible to enroll, and if:  (1) That person was covered under an individual or group contract or policy issued by any insurer and that persons health benefit plan was eliminated by the employer or the insurer; or  (2) That person was covered under an individual or group contract or policy issued by any insurer and that person has terminated employment and at, or following, termination of employment that person is not eligible or is no longer eligible for COBRA continuation coverage under group health plans as provided for in 42 U.S.C.  300bb-1 et seq., or for extended medical benefits as provided in Chapter 19.1 of this title.  (c) Notwithstanding subsection (b) of this section, this section does not provide continuity of coverage for a late enrollee.  (d) Except as otherwise provided in this section, in a group health benefit contract subject to this section, any insurer covering employees of the employer must, for any person described in subsection (b) of this section, waive any medical underwriting, but only to the extent that the underwriting is used to exclude a specific condition or the person, or waive preexisting conditions exclusion or limitations to the extent that benefits would have been payable under the prior contract if that contract were still in effect. The issuer of the succeeding contract is not required to duplicate any benefits covered by the issuer of the prior contract.  History of Section.P.L. 1991, ch. 321,  1; P.L. 1992, ch. 387,  1. 
 27-20.4-6. Jurisdiction. This chapter shall apply to policies and certificates issued, delivered, or renewed in the state of Rhode Island and certificates of multiple employer trusts located in other states where the employer is located in the state of Rhode Island.  History of Section.P.L. 1992, ch. 387,  2. 
 27-20.4-7. Rulemaking authority. The director shall issue regulations in accordance with chapter 35 of title 42 for the implementation and administration of this chapter.  History of Section.P.L. 1992, ch. 387,  2. 
 27-20.4-8. Penalties. Whenever the director shall have cause to believe that a violation of this chapter or the regulations promulgated pursuant to this chapter has occurred, the director may, in accordance with the requirements of the Administrative Procedures Act, chapter 35 of title 42, revoke or suspend a license, levy an administrative penalty in an amount not less than five hundred dollars ($500) nor more than five thousand dollars ($5,000), order the violator to cease marketing any health benefit plans in the state, require the violator to take any actions necessary to comply with the provisions of law, or any combination of these actions.  History of Section.P.L. 1992, ch. 387,  2. 
 27-20.4-9. Limited benefit policy  Exclusion. Any long term care insurance policy and any accident and sickness insurance policy whose benefits are limited to income protection or the furnishing of disability income or a limited health benefit coverage are excluded from the provisions of this chapter. A limited benefit policy, for the purposes of this section, is any accident or sickness policy that covers one or more specified risks including, but not limited to, accidental death or injury or specified disease.  History of Section.P.L. 1992, ch. 387,  2. 
 27-20.5-1. Restriction on participation prohibited. It shall be unlawful for any nonprofit medical service corporation, hospital service corporation, health maintenance organization, or any other insurer offering and/or insuring health services on a prepaid basis as defined in  42-62-4(7), or any other person, to provide that providers of medical services defined in  27-20-1 shall render those services exclusively to subscribers of any one particular nonprofit or for-profit medical service corporation, hospital service corporation, health maintenance organization, insurers, or any other person in order for the provider to be a participant in the nonprofit or for-profit medical service corporation, hospital service corporation, health maintenance organization, or any other person; provided, that this section shall not apply to medical service providers who voluntarily agree to render those services on a full-time basis to a health maintenance organization.  History of Section.P.L. 1986, ch. 456,  1. 
 27-20.6-1. Definitions. As used in this chapter, the following terms shall have the following meanings: (1) Insurer means every nonprofit medical service corporation, hospital service corporation, health maintenance organization, or other insurer offering and/or insuring health services; the term shall in addition include any entity defined as an insurer under  42-62-4; and  (2) Primary insurer means the insurer primarily liable in accordance with the anti-duplication provisions established by regulations promulgated by the director of business regulation.  History of Section.P.L. 1989, ch. 373,  1. 
 27-20.6-2. Coordination of information. Every insurer issuing contracts for health care coverage which contain a provision for the coordination of benefits shall exchange information with respect to those contracts with other insurers as may be necessary to coordinate benefits in order to avoid duplication of payments for the same health care services rendered.  History of Section.P.L. 1989, ch. 373,  1. 
 27-20.6-3. Reimbursement. Each primary insurer, to the extent of its contractual liability, shall reimburse any other insurer any amounts actually paid by the other insurer for health care services rendered; provided, no insurer shall reimburse for any benefit or coverages in excess of those specified in the contract.  History of Section.P.L. 1989, ch. 373,  1. 
 27-20.6-4. Failure to comply. The failure of any insurer to comply with a written request for reimbursement within forty-five (45) days of receipt of the request shall result in the imposition of interest upon the amount of money due at the rate of one percent (1%) per month from the date the request for reimbursement was made until the date payment is made.  History of Section.P.L. 1989, ch. 373,  1. 
 27-20.6-5. Arbitration. (a) Whenever there exists a dispute between insurers under the provisions of this chapter, the dispute shall be submitted for resolution to an impartial, independent arbitrator who has no affiliation with either party to the dispute. The arbitrator shall be mutually agreed upon by the parties to the dispute. In the event that no mutual agreement can be reached, the arbitrator shall be appointed by the director of the department of business regulation from the list established under subsection (b) of this section. The fees of the arbitrator shall be paid by the losing party.  (b) The director of the department of business regulation shall establish a list of authorized arbitrators, each of whom shall be a member in good standing of the Rhode Island Bar Association, for use pursuant to the provisions of this section.  History of Section.P.L. 1989, ch. 373,  1. 
 27-20.6-6. Rules and regulations. The director of the department of business regulation shall promulgate rules and regulations, using the NAIC coordination of benefits model regulations as a guideline, which shall address: (1) the necessity and/or reasonableness of administrative penalties by entities subject to this chapter; (2) other procedures which may be necessary to carry out the provisions of this chapter.  History of Section.P.L. 1989, ch. 373,  1; P.L. 2002, ch. 292,  42. 
 27-20.7-1. Short title. This chapter shall be known as The Third Party Health Insurance Administrators Act. History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-10. Notice and disclosure of charges and fees. (a) When the services of an administrator are utilized, the administrator shall provide a written notice approved by the insurer to covered individuals advising them of the identity of, and relationship among, the administrator, the policyholder and the insurer.  (b) When an administrator collects funds, the reason for collection of each item must be identified to the insured party and each item must be shown separately from any premium. Additional charges may not be made for services to the extent the services have been paid for by the insurer.  (c) The administrator shall disclose to the insurer all charges, fees and commissions received from all services in connection with the provision of administrative services for the insurer, including any fees or commissions paid by insurers providing reinsurance.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-11. Delivery of materials. Any policies, certificates, booklets, termination notices or other written communications delivered by the insurer to the administrator for delivery to insured parties or covered individuals shall be delivered by the administrator promptly after receipt of instructions from the insurer to deliver them.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-12. Certificate of authority required. (a) No person shall act as, or offer to act as, or hold himself or herself out to be an administrator in this state without a valid certificate of authority as an administrator issued by the commissioner.  (b) Applicants to be an administrator shall make an application to the commissioner upon a form to be furnished by the commissioner. The application shall include or be accompanied by the following information and documents:  (1) All basic organizational documents of the administrator, including any articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, shareholder agreement and other applicable documents and all amendments to those documents;  (2) The bylaws, rules, regulations or similar documents regulating the internal affairs of the administrator;  (3) The names, addresses, official positions and professional qualifications of the individuals who are responsible for the conduct of affairs of the administrator; including all members of the board of directors, board of trustees, executive committee or other governing board or committee; the principal officers in the case of a corporation or the partners or members in the case of a partnership or association; shareholders holding directly or indirectly ten percent (10%) or more of the voting securities of the administrator; and any other person who exercises control or influence over the affairs of the administrator;  (4) Annual financial statements or reports for the two (2) most recent years which prove that the applicant is solvent and any information that the commissioner may require in order to review the current financial condition of the applicant;  (5) A statement describing the business plan including information on staffing levels and activities proposed in this state and nationwide. The plan must provide details setting forth the administrators capability for providing a sufficient number of experienced and qualified personnel in the areas of claims processing, record keeping and underwriting;  (6) If the applicant will be managing the solicitation of new or renewal business, proof that it employs or has contracted with an agent licensed by this state for solicitation and taking of applications. An applicant that intends to directly solicit insurance contracts or to act as an insurance producer must provide proof that it has a license as an insurance producer in this state; and  (7) Any other pertinent information that may be required by the commissioner.  (c) The applicant shall make available, for inspection by the commissioner, copies of all contracts with insurers or other persons utilizing the services of the administrator.  (d) The commissioner may refuse to issue a certificate of authority if the commissioner determines that the administrator, or any individual responsible for the conduct of affairs of the administrator as defined in subdivision (b)(3) of this section, is not competent, trustworthy, financially responsible or of good personal and business reputation, or has had an insurance or an administrator license denied or revoked for cause by any state.  (e) A certificate of authority issued under this section shall remain valid, unless surrendered, suspended or revoked by the commissioner, for so long as the administrator continues in business in this state and remains in compliance with this chapter.  (f) An administrator is not required to hold a certificate of authority as an administrator in this state if all of the following conditions are met:  (1) The administrator has its principal place of business in another state;  (2) The administrator is not soliciting business as an administrator in this state;  (3) In the case of any group policy or plan of insurance serviced by the administrator, the lesser of five percent (5%) or one hundred (100) certificate holders reside in this state.  (g) A person is not required to hold a certificate of authority as an administrator in this state if the person exclusively provides services to one or more bona fide employee benefit plans each of which is established by an employer or an employee organization, or both, and for which the insurance laws of this state are preempted pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1001 et seq. These persons shall register with the commissioner annually, verifying their status as described in this section.  (h) An administrator shall immediately notify the commissioner of any material change in its ownership, control or other fact or circumstance affecting its qualification for a certificate of authority in this state.  (i) No bonding shall be required by the commissioner of any administrator whose business is restricted solely to benefit plans which are either fully insured by an authorized insurer or which are bona fide employee benefit plans established by an employer or any employee organization, or both, for which the insurance laws of this state are preempted pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1001 et seq.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-13. Waiver of application for certification. Upon request from an administrator, the commissioner may waive the application requirements of  27-20.7-12(b) if the administrator has a valid certificate of authority as an administrator issued in a state which has standards for administrators that are at least as stringent as those contained in the model statute for third party administrators of the National Association of Insurance Commissioners.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-14. Annual report and filing fee. (a) Each administrator shall file an annual report for the preceding calendar year with the commissioner on or before March 1 of each year, or within any extension of time for filing as the commissioner for good cause may grant. The report shall be in the form and contain any matters that the commissioner prescribes.  (b) The annual report shall include the complete names and addresses of all insurers with which the administrator had an agreement during the preceding fiscal year.  (c) At the time of filing its annual report, the administrator shall pay a filing fee as required by the commissioner.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1; P.L. 2014, ch. 91,  4; P.L. 2014, ch. 94,  4. 
 27-20.7-15. Grounds for suspension or revocation of certificate of authority. (a) The certificate of authority of an administrator shall be suspended or revoked if the commissioner finds that the administrator is:  (1) In an unsound financial condition;  (2) Using any methods or practices in the conduct of its business so as to render its further transaction of business in this state hazardous or injurious to insured persons or the public; or  (3) Has failed to pay any judgment rendered against it in this state within sixty (60) days after the judgment has become final.  (b) The commissioner may in his or her discretion, suspend or revoke the certificate of authority of an administrator if the commissioner finds that the administrator:  (1) Has violated any lawful rule or order of the commissioner or any provision of the insurance laws of this state;  (2) Has refused to be examined or to produce its accounts, records and files for examination, or if any of its officers has refused to give information with respect to its affairs or has refused to perform any other legal obligation as to an examination, when required by the commissioner;  (3) Has, without just cause, refused to pay proper claims or perform services arising under its contracts or has, without just cause, caused covered individuals to accept less than the amount due them or caused covered individuals to employ attorneys or bring suit against the administrator to secure full payment or settlement of the claims;  (4) Is affiliated with or under the same general management or interlocking directorate or ownership as another administrator or insurer that unlawfully transacts business in this state without having a certificate of authority;  (5) Has at any time failed to meet any qualification for which issuance of the certificate could have been refused had the failure then existed and been known to the department;  (6) Has been convicted of, or has entered a plea of guilty or nolo contendere to, a felony without regard to whether adjudication was withheld; or  (7) Is under suspension or revocation in another state.  (c) The commissioner may in his or her discretion and without advance notice or hearing immediately suspend the certificate of an administrator if the commissioner finds that one or more of the following circumstances exist:  (1) The administrator is insolvent or impaired;  (2) A proceeding for receivership, conservatorship, rehabilitation or other delinquency proceeding regarding the administrator has been commenced in any state; or  (3) The financial condition or business practices of the administrator pose an imminent threat to the public health, safety or welfare of the residents of this state.  (d) If the commissioner finds that one or more grounds exist for the suspension or revocation of a certificate of authority issued under this part, the commissioner may, in lieu of suspension or revocation, impose a fine upon the administrator.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-16. Unauthorized third party administrator business. The unauthorized conduct of the business of an administrator shall be treated as unauthorized insurance business and shall be subject to the same penalties as provided in  27-16-1.3 for violation of  27-16-1.2.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-2. Definitions. As used in this chapter, the following terms have the following meanings: (1) Administrator means a person who directly or indirectly solicits or effects coverage of, underwrites, collects charges or premiums from, or adjusts or settles claims on residents of this state, or residents of another state from offices in this state, in connection with life or health insurance coverage or annuities, except any of the following:  (i) An employer on behalf of its employees or the employees of one or more subsidiaries or affiliated corporations of the employer;  (ii) A union on behalf of its members;  (iii) An insurer which is authorized to transact insurance in this state with respect to a policy lawfully issued and delivered in and pursuant to the laws of this state or another state;  (iv) A producer licensed to sell life or health insurance in this state, whose activities are limited exclusively to the sale of insurance;  (v) A creditor on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtors;  (vi) A trust and its trustees, agents and employees acting pursuant to the trust established in conformity with 29 U.S.C.  186;  (vii) A trust exempt from taxation under  501(a) of the Internal Revenue Code, 26 U.S.C.  501(a), its trustees and employees acting pursuant to the trust, or a custodian and the custodians agents or employees acting pursuant to a custodian account which meets the requirements of  401(f) of the Internal Revenue Code, 26 U.S.C.  401(f);  (viii) A credit union or a financial institution which is subject to supervision or examination by federal or state banking authorities, or a mortgage lender, to the extent they collect and remit premiums to licensed insurance producers or authorized insurers in connection with loan payments;  (ix) A credit card issuing company which advances for and collects premiums or charges from its credit card holders who have authorized collection if the company does not adjust or settle claims;  (x) A person who adjusts or settles claims in the normal course of that persons practice or employment as an attorney at law and who does not collect charges or premiums in connection with life or health insurance coverage or annuities;  (xi) An adjuster licensed by this state whose activities are limited to adjustment of claims;  (xii) A person who acts solely as an administrator of one or more bona fide employee benefit plans established by an employer or an employee organization, or both, for which the insurance laws of this state are preempted pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C.  1001 et seq. That person shall comply with the requirements of  27-20.7-12(g); or  (xiii) A person licensed as a managing general agent in this state, whose activities are limited exclusively to the scope of activities conveyed under that license.  (2) Affiliate or affiliated means an entity or person who directly or indirectly through one or more intermediaries controls or is controlled by, or is under common control with, a specified entity or person.  (3) Commissioner means the commissioner of insurance.  (4) Control has the same meaning as that term is defined in  27-35-1(c).  (5) Insurance or insurance coverage means any coverage offered or provided by an insurer.  (6) Insurer includes all persons, firms or corporations offering and/or insuring health services on a prepaid basis, including, but not limited to, policies of accident and sickness insurance as defined by chapter 18 of this title, nonprofit hospital or medical service plans as defined by chapters 19 and 20 of this title, or any other entity whose primary function is to provide diagnostic, therapeutic or preventive services to a defined population on the basis of a periodic premium. It includes all persons, firms or corporations providing health benefits coverage for employees on a self-insurance basis without the intervention of other entities. Insurer does not include a bona fide employee benefit plan established by an employer or an employee organization, or both, for which the insurance laws of this state are preempted pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1001 et seq.  (7) Underwrites or underwriting means, but is not limited to, the acceptance of employer or individual applications for coverage of individuals in accordance with the written rules of the insurer; the overall planning and coordinating of an insurance program; and the ability to procure bonds and excess insurance.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-3. Written agreement. (a) No administrator shall act as an administrator without a written agreement between the administrator and the insurer, and the written agreement shall be retained as part of the official records of both the insurer and the administrator for the duration of the agreement and for five (5) years after this. The agreement shall contain all provisions required by this section, except insofar as those requirements do not apply to the functions performed by the administrator.  (b) The written agreement shall include a statement of duties which the administrator is expected to perform on behalf of the insurer and the lines, classes or types of insurance for which the administrator is to be authorized to administer. The agreement shall make provisions with respect to underwriting or other standards pertaining to the business underwritten by the insurer.  (c) The insurer or administrator may, with written notice, terminate the written agreement for cause as provided in the agreement. The insurer may suspend the underwriting authority of the administrator during the pendency of any dispute regarding the cause for termination of the written agreement. The insurer shall fulfill any lawful obligations with respect to policies affected by the written agreement, regardless of any dispute between the insurer and the administrator.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-4. Payments to administrator. If an insurer utilizes the services of an administrator, the payment to the administrator of any premiums or charges for insurance by or on behalf of the insured party shall be deemed to have been received by the insurer, and the payment of return premiums or claim payments forwarded by the insurer to the administrator shall not be deemed to have been paid to the insured party or claimant until the payments are received by the insured party or claimant. Nothing in this section limits any right of the insurer against the administrator resulting from the failure of the administrator to make payments to the insurer, insured parties or claimants.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-5. Maintenance of records. (a) Every administrator shall maintain and make available to the insurer complete books and records of all transactions performed on behalf of the insurer. The books and records shall be maintained in accordance with prudent standards of insurance record keeping and must be maintained for a period of not less than five (5) years from the date of their creation.  (b) The commissioner shall have access to books and records maintained by an administrator for the purposes of examination, audit and inspection. Any documents, materials or other information in the possession or control of the department of business regulation that are furnished by a third party administrator, insurer, producer, or an employee or agent acting on behalf of the third party administrator, insurer or producer, or obtained by the commissioner in an investigation, shall be confidential by law and privileged, shall not be subject to chapter 2 of title 38, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. The commissioner is nevertheless authorized to use the documents, materials or other information in the furtherance of any regulatory or legal action brought as a part of the commissioners official duties.  (c) Neither the commissioner nor any person who received documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials or information subject to subsection (b) of this section.  (d) In order to assist in the performance of the commissioners duties, the commissioner:  (1) May share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subsection (b) of this section, with other state or federal regulatory agencies, with the National Association of Insurance Commissioners, its affiliates or subsidiaries, and with state, federal and international law enforcement authorities, provided that the recipient agrees to maintain the confidential and privileged status of the document, material or other information; and  (2) May receive documents, materials or information, including confidential and privileged documents, materials or information, from the National Association of Insurance Commissioners, it affiliates or subsidiaries, and from regulatory and law enforcement officials or other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information.  (e) No waiver of any applicable privilege or claim of confidentiality in the documents, materials or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subsection (d) of this section.  (f) Nothing in this chapter shall prohibit the insurance commissioner from releasing final, adjudicated actions including for cause terminations that are open to public inspection pursuant to chapter 2 of title 38 to a database or other clearinghouse service maintained by the National Association of Insurance Commissioners, its affiliates or subsidiaries of the National Association of Insurance Commissioners.  (g) The insurer shall own the records generated by the administrator pertaining to the insurer. The administrator shall retain the right to continuing access to books and records to permit the administrator to fulfill all of its contractual obligations to insured parties, claimants and the insurer.  (h) In the event the insurer and the administrator cancel their agreement, notwithstanding the provisions of subsection (a) of this section, the administrator may, by written agreement with the insurer, transfer all records to a new administrator rather than retain them for five (5) years. In those cases, the new administrator shall acknowledge, in writing, that it is responsible for retaining the records of the prior administrator as required in subsection (a) of this section.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-6. Approval of advertising. An administrator may use only advertising pertaining to the business underwritten by an insurer that has been approved in writing by the insurer in advance of its use.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-7. Responsibilities of the insurer. (a) If an insurer utilizes the services of an administrator, the insurer shall be responsible for determining the benefits, premium rates, underwriting criteria and claims payment procedures applicable to the coverage and for securing reinsurance, if any. The rules pertaining to these matters must be provided, in writing, by the insurer to the administrator. The responsibilities of the administrator as to any of these matters shall be set forth in the written agreement between the administrator and the insurer.  (b) It is the sole responsibility of the insurer to provide for competent administration of its programs.  (c) In cases where an administrator administers benefits for more than one hundred (100) certificate holders on behalf of an insurer, the insurer shall, at least semi-annually, conduct a review of the operations of the administrator. At least one of these reviews shall be an on-site audit of the operations of the administrator.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-8. Premium collection and payment of claims. (a) All insurance charges or premiums collected by an administrator on behalf of or for an insurer or insurers, and the return of premiums received from that insurer or insurers, shall be held by the administrator in a fiduciary capacity. The funds shall be immediately remitted to the person or persons entitled to them or shall be deposited promptly in a fiduciary account established and maintained by the administrator in a federally or state insured financial institution. The written agreement between the administrator and the insurer shall provide for the administrator to periodically render an accounting to the insurer detailing all transactions performed by the administrator pertaining to the business underwritten by the insurer.  (b) If charges or premiums deposited in a fiduciary account have been collected on behalf of or for one or more insurers, the administrator shall keep records clearly recording the deposits in and withdrawals from the account on behalf of each insurer. The administrator shall keep copies of all the records and, upon requests of an insurer, shall furnish the insurer with copies of the records pertaining to the deposits and withdrawals.  (c) The administrator shall not pay any claim by withdrawals from a fiduciary account in which premiums or charges are deposited. Withdrawals from the account shall be made as provided in the written agreement between the administrator and the insurer. The written agreement shall address, but not be limited to, the following:  (1) Remittance to an insurer entitled to remittance;  (2) Deposit in an account maintained in the name of the insurer;  (3) Transfer to and deposit in a claims paying account, with claims to be paid as provided for in subsection (d) of this section;  (4) Payment to a group policyholder for remittance to the insurer entitled to the remittance;  (5) Payment to the administrator of its commissions, fees or charges; and  (6) Remittance of return premium to the person or persons entitled to the return premium.  (d) All claims paid by the administrator from funds collected on behalf of or for an insurer shall be paid only on drafts or checks of and as authorized by the insurer.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.7-9. Compensation to the administrator. (a) An administrator shall not enter into an agreement or understanding with an insurer in which the effect is to make the amount of the administrators commissions, fees, or charges contingent upon savings effected in the adjustment, settlement and payment of losses covered by the insurers obligations. This provision shall not prohibit an administrator from receiving performance-based compensation for providing hospital or other auditing services.  (b) This section shall not prevent the compensation of an administrator from being based on premiums or charges collected or the number of claims paid or processed.  History of Section.P.L. 2001, ch. 83,  1; P.L. 2001, ch. 242,  1. 
 27-20.8-1. Definitions. For the purposes of this chapter, the following terms shall mean: (1) Director shall mean the director of the department of business regulation.  (2) Health plan shall mean an insurance carrier as defined in chapters 18, 19, 20 and 41 of this title.  (3) Insured shall mean any person who is entitled to have pharmacy services paid by a health plan pursuant to a policy, certificate, contract or agreement of insurance or coverage including those administered for the health plan under a contract with a third-party administrator that manages pharmacy benefits or pharmacy network contracts.  History of Section.P.L. 2004, ch. 370,  1; P.L. 2004, ch. 442,  1; P.L. 2008, ch. 475,  86. 
 27-20.8-2. Pharmacy benefit, limits and co-payments. Any health plan that offers pharmacy benefits shall comply with the following: (a) When a health plans pharmacy benefit has a dollar limit, the insureds use of such benefit shall be determined based on the health plans contracted rate to purchase the drug minus the enrollees applicable co-payment for covered drugs. The balance will apply towards the enrollees dollars limit.  (b) When a health plan charges a co-payment for covered prescription drugs that is based on a percent of the drug cost, the health plan shall disclose within the group policy or individual policy benefits description statement whether the co-payment is based on the plans contracted rate to purchase the drug or some other cost basis such as retail price.  History of Section.P.L. 2004, ch. 370,  1; P.L. 2004, ch. 442,  1. 
 27-20.8-3. Co-pay cap for prescription insulin.  (a) As used in this section, unless the context otherwise requires, prescription insulin drug means a prescription drug, as defined in  21-31-2, that contains insulin and is used to treat diabetes.  (b) A health plan that provides coverage for prescription insulin drugs pursuant to the terms of a health coverage plan the health plan offers shall cap the total amount that a covered person is required to pay for a covered prescription insulin drug at an amount not to exceed forty dollars ($40.00), per thirty-day (30) supply of insulin. Coverage for prescription insulin drugs shall not be subject to any deductible.  (c) Nothing in this section prevents a health plan from reducing a covered persons cost sharing to an amount less than the amount specified in subsection (b) of this section.  (d) The office of the health insurance commissioner may use any of its enforcement powers to obtain a health plans compliance with this section.  (e) The office of the health insurance commissioner may promulgate rules and regulations as necessary to implement and administer this section and to align with federal requirements.  History of Section.P.L. 2021, ch. 110,  1, effective January 1, 2022; P.L. 2021, ch. 163,  1, effective January 1, 2022. 
 27-20.8-4. Price disclosure.  A plan sponsor, health insurance carrier, or pharmacy benefits manager shall not prohibit a pharmacist from providing an insured information regarding the amount of the insureds cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower-priced drug to the insured if one is available.  History of Section.P.L. 2021, ch. 164,  1, effective July 6, 2021; P.L. 2021, ch. 165,  1, effective July 6, 2021. 
 27-20.9-1. Health care contracts  Required provisions  Definitions. (a) On and after January 1, 2008, a health insurer that contracts with a health care provider shall comply with the provisions of this chapter and shall include the provisions required by this chapter in the health care contract. A contract in existence prior to January 1, 2008, that is renewed or renews by its terms shall comply with the provisions of this chapter no later than December 31, 2008.  (b) As used in this chapter, unless the context otherwise requires:  (1) Health care contract means a contract entered into or renewed between a health insurer and a health care provider for the delivery of health care services to others.  (2) Health care provider means a person licensed or certified in this state to practice medicine, pharmacy, chiropractic, nursing, physical therapy, podiatry, dentistry, optometry, occupational therapy, or other healing arts.  (3) Health insurer means every nonprofit medical service corporation, hospital service corporation, health maintenance organization, or other insurer offering and/or insuring health services; the term shall in addition include any entity defined as an insurer under  42-62-4 and any third-party administrator when interacting with health care providers and enrollees on behalf of such an insurer.  History of Section.P.L. 2007, ch. 86,  1; P.L. 2007, ch. 215,  1; P.L. 2008, ch. 475,  87. 
 27-20.9-2. Credentialing  Insurers shall notify providers of initial credentialing within ten business days of approval by the insurer credentialing committee. The health insurer shall reimburse the health care provider for covered services rendered by the health care provider to the health insurers subscribers or members following the first business day after the credentialing committees approval, provided that the health care provider returns a signed health care contract within fifteen (15) business days of receipt from the health insurer.  History of Section.P.L. 2007, ch. 86,  1; P.L. 2007, ch. 215,  1. 
 27-20.9-3. Pay-for-performance guidelines. A health insurer shall not require a physician, as a condition of contracting, to participate in any financial or reimbursement incentive program, commonly referred to as pay-for-performance programs unless such program meets the principles and guidelines for pay-for-performance programs endorsed by the national quality forum and adopted by the AQA Alliance or the hospital quality alliance, or similar principles and guidelines for pay-for-performance programs approved by the office of the health insurance commissioner.  History of Section.P.L. 2007, ch. 86,  1; P.L. 2007, ch. 215,  1. 
 27-20-1.1. Applicability. This chapter shall apply to any nonprofit hospital service corporation which provides coverage or benefits for medical services under the provisions of chapter 19 of this title or otherwise.  History of Section.P.L. 1987, ch. 107,  5. 
 27-20-1. Definitions. As used in this chapter: (1) Adverse benefit determination means any of the following: a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of a an individuals eligibility to participate in a plan or to receive coverage under a plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit resulting from the application of any utilization review, as well as a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate. The term also includes a rescission of coverage determination.  (2) Affordable Care Act means the federal Patient Protection and Affordable Care Act of 2010, as amended by the federal Health Care and Education Reconciliation Act of 2010, and federal regulations adopted thereunder;  (3) Certified registered nurse practitioners is an expanded role utilizing independent knowledge of physical assessment and management of health care and illnesses. The practice includes collaboration with other licensed healthcare professionals including, but not limited to, physicians, pharmacists, podiatrists, dentists, and nurses;  (4) Commissioner or health insurance commissioner means that individual appointed pursuant to  42-14.5-1.  (5) Counselor in mental health means a person who has been licensed pursuant to  5-63.2-9.  (6) Essential health benefits shall have the meaning set forth in section 1302(b) of the federal Affordable Care Act [42 U.S.C.  18022(b)].  (7) Grandfathered health plan means any group health plan or health insurance coverage subject to 42 U.S.C.  18011.  (8) Group health insurance coverage means, in connection with a group health plan, health insurance coverage offered in connection with such plan.  (9) Group health plan means an employee welfare benefit plan as defined in 29 U.S.C.  1002(1) to the extent that the plan provides health benefits to employees or their dependents directly or through insurance, reimbursement, or otherwise.  (10) Health benefits or covered benefits means coverage or benefits for the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body including coverage or benefits for transportation primarily for and essential thereto, and including medical services as defined in  27-19-17;  (11) Healthcare facility means an institution providing healthcare services or a healthcare setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings.  (12) Healthcare professional means a physician or other healthcare practitioner licensed, accredited or certified to perform specified healthcare services consistent with state law.  (13) Healthcare provider or provider means a healthcare professional or a healthcare facility.  (14) Healthcare services means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease.  (15) Health insurance carrier means a person, firm, corporation or other entity subject to the jurisdiction of the commissioner under this chapter, and includes a nonprofit medical service corporation. Such term does not include a group health plan.  (16) Health plan or health benefit plan means health insurance coverage and a group health plan, including coverage provided through an association plan if it covers Rhode Island residents. Except to the extent specifically provided by the federal Affordable Care Act, the term health plan shall not include a group health plan to the extent state regulation of the health plan is preempted under section 514 of the federal Employee Retirement Income Security Act of 1974 [29 U.S.C.  1144]. The term also shall not include:  (A)(i) Coverage only for accident, or disability income insurance, or any combination thereof.  (ii) Coverage issued as a supplement to liability insurance.  (iii) Liability insurance, including general liability insurance and automobile liability insurance.  (iv) Workers compensation or similar insurance.  (v) Automobile medical payment insurance.  (vi) Credit-only insurance.  (vii) Coverage for on-site medical clinics.  (viii) Other similar insurance coverage,  specified in federal regulations issued pursuant to Federal Pub. L. No. 104-191, the federal health insurance portability and accountability act of 1996 (HIPAA), under which benefits for medical care are secondary or incidental to other insurance benefits.  (B) The following benefits if they are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the plan:  (i) Limited scope dental or vision benefits.  (ii) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.  (iii) Other excepted benefits specified in federal regulations issued pursuant to federal Pub. L. No. 104-191 (HIPAA).  (C) The following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor:  (i) Coverage only for a specified disease or illness.  (ii) Hospital indemnity or other fixed indemnity insurance.  (D) The following if offered as a separate policy, certificate or contract of insurance:  (i) Medicare supplement health insurance as defined under section 1882(g)(1) of the federal Social Security Act [42 U.S.C.  1395ss].  (ii) Coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code (Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)).  (iii) Similar supplemental coverage provided to coverage under a group health plan.  (17) Licensed midwife means any midwife licensed under  23-13-9;  (18) Medical services means those professional services rendered by persons duly licensed under the laws of this state to practice medicine, surgery, chiropractic, podiatry, and other professional services rendered by a licensed midwife, certified registered nurse practitioners, and psychiatric and mental health nurse clinical specialists, and appliances, drugs, medicines, supplies, and nursing care necessary in connection with the services, or the expense indemnity for the services, appliances, drugs, medicines, supplies, and care, as may be specified in any nonprofit medical service plan. Medical service shall not be construed to include hospital services;  (19) Nonprofit medical service corporation means any corporation organized pursuant hereto for the purpose of establishing, maintaining, and operating a nonprofit medical service plan;  (20) Nonprofit medical service plan means a plan by which specified medical service is provided to subscribers to the plan by a nonprofit medical service corporation;  (21) Office of the health insurance commissioner means the agency established under  42-14.5-1.  (22) Psychiatric and mental health nurse clinical specialist is an expanded role utilizing independent knowledge and management of mental health and illnesses. The practice includes collaboration with other licensed healthcare professionals, including, but not limited to, psychiatrists, psychologists, physicians, pharmacists, and nurses;  (23) Rescission means a cancellation or discontinuance of coverage that has retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.  (24) Subscribers means those persons or groups of persons who contract with a nonprofit medical service corporation for medical service pursuant to a nonprofit medical service plan; and  (25) Therapist in marriage and family practice means a person who has been licensed pursuant to  5-63.2-10.  History of Section.P.L. 1945, ch. 1598,  1; G.L. 1956,  27-20-1; P.L. 1961, ch. 136,  1; P.L. 1987, ch. 129,  1; P.L. 1990, ch. 168,  2; P.L. 1991, ch. 361,  5; P.L. 1994, ch. 89,  4; P.L. 2012, ch. 256,  7; P.L. 2012, ch. 262,  7. 
 27-20-10. Commission plans for solicitors or insurance producers. No person shall be engaged to solicit subscribers to any nonprofit medical service plan upon a commission basis or upon any other basis by which the payment of the compensation or expenses of the person shall be conditioned upon the enrollment of subscribers, unless the method of solicitation and rate of compensation shall have had the prior written approval of the director of business regulation.  History of Section.P.L. 1945, ch. 1598,  6; G.L. 1956,  27-20-10. 
 27-20-11. Investment standards. (a) All nonprofit medical 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 medical 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 are not considered admitted assets.  History of Section.P.L. 1945, ch. 1598,  7; G.L. 1956,  27-20-11; P.L. 1999, ch. 45,  2. 
 27-20-12. Corporation deemed public charitable institution. Every nonprofit medical service corporation is declared to be and shall be deemed to be a charitable corporation and an incorporated public charitable institution.  History of Section.P.L. 1945, ch. 1598,  8; G.L. 1956,  27-20-12. 
 27-20-13. Adoption of chapter by hospital service corporation. Any nonprofit hospital service corporation organized pursuant to the provisions of chapter 19 of this title may, with the consent of the Rhode Island Medical Society evidenced by the affidavit of the president and secretary of the society filed in the office of the secretary of state, amend its articles of association to adopt the provisions of this chapter, and, upon that adoption, the corporation shall have and exercise all of the powers and be subject to all of the duties and responsibilities of a nonprofit medical service corporation to the same extent as though it had been incorporated as a nonprofit medical service corporation.  History of Section.P.L. 1945, ch. 1598,  9; G.L. 1956,  27-20-13. 
 27-20-14. Coverage for adoptive children. Subscribers to any nonprofit medical service plan who have satisfied the continuous membership requirements of the plan and who adopt children under the guardianship and custody of the director of the department of children, youth, and families shall be afforded coverage under the plan for the adopted child without any waiting period, notwithstanding the fact that the adopted child may have any preexisting medical condition.  History of Section.P.L. 1982, ch. 183,  2. 
 27-20-15. Itemized bills for services rendered. Upon completion of medical services under the provisions of this chapter, each provider of those services shall upon request provide a copy of an itemized bill to each patient; provided, that nothing contained in this section shall apply to any hospital operated by the state of Rhode Island, its departments, or agencies.  History of Section.P.L. 1985, ch. 529,  2. 
 27-20-16. Changing coverage. No group health insurer subject to the provisions of this chapter shall change contract provisions as specified in the group plan master contract during the term of that contract without prior written agreement of the employer, except for changes mandated under state or federal legislative enactment and changes resulting from a labor/management collective bargaining agreement, or changes necessary to meet insurance regulations promulgated by the department of business regulation.  History of Section.P.L. 1988, ch. 384,  3. 
 27-20-17.1. Insurance coverage for post-partum hospital stays. (a) Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for a forty-eight (48) hour time period in a hospital after a vaginal birth and ninety-six (96) hours after a Cesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending health care provider in consultation with the mother. The decision shall be made in accordance with the standards for guidelines for perinatal care published by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics. The standards shall be relative to early discharge, defined as less than forth-eight (48) hours for a vaginal delivery and ninety-six (96) for a Cesarean delivery. In the case of early discharge, post-delivery care shall include home visits, parent education, assistance and training in breast or bottle feeding and the performance of any necessary and appropriate clinical tests or any other tests or services consistent with the guidelines provided in this subsection.  (b) For the purposes of this section, attending health care provider includes the attending obstetrician, pediatrician, family practitioner, general practitioner or certified nurse midwife attending the mother and newly born child.  (c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.  History of Section.P.L. 1996, ch. 246,  4; P.L. 1996, ch. 260,  4; P.L. 2002, ch. 292,  39. 
 27-20-17. Mammograms and pap smears  Coverage mandated. (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 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.  History of Section.P.L. 1988, ch. 532,  2; P.L. 2005, ch. 405,  3. 
 27-20-18. Mammograms  Quality assurance standards. A mammogram eligible for reimbursement under  27-20-17 shall be reimbursed only if the facility in which the mammogram has been taken and processed, and the licensed physician interpreting the mammogram, both meet state-approved quality assurance standards for taking, processing, and interpreting mammograms. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section.  History of Section.P.L. 1989, ch. 217,  3. 
 27-20-19. Pap smears  Quality assurance standards. A pap smear eligible for reimbursement under  27-20-17 shall be reimbursed only if the laboratory in which the pap smear is processed is licensed by the department of health specifically to perform cervical cytology, or is accredited by the American Society of Cytology, or is accredited by the College of American Pathologists, or is accredited by the joint commission on accreditation of health care organizations or the American Osteopathic Association, at the time the pap smear is processed.  History of Section.P.L. 1989, ch. 217,  10. 
 27-20-2. Organization as charitable corporation  Insurance laws inapplicable. Each nonprofit medical service corporation shall be incorporated as a charitable corporation under the provisions of chapter 6 of title 7, and shall be subject to that chapter and to this chapter. The laws of this state relative to insurance companies or to the business of insurance, and acts in amendment or in addition to those laws, shall not apply to any nonprofit medical service corporation unless expressly provided in those laws. Each nonprofit medical service corporation shall be deemed to be an insurer, for the purposes of compliance with chapter 44-17.  History of Section.P.L. 1945, ch. 1598,  2; G.L. 1956,  27-20-2; P.L. 2007, ch. 73, art. 28,  2. 
 27-20-20. Coverage for infertility. (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).  History of Section.P.L. 1989, ch. 478,  3; P.L. 2002, ch. 292,  39; P.L. 2006, ch. 246, art. 34,  3; P.L. 2007, ch. 411,  3; P.L. 2017, ch. 132,  3; P.L. 2017, ch. 150,  3. 
 27-20-21. Nonprofit medical service corporation assessment. (a) Notwithstanding any other provisions of law, each domestic nonprofit medical service corporation shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulations.  (b) The minimum assessment charged shall be one thousand dollars ($1,000).  History of Section.P.L. 1990, ch. 65, art. 29,  3; P.L. 1993, ch. 180,  16; P.L. 2002, ch. 292,  132. 
 27-20-22. Discontinuance of coverage  Chronic disabilities. No nonprofit medical service corporation subject to the provisions of this chapter shall discontinue reimbursement or providing services for the covered health care 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.  History of Section.P.L. 1991, ch. 127,  3. 
 27-20-23.1. Medication synchronization. (a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days supply for the purpose of synchronizing the patients medications and the insureds or enrollees maintenance-prescription drug(s) to be synchronized meets all of the following requirements:  (1) Is covered by the policy, certificate, or contract described in this chapter;  (2) Is used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee;  (3) Except as otherwise provided in this subparagraph, is not a controlled substance included in schedules II to V;  (4) Meets all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insureds or enrollees multiple, maintenance-prescription drugs;  (5) Is of a formulation that can be effectively split over required short-fill periods to achieve synchronization; and  (6) Does not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insureds or enrollees multiple, maintenance-prescription drugs.  (b) The plan or policy described in subsection (a) shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insureds or enrollees multiple, maintenance-prescription drugs.  (c) The plan or policy described in subsection (a) shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.  (d) A synchronization shall only occur once per year per maintenance-prescription drug.  History of Section.P.L. 2016, ch. 179,  3; P.L. 2016, ch. 196,  3. 
 27-20-23.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies. (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 pharmacys 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 Administrations 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 pharmacys 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.  History of Section.P.L. 2016, ch. 166,  3; P.L. 2016, ch. 168,  3. 
 27-20-23. Drug coverage. No group health insurer subject to the provisions of this chapter that provides coverage for prescription drugs under a group plan master contract delivered, issued for delivery, or renewed in this state may require any person covered under the contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for the drugs.  History of Section.P.L. 1991, ch. 345,  3; P.L. 2002, ch. 292,  39. 
 27-20-24. Rehabilitation, liquidation, or conservation. (a) Any rehabilitation, liquidation, administrative supervision, or conservation of a nonprofit medical service corporation organized under this chapter shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director of business regulation to rehabilitate, liquidate, or conserve a nonprofit medical service corporation upon any one or more of the following grounds:  (1) That the nonprofit medical service corporation is insolvent; for the purposes of this section, the term insolvent means the inability of the nonprofit medical service corporation to meet its debts and financial obligations as they become due;  (2) That the nonprofit medical service corporation fails or refuses to comply with a lawful order of the director of business regulation reasonably designed to correct unsound business policies or practices which, if uncorrected, could reasonably lead to insolvency as defined in subdivision (1); or  (3) That the nonprofit medical service corporations financial condition is such as to render its further transaction of business hazardous to the public or its subscribers or members.  (b) A claim by a health care provider shall not be asserted against any subscriber or member of the nonprofit medical service corporation in the event of the rehabilitation, liquidation, conservation, or administrative supervision of the nonprofit medical service corporation.  History of Section.P.L. 1993, ch. 180,  17. 
 27-20-25.1. No derogation of attorney general. 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.  History of Section.P.L. 1998, ch. 90,  7. 
 27-20-25.2. Health insurance rates. No insurance company organized as a stock or mutual corporation which merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or acquires control of a non-profit hospital service corporation organized under chapter 19 of this title, a non-profit medical service corporation organized under this chapter or a health maintenance organization organized under chapter 41 of this title may: (1) file with any state agency for review or approval any proposed rate to be used by the company in the state, or (2) charge to any party in the state any rate or premium, which takes into account or reflects in any manner the value of any contribution, distribution or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or account for the assets of a non-profit hospital service corporation, non-profit medical service corporation or health maintenance organization. For any rate that is to be charged to policy holders, regardless of whether this rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the companys compliance with this section.  History of Section.P.L. 1999, ch. 215,  4; P.L. 1999, ch. 376,  4. 
 27-20-25. Holding company systems. 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.  History of Section.P.L. 1993, ch. 180,  17; P.L. 1998, ch. 90,  2; P.L. 2000, ch. 178,  4; P.L. 2000, ch. 200,  14; P.L. 2000, ch. 229,  14. 
 27-20-26. Regulations. The director of the department of business regulation may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.  History of Section.P.L. 1993, ch. 180,  17. 
 27-20-27.1. Reliable evidence defined. [Repealed on effective date of  27-20-64.] Reliable evidence means: (1) Evidence including published reports and articles in authoritative, peer reviewed medical and scientific literature;  (2) A written informed consent used by the treating facility or by another facility studying substantially the same service; or  (3) A written protocol or protocols used by the treating facility or protocols of another facility studying substantially the same service.  History of Section.P.L. 1994, ch. 301,  3. 
 27-20-27.2. Conditions of coverage. [Repealed on effective date of  27-20-64.] As provided in  27-20-27, coverage shall be extended to new cancer therapies still under investigation when the following circumstances are present:  (1) Treatment is being provided pursuant to a phase II, III or IV clinical trial which has been approved by the National Institutes of Health (NIH) in cooperation with the National Cancer Institute (NCI), community clinical oncology programs; the Food and Drug Administration in the form of an investigational new drug (IND) exemption; the Department of Veterans Affairs; or a qualified nongovernmental research entity as identified in the guidelines for NCI cancer center support grants;  (2) The proposed therapy has been reviewed and approved by a qualified institutional review board (IRB);  (3) The facility and personnel providing the treatment are capable of doing so by virtue of their experience, training, and volume of patients treated to maintain expertise;  (4) The patients receiving the investigational treatment meet all protocol requirements;  (5) There is no clearly superior, noninvestigational alternative to the protocol treatment;  (6) The available clinical or preclinical data provide a reasonable expectation that the protocol treatment will be at least as efficacious as the noninvestigational alternative; and  (7) The coverage of new cancer therapy treatment provided pursuant to a phase II clinical trial is not required for only that portion of that treatment that is provided as part of the phase II clinical trial and is funded by a national agency, such as the National Cancer Institute, the Veterans Administration, the Department of Defense, or funded by commercial organizations such as the biotechnical and/or pharmaceutical industry or manufacturers of medical devices. Any portions of a phase II trial which are customarily funded by government, biotechnical and/or pharmaceutical and/or medical device industry sources in Rhode Island or in other states shall continue to be funded in Rhode Island and coverage pursuant to this section supplements, does not supplant customary funding.  History of Section.P.L. 1994, ch. 301,  3; P.L. 1997, ch. 51,  3, 7; P.L. 1997, ch. 92,  3, 7; P.L. 1999, ch. 134,  3. 
 27-20-27.3. Managed care. [Repealed on effective date of  27-20-64.] Nothing in this chapter shall preclude the conducting of managed care reviews and medical necessity reviews by an insurer, hospital or medical service corporation, or health maintenance organization. A nonprofit medical service corporation may, as a condition of coverage, require its members to obtain new cancer therapies still under investigation as outlined in this chapter from providers and facilities designated by the nonprofit medical service corporation to render these new cancer therapies.  History of Section.P.L. 1994, ch. 301,  3; P.L. 1998, ch. 441,  21. 
 27-20-27. New cancer therapies  Under investigation. [Repealed on effective date of  27-20-64.] Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical service plan contract delivered, issued for delivery or renewed in this state shall provide coverage for new cancer therapies still under investigation as outlined in this chapter.  History of Section.P.L. 1994, ch. 301,  3. 
 27-20-28. Repealed.
 27-20-29.1. Insurance coverage for mastectomy hospital stays. (a) The Rhode Island General Assembly recognizes that breast cancer is a unique illness with both a physical and emotional impact on patients. Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for a minimum forty-eight (48) hour time period in a hospital after the surgical procedures known as a mastectomy, and a minimum twenty-four (24) hours after an axillary node dissection. Any decision to shorten this minimum coverage shall be made by the attending physician in consultation with and upon agreement by the patient. If the patient participates in an early discharge, defined as in-patient care following a mastectomy that is less than forty-eight hours and in-patient care following an axillary node dissection that is less than twenty-four (24) hours, coverage shall include a minimum of one home visit conducted by a physician or registered nurse.  (b) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 23 of title 17.12. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.  (c) All plans subject to this section shall provide notice to each enrollee:  (1) In the next mass mailing made by the plan to the employee; or  (2) As part of any informational packet sent to the enrollee.  History of Section.P.L. 1997, ch. 24,  3; P.L. 1997, ch. 25,  3; P.L. 2002, ch. 292,  39. 
 27-20-29. Mastectomy treatment. (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 patients 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.  History of Section.P.L. 1996, ch. 66,  3; P.L. 2002, ch. 292,  39; P.L. 2004, ch. 41,  3; P.L. 2004, ch. 45,  3; P.L. 2018, ch. 114,  3; P.L. 2018, ch. 204,  3. 
 27-20-3. Qualifications of directors. A majority of the directors of a nonprofit medical service corporation, other than a corporation organized pursuant to the provisions of chapter 19 of this title, must at all times be doctors of medicine duly licensed to practice under the laws of this state. The directors of any nonprofit medical service corporation formed after January 1, 1964 shall consist of an equal number of representatives of the public, doctors of medicine duly licensed to practice under the laws of this state, and subscribers.  History of Section.P.L. 1945, ch. 1598,  2; G.L. 1956,  27-20-3; P.L. 1964, ch. 79,  2. 
 27-20-30. Diabetes treatment. (a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage, shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps, and appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this chapter shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a physician. These policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self-management and treatment of their diabetes, including information on the nutritional management of diabetes. The coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician diagnosis a significant change in the patients symptoms or conditions which necessitate changes in a patients self-management, or where reeducation or refresher training is necessary. This education, when medically necessary and prescribed by a physician, may be provided only by the physician or, upon his or her referral, to an appropriately licensed and certified health care provider, and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.  (b) Benefit plans offered by a hospital service corporation may impose copayment and/or deductibles for the benefits mandated by this chapter, however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for other supplies, equipment, or physician office visits. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.  History of Section.P.L. 1996, ch. 106,  3; P.L. 2002, ch. 292,  39. 
 27-20-31.1. Hysterectomy or myomectomy treatment. 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.  History of Section.P.L. 2022, ch. 370,  3, effective June 29, 2022; P.L. 2022, ch. 371,  3, effective June 29, 2022. 
 27-20-31. Primary and preventive obstetric and gynecological care. Any insurer or nonprofit health service plan that provides obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health maintenance organization shall permit a woman to receive an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the woman to first obtain a referral from a primary care provider.  History of Section.P.L. 1997, ch. 166,  3; P.L. 1997, ch. 174,  3. 
 27-20-32. Whistleblowers protection. No nonprofit medical service corporation pursuant to this chapter or any other insurer offering and/or insuring health services on a prepaid basis as defined in  42-62-4(7) shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state.  History of Section.P.L. 1997, ch. 167,  3. 
 27-20-33. Penalties and remedies. (a) Any person, firm, corporation, association or other legal entity who or which shall violate the provisions of  27-20-32 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one year, or by both a fine and imprisonment.  (b) In addition to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall willfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each violation, and each violation shall constitute a separate and distinct offense under this section.  History of Section.P.L. 1997, ch. 167,  3. 
 27-20-34. Additional relief and damages  Reinstatement. (a) A physician or other medical provider who alleges a violation of this chapter may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.  (b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.  (c) The court rendering a judgment in an action under this chapter shall order, as the court considers appropriate, reinstatement of the provider agreement.  History of Section.P.L. 1997, ch. 167,  3. 
 27-20-35.1. Third party reimbursement for services of registered nurse first assistants. (a) Every individual or group health insurance contract, plan or policy delivered, issued or renewed by an insurer or nonprofit or for profit health service corporation which provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a registered nurse first assistant, provided, that the following conditions are met:  (1) The registered nurse first assistant provides certain health care services under the supervision of a licensed physician; is currently licensed as a registered nurse in Rhode Island; has successfully completed a course in preparing the registered nurse as a first assistant in accordance with the Association of Operating Room Nurses core curriculum guide for the registered nurse first assistant and includes a minimum of one academic year in a college or university with didactic instruction and clinical internship programs; and is certified in perioperative nursing by the Certification Board of Perioperative Nursing (minimum of two years perioperative experience);  (2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and  (3) The registered nurse first assistant is not a salaried employee of the licensed hospital or facility for which the nonprofit hospital service corporation has an alternative contractual relationship to fund the services of a registered nurse first assistant.  (b) It remains within the sole discretion of the nonprofit medical service corporation as to which registered nurse first assistant in surgery it contracts with. Reimbursement is provided according to the respective principles and policies of the nonprofit medical service corporation: provided, that no nonprofit medical service corporation is required to provide direct reimbursement, or pay for duplicative services actually rendered by a registered nurse first assistant and any other health care provider. Nothing contained in this section precludes the nonprofit medical service corporations from conducting managed care, medical necessity or utilization review.  History of Section.P.L. 1999, ch. 509,  3; P.L. 2002, ch. 292,  39. 
 27-20-35. Third-party reimbursement for services of certain healthcare workers. (a) Every individual or group health insurance contract, plan, or policy delivered, issued, or renewed by an insurer or nonprofit or for-profit health service corporation that provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the board of nurse registration and nursing education; provided, that the following conditions are met:  (1) The certified registered nurse anesthetist adheres to the practice of certified registered nurse anesthesia as defined by and in accordance with  5-34.2-2.  (2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and  (3) The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the nonprofit medical service corporation has an alternative contractual relationship to fund the services of a certified registered nurse anesthetist.  (b) It shall remain within the sole discretion of the nonprofit medical service corporation as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit medical service corporation; provided, that no nonprofit medical service corporation may be required to pay for duplicative services actually rendered by a certified registered nurse anesthetist and any other healthcare provider. Nothing contained in this section shall preclude the nonprofit medical service corporation from conducting managed care, medical necessity, or utilization review.  (c) Providers. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that providers license or certification under applicable state law. This section shall not require that a group health plan or health insurance issuer contract with any healthcare provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures.  History of Section.P.L. 1997, ch. 345,  3; P.L. 1997, ch. 365,  3; P.L. 2002, ch. 292,  39; P.L. 2015, ch. 205,  3; P.L. 2015, ch. 223,  3. 
 27-20-36. Human leukocyte antigen testing. Every individual or group hospital or medical services plan contract delivered or renewed in this state shall include coverage of the cost for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B, and DR antigens for utilization in bone marrow transplantation. The testing must be performed in a facility that is accredited by the American Association of Blood Banks or its successors, and is licensed under the Clinical Laboratory Improvement Act, 42 U.S.C.  263a. At the time of the testing, the person being tested must complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program. The group hospital or medical services plan contract may limit each subscriber to one of these testings per lifetime.  History of Section.P.L. 1998, ch. 8,  3; P.L. 1998, ch. 9,  3; P.L. 2002, ch. 292,  39. 
 27-20-37. Drug coverage. (a) Any nonprofit medical-service corporation that utilizes a formulary of medications for which coverage is provided under an individual or group plan master contract shall require any physician or other person authorized by the department of health to prescribe medication to prescribe from the formulary. A physician or other person authorized by the department of health to prescribe medication shall be allowed to prescribe medications previously on, or not on, the nonprofit medical-service corporations formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. A nonprofit medical-service corporation shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the nonprofit medical-service corporations medical-exception criteria for the coverage of that medication.  (b) A nonprofit medical-service corporations medical-exception criteria for the coverage of non-formulary medications shall be developed in accordance with  23-17.13-3(c)(3) [repealed].  (c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23 [repealed].  (d) Prior to removing a prescription drug from its plans formulary or making any change in the preferred or tiered, cost-sharing status of a covered prescription drug, a nonprofit medical-service corporation must provide at least thirty (30) days notice to authorized prescribers by established communication methods of policy and program updates and by updating available references on web-based publications. All adversely affected members must be provided at least thirty (30) days notice prior to the date such change becomes effective by a direct notification:  (i) The written or electronic notice must contain the following information:  (A) The name of the affected prescription drug;  (B) Whether the plan is removing the prescription drug from the formulary, or changing its preferred or tiered, cost-sharing status; and  (C) The means by which subscribers may obtain a coverage determination or medical exception, in the case of drugs that will require prior authorization or are formulary exclusions respectively.  (ii) A nonprofit medical-service corporation may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the nonprofit medical-service corporation or the Food and Drug Administration, or removed from the market by their manufacturer, without meeting the requirements of this section.  History of Section.P.L. 1998, ch. 290,  3; P.L. 2016, ch. 541,  3; P.L. 2017, ch. 274,  3; P.L. 2017, ch. 361,  3. 
 27-20-38. Restricted annual rate payments prohibited. (a) No corporation organized under this chapter shall compensate any provider of outpatient service by using the restricted annual rate method of payment.  (b) The restricted annual rate method of payment is defined as any method of payment that sets, as all or part of its payment scheme, a total payment limit for mental health and/or substance abuse treatment services for each person seeking treatment based on a per person per unit of time criterion that disregards the extent of treatment and/or degree of services rendered.  (c) This prohibition shall not be construed to prohibit or limit capitation or other risk sharing agreements between providers and insurers permissible by law.  History of Section.P.L. 1998, ch. 352,  3. 
 27-20-39.1. Genetic information. (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.  (b) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage excluding disability income, long term care and insurance supplemental policies which only provide coverage for specified diseases or other supplemental policies, shall:  (1) Use genetic information or request for genetic information or the results of genetic information or other genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a group or an individuals health insurance policy, contract, or plan;  (2) Request or require genetic information for the purpose of determining whether or not to issue or renew a group or individuals health benefits coverage, to set reimbursement/co-pay levels or determine covered benefits and services;  (3) Release the results of genetic information without the prior written authorization of the individual from whom the information was obtained, except in a format by which individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure. An exception shall exist for participation in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule);  (4) Request or require information as to whether an individual has genetic information, or participated in genetic information of any kind, whether for clinical or research purposes.  (c) For the purposes of this section, genetic information is information about genes, gene product, or inherited characteristics that may derive from the individual or a family member.  History of Section.P.L. 2001, ch. 38,  6; P.L. 2001, ch. 54,  6; P.L. 2002, ch. 292,  39. 
 27-20-39. Genetic testing. (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.  (b) No nonprofit health insurer subject to the provisions of this chapter shall:  (1) Use a genetic test or request for a genetic test or the results of a genetic test to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a group or individuals health insurance policy, contract, or plan;  (2) Request or require a genetic test for the purpose of determining whether or not to issue or renew health benefits coverage, to set reimbursement/co-pay levels or determine covered benefits and services;  (3) Release the results of a genetic test without the prior written authorization of the individual from whom the test was obtained, except in a format by which individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure. An exception shall exist for participation in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule); or  (4) Request or require information as to whether an individual has ever had a genetic test, or participated in genetic testing of any kind, whether for clinical or research purposes.  (c) For the purposes of this section, genetic testing is the analysis of an individuals DNA, RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes include predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be included provided there is an approved release by a parent or guardian. Tests for metabolites are covered only when they are undertaken with high probability that an excess of deficiency of the metabolite indicates the presence of heritable mutations in single genes. Genetic testing does not mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs or for HIV infections.  History of Section.P.L. 1998, ch. 380,  3; P.L. 2001, ch. 38,  5; P.L. 2001, ch. 54,  5. 
 27-20-4. Approval of articles of association. No articles of association of a nonprofit medical service corporation shall be filed in the office of the secretary of state unless and until the governor shall have certified in writing upon those articles that he or she has determined that public convenience and advantage will be promoted by the establishment of the corporation and that the filing of the articles has the approval of the Rhode Island Medical Society as evidenced by an affidavit of the president and secretary of the society. No articles of association of a nonprofit medical service corporation formed after January 1, 1964 shall be filed in the office of the secretary of state unless and until the governor shall have certified in writing upon the articles that he or she has determined that public convenience and advantage will be promoted by the establishment of the corporation.  History of Section.P.L. 1945, ch. 1598,  2; G.L. 1956,  27-20-4; P.L. 1964, ch. 79,  3. 
 27-20-40. Repealed.
 27-20-41. Magnetic resonance imaging  Quality assurance standards. (a) Except as otherwise provided in subsection (b) of this section, a magnetic resonance imaging examination eligible for reimbursement under the provisions of any individual or group health insurance contract, plan or policy delivered in this state shall be reimbursed only if the facility at which the examination has been conducted and processed is accredited by either the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC) or an alternate nationally recognized accrediting organization whose accreditation standards are substantially similar to and no less stringent than current or subsequent ACR or IAC standards and have been reviewed and deemed adequate by the department of health. All accreditation standards under this section, whether promulgated by the ACR, IAC, or an alternate nationally recognized accrediting organization, shall include, but shall not be limited to, provisions for establishing the qualifications of the physician, standards for quality control and routine performance monitoring by a medical physicist, qualifications of the technologist including minimum standards of supervised clinical experience, personnel and patient safety guidelines, and standards for initial and ongoing quality control using clinical image review and quantitative testing.  (b) Any facility conducting and processing magnetic resonance imaging examinations which, as of June 30, 2006 is receiving reimbursement for such services by a health insurer, health maintenance organization or health plan, but is not accredited pursuant to subsection (a), shall file its application for accreditation within eighteen (18) months of June 28, 2007. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. A facility which begins conducting and processing, of magnetic resonance imaging examinations after June 30, 2006 shall file its application for accreditation within twelve (12) months of the date of initiation of the magnetic resonance imaging examinations. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. After such accreditation is obtained, a facility conducting and processing, magnetic resonance imaging examinations shall, at all times, maintain accreditation with the appropriate accrediting body. Notwithstanding anything herein to the contrary, any facility which has filed for accreditation pursuant to this subsection (b) and which has not been refused accreditation or withdrawn its application, will be deemed provisionally accredited for the twelve (12) month period dating from the application filing date. Provided, further, that notwithstanding any provisions of the general or public laws to the contrary, any facility conducting and processing magnetic resonance imaging examinations shall conform to the standards of the appropriate accrediting body at all times, including during the accreditation process and shall certify said conformance to any reimbursing health insurer, health maintenance organization or health plan.  History of Section.P.L. 1999, ch. 169,  4; P.L. 2005, ch. 207,  4; P.L. 2006, ch. 596,  4; P.L. 2007, ch. 140,  4; P.L. 2007, ch. 277,  4; P.L. 2008, ch. 475,  85. 
 27-20-42. Acupuncture services. (a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or renewed in this state which provides medical coverage, and every group policy which provides for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition shall provide, as an optional rider, coverage for the services of a doctor of acupuncture as a provider of acupuncture services.  (b) For the purposes of this section:  (1) Doctor of acupuncture means a practitioner licensed under chapter 37.2 of title 5.  (2) 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).  (c) It remains within the sole discretion of the non-profit medical service corporation as to which doctor of acupuncture it contracts with. Reimbursement is provided according to the respective principles and policies of the non-profit medical service corporation; provided, that no non-profit medical service corporation may be required to pay for duplicative services actually rendered by a doctor of acupuncture and any other health care provider. Nothing contained in this section precludes non-profit medical service corporations from conducting managed care, medical necessity or utilization review.  History of Section.P.L. 1999, ch. 288,  3. 
 27-20-43. F.D.A. approved prescription contraceptive drugs and devices. (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 F.D.A. 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 medical service corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods which are contrary to the religious employers 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.  History of Section.P.L. 2000, ch. 120,  3; P.L. 2000, ch. 126,  3; P.L. 2002, ch. 292,  39; P.L. 2018, ch. 230,  6; P.L. 2018, ch. 234,  6. 
 27-20-44. Prostate and colorectal examinations  Coverage mandated  The Maryellen Goodwin Colorectal Cancer Screening Act.  (a) Subscribers to any nonprofit medical service corporation plan shall be afforded coverage under the plan for prostate and colorectal examinations and laboratory tests for cancer for any nonsymptomatic person covered under the policy or plan. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal.  (b) An insurer or the corporation may not impose cost sharing on the coverage required by subsection (a) when the services are delivered within the health insurers provider network.  History of Section.P.L. 2000, ch. 125,  3; P.L. 2000, ch. 345,  3; P.L. 2021, ch. 7,  4, effective April 29, 2021; P.L. 2021, ch. 8,  4, effective April 29, 2021. 
 27-20-45. Eligibility for childrens benefits. (a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state which provides health benefits coverage for dependents, except for supplemental policies which only provide coverage for specified diseases and other supplemental policies, shall make coverage available for children until attainment of twenty-six (26) years of age, and an unmarried child of any age who is financially dependent upon the parent and medically determined to have a physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve (12) months.  (2) With respect to a child who has not attained twenty-six (26) years of age, a nonprofit medical service corporation shall not define dependent for purposes of eligibility for dependent coverage of children other than the terms of a relationship between a child and the plan participant or subscriber.  (3) A nonprofit medical service corporation shall not deny or restrict coverage for a child who has not attained twenty-six (26) years of age based on the presence or absence of the childs financial dependency upon the participant, primary subscriber or any other person, residency with the participant and in the individual market the primary subscriber, or with any other person, marital status, student status, employment or any combination of those factors. A nonprofit medical service corporation shall not deny or restrict coverage of a child based on eligibility for other coverage, except as provided in (b)(1) of this section.  (4) Nothing in this section shall be construed to require a health insurance carrier to make coverage available for the child of a child receiving dependent coverage, unless the grandparent becomes the legal guardian or adoptive parent of that grandchild.  (5) The terms of coverage in a health benefit plan offered by a nonprofit medical service corporation or providing dependent coverage of children cannot vary based on age except for children who are twenty-six (26) years of age or older.  (b)(1) For plan years beginning before January 1, 2014, a group health plan providing group health insurance coverage that is a grandfathered health plan and makes available dependent coverage of children may exclude an adult child who has not attained twenty-six (26) years of age from coverage only if the adult child is eligible to enroll in an eligible employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of the federal Internal Revenue Code, other than the group health plan of a parent.  (2) For plan years, beginning on or after January 1, 2014, a health insurance carrier providing group health insurance coverage that is a grandfathered health plan shall comply with the requirements of this section.  (c) This section does not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; or (8) other limited benefit policies.  History of Section.P.L. 2000, ch. 214,  3; P.L. 2002, ch. 292,  39; P.L. 2006, ch. 377,  4; P.L. 2006, ch. 469,  4; P.L. 2012, ch. 256,  7; P.L. 2012, ch. 262,  7. 
 27-20-46. Hearing aids. (a)(1) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide coverage for one thousand five hundred dollars ($1,500) per individual hearing aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall provide coverage for seven hundred dollars ($700) per individual hearing aid per ear, every three (3) years for anyone of the age of nineteen (19) years and older.  (2) Every group health insurance contract or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide, as an optional rider, additional hearing aid coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group policies subject to the small employer health insurance availability act, chapter 50 of this title.  (b) For the purposes of this section, hearing aid means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices, including, but not limited to, FM systems.  (c) It shall remain within the sole discretion of the nonprofit medical service corporation as to the provider of hearing aids with which they choose to contract. Reimbursement shall be provided according to the respective principles and policies of the nonprofit medical service corporation. Nothing contained in this section precludes the nonprofit medical service corporation from conducting managed care, medical necessity, or utilization review.  History of Section.P.L. 2000, ch. 461,  3; P.L. 2004, ch. 539,  3; P.L. 2004, ch. 550,  3; P.L. 2005, ch. 374,  3; P.L. 2005, ch. 395,  3; P.L. 2006, ch. 595,  3; P.L. 2006, ch. 614,  3. 
 27-20-47. Prompt processing of claims. (a) A health care entity or health plan operating in the state shall pay all complete claims for covered health care services submitted to the health care entity or health plan by a health care provider or by a policyholder within forty (40) calendar days following the date of receipt of a complete written claim or within thirty (30) calendar days following the date of receipt of a complete electronic claim. Each health plan shall establish a written standard defining what constitutes a complete claim and shall distribute the standard to all participating providers.  (b) If the health care entity or health plan denies or pends a claim, the health care entity or health plan shall have thirty (30) calendar days from receipt of the claim to notify in writing the health care provider or policyholder of any and all reasons for denying or pending the claim and what, if any, additional information is required to process the claim. No health care entity or health plan may limit the time period in which additional information may be submitted to complete a claim.  (c) Any claim that is resubmitted by a health care provider or policyholder shall be treated by the health care entity or health plan pursuant to the provisions of subsection (a) of this section.  (d) A health care entity or health plan which fails to reimburse the health care provider or policyholder after receipt by the health care entity or health plan of a complete claim within the required timeframes shall pay to the health care provider or the policyholder who submitted the claim, in addition to any reimbursement for health care services provided, interest which shall accrue at the rate of twelve percent (12%) per annum commencing on the thirty-first (31st) day after receipt of a complete electronic claim or on the forty-first (41st) day after receipt of a complete written claim, and ending on the date the payment is issued to the health care provider or the policyholder.  (e) Exceptions to the requirements of this section are as follows:  (1) No health care entity or health plan operating in the state shall be in violation of this section for a claim submitted by a health care provider or policyholder if:  (i) Failure to comply is caused by a directive from a court or federal or state agency;  (ii) The health care entity or health plan is in liquidation or rehabilitation or is operating in compliance with a court-ordered plan of rehabilitation; or  (iii) The health care entity or health plans compliance is rendered impossible due to matters beyond its control that are not caused by it.  (2) No health care entity or health plan operating in the state shall be in violation of this section for any claim: (i) initially submitted more than ninety (90) days after the service is rendered, or (ii) resubmitted more than ninety (90) days after the date the health care provider received the notice provided for in  27-18-61(b); provided, this exception shall not apply in the event compliance is rendered impossible due to matters beyond the control of the health care provider and were not caused by the health care provider.  (3) No health care entity or health plan operating in the state shall be in violation of this section while the claim is pending due to a fraud investigation by a state or federal agency.  (4) No health care entity or health plan operating in the state shall be obligated under this section to pay interest to any health care provider or policyholder for any claim if the director of the department of business regulation finds that the entity or plan is in substantial compliance with this section. A health care entity or health plan seeking such a finding from the director shall submit any documentation that the director shall require. A health care entity or health plan which is found to be in substantial compliance with this section shall after this submit any documentation that the director may require on an annual basis for the director to assess ongoing compliance with this section.  (5) A health care entity or health plan may petition the director for a waiver of the provision of this section for a period not to exceed ninety (90) days in the event the health care entity or health plan is converting or substantially modifying its claims processing systems.  (f) For purposes of this section, the following definitions apply:  (1) Claim means: (i) a bill or invoice for covered services; (ii) a line item of service; or (iii) all services for one patient or subscriber within a bill or invoice.  (2) Date of receipt means the date the health care entity or health plan receives the claim whether via electronic submission or has a paper claim.  (3) Health care 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 described in  23-17.13-2(2), that operates a health plan.  (4) Health care provider means an individual clinician, either in practice independently or in a group, who provides health care services, and referred to as a non-institutional provider.  (5) Health care services include, but are not limited to, medical, mental health, substance abuse, dental and any other services covered under the terms of the specific health plan.  (6) Health plan means a plan operated by a health care entity that provides for the delivery of health care services to persons enrolled in the plan through:  (i) Arrangements with selected providers to furnish health care services; and/or  (ii) Financial incentive for persons enrolled in the plan to use the participating providers and procedures provided for by the health plan.  (7) Policyholder means a person covered under a health plan or a representative designated by that person.  (8) Substantial compliance means that the health care entity or health plan is processing and paying ninety-five percent (95%) or more of all claims within the time frame provided for in  27-18-61(a) and (b).  (g) Any provision in a contract between a health care entity or a health plan and a health care provider which is inconsistent with this section shall be void and of no force and effect.  History of Section.P.L. 2001, ch. 119,  3; P.L. 2001, ch. 380,  3. 
 27-20-48. Mandatory coverage for certain lyme disease treatments. Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2004 shall provide coverage for diagnostic testing and long-term antibiotic treatment of chronic lyme disease when determined to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of title 5 entitled lyme disease diagnosis and treatment after making a thorough evaluation of the patients symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as unproven, experimental, or investigational in nature.  History of Section.P.L. 2003, ch. 113,  5; P.L. 2003, ch. 114,  5; P.L. 2004, ch. 34,  4; P.L. 2004, ch. 35,  4. 
 27-20-49. Dental insurance assignment of benefits. Every entity providing a contract of insurance as defined in this chapter shall allow, as a provision in a group or individual policy, contract or health benefit plan for coverage of dental services, any person insured by such entity to direct, in writing, that benefits from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by such entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.  History of Section.P.L. 2004, ch. 268,  3; P.L. 2004, ch. 386,  3. 
 27-20-5.1. Cancellation of coverage by employers. 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.  History of Section.P.L. 1971, ch. 228,  2. 
 27-20-5.2. Repealed.
 27-20-5.3. Patient responsibility  Administrative requirements. For health benefit contracts issued, renewed, or delivered on or after April 1, 2002, the following shall apply:  (1) The amount of copayments for physician office visits and hospital emergency room visits shall be printed on the subscriber identification cards issued to insureds.  (2) A schedule of all applicable copayments, by product or by group, in paper or electronic format, or both, shall be published, updated, and distributed to participating providers.  (3) On an annual basis, notification shall be provided to subscribers regarding their responsibility for copayments and deductibles.  History of Section.P.L. 2001, ch. 283,  2. 
 27-20-5. Contracts with subscribers. Each nonprofit medical service corporation may contract with its subscribers for any medical service as may be provided under any nonprofit medical service plan adopted by the corporation; provided, that:  (1) If any medical service as may be provided for shall include service which may be lawfully performed or rendered by a podiatrist, the contract shall provide for the payment for the service so performed or rendered by a podiatrist;  (2) If any medical service as may be provided for shall include service which may be lawfully performed or rendered by a certified registered nurse practitioner or psychiatric and mental health nurse clinical specialist, the contract will provide for the payment for the service performed or rendered by a certified registered nurse practitioner or psychiatric and mental health nurse clinical specialist to subscribers. No nonprofit medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement to a certified registered nurse practitioner; provided, that no nonprofit medical service corporation may be required to pay for duplicative services actually rendered by both a certified registered nurse practitioner and any other health care provider;  (3) If any medical service as may be provided for shall include service which may be lawfully performed or rendered by a licensed midwife, the contract delivered, issued for delivery, or renewed in this state shall provide for the payment for the service performed or rendered by a licensed midwife in accordance with each health insurers respective principles and mechanisms of reimbursement credentialing and contracting if those services are within the licensed midwives area of professional competence as defined by regulations promulgated pursuant to  23-13-9, and are currently reimbursed when rendered by any other licensed health care provider. No nonprofit medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement except when the requirements are also applicable to other categories of health care providers; provided, no insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a licensed midwife and any other health care provider. Direct payment for licensed midwives will be contingent upon services rendered in a licensed health care facility and for services rendered in accordance with rules and regulations promulgated by the department of health; provided, that this provision shall not prohibit payment for services pursuant to  42-62-26 or for other services reimbursed by third party payors; and  (4) If any medical service which may be provided for shall include service which may be rendered by a counselor in mental health or a therapist in marriage and family practice, excluding marital and family therapy unless there is an individual diagnosed with a mental disorder, the contract shall provide for payment for the service performed or rendered when deemed medically necessary by the nonprofit medical service corporation in accordance with its standard medical management protocols and within the nonprofit medical service corporations subscriber contractual limits. In the case of a limited provider network, it shall remain within the sole discretion of the nonprofit medical service corporation as to which certified counselors in mental health and certified therapists in marriage and family practice with which it shall contract. Nothing contained in this subdivision shall require the nonprofit medical service corporation to provide coverage other than in conjunction with a related medical illness.  (5) No contract between a nonprofit medical service corporation and a dentist for the provisions of services to patients may require that the dentist indemnify or hold harmless the nonprofit medical service corporation for any expenses and liabilities, including without limitation, judgments, settlements, attorneys fees, court costs, and any associated charges, incurred in connection with any claim or action brought against the nonprofit medical service corporation based on the nonprofit medical service corporations management decisions, or utilization review provisions for any patient.  History of Section.P.L. 1945, ch. 1598,  3; G.L. 1956,  27-20-5; P.L. 1961, ch. 136,  2; P.L. 1990, ch. 168,  2; P.L. 1991, ch. 361,  5; P.L. 1994, ch. 89,  4; P.L. 1999, ch. 481,  3; P.L. 2002, ch. 292,  39. 
 27-20-50. Coverage for early intervention services. (a) Every individual or group hospital or medical expense insurance policy or contract providing coverage for dependent children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of early intervention services which coverage shall take effect no later than January 1, 2005. Such coverage shall 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.  1471 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.  History of Section.P.L. 2004, ch. 595, art. 22,  3; P.L. 2004, ch. 598,  4; P.L. 2005, ch. 97,  3; P.L. 2005, ch. 99,  3; P.L. 2008, ch. 475,  85. 
 27-20-51. Post-payment audits. (a) Except as otherwise provided herein, any review, audit, or investigation by a nonprofit medical service corporation of a healthcare providers 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 payers claims appeal policies or the claim is subject to continual claims submission.  (c) For the purposes of this section, healthcare provider means an individual clinician, either in practice independently or in a group, who provides healthcare services, and any healthcare facility, as defined in  27-20-1, including any mental health and/or substance abuse treatment facility, physician, or other licensed practitioner identified to the review agent as having primary responsibility for the care, treatment, and services rendered to a patient.  (d) Except for those contracts where the health insurer or plan has the right to unilaterally amend the terms of the contract, the parties shall be able to negotiate contract terms which allow for different time frames than are prescribed herein.  History of Section.P.L. 2006, ch. 86,  3; P.L. 2006, ch. 97,  3; P.L. 2013, ch. 251,  3; P.L. 2013, ch. 395,  3; P.L. 2014, ch. 201,  3; P.L. 2014, ch. 214,  3; P.L. 2017, ch. 368,  3; P.L. 2017, ch. 375,  3; P.L. 2022, ch. 157,  3, effective June 27, 2022; P.L. 2022, ch. 158,  3, effective June 27, 2022. 
 27-20-52. Reimbursement for orthotics and prosthetic services. (a) As used in this section:  (1) Federal reimbursement rates means the current listed fee schedule from the Centers for Medicare and Medicaid Services, listing the current Healthcare Common Procedure Coding system (HCPCS) and the corresponding reimbursement rates.  (2) Orthosis means a custom fabricated brace or support that is designed based on medical necessity. Orthosis does not include prefabricated or direct-formed orthotic devices, as defined in this section, or any of the following assistive technology devices: commercially available knee orthoses used following injury or surgery; spastic muscle-tone inhibiting orthoses; upper extremity adaptive equipment; finger splints; hand splints; wrist gauntlets; face masks used following burns; wheelchair seating that is an integral part of the wheelchair and not worn by the patient independent of the wheelchair; fabric or elastic supports; corsets; low-temperature formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; and other similar devices as determined by the director of the department of health, such as those commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility.  (3) Orthotics means the science and practice of evaluating measuring, designing, fabricating, assembling, fitting, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of, an orthosis for the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury or deformity. The practice of orthotics encompasses evaluation, treatment, and consultation; with basic observational gait and postural analysis, orthotists assess and design orthoses to maximize function and provide not only the support but the alignment necessary to either prevent or correct a deformity or to improve the safety and efficiency of mobility or locomotion or both. Orthotic practice includes providing continuing patient care in order to assess its effect on the patients tissues and to assure proper fit and function of the orthotic device by periodic evaluation.  (4) Prosthesis means an artificial limb that is alignable or, in lower-extremity applications capable of weight bearing. Prosthesis means an artificial medical device that is not surgically implanted and that is used to replace a missing limb, appendage, or other external human body part including an artificial limb, hand, or foot. The term does not include artificial eyes, ears, noses, dental appliances, osotmy products, or devices such as eyelashes or wigs.  (5) Prosthetics means the science and practice of evaluation, measuring, designing, fabricating, assembling, fitting, aligning, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of, a prosthesis through the replacement of external parts of a human body lost due to amputation or congenital deformities or absences. The practice of prosthetics also includes the generation of an image, form, or mold that replicates the patients body or body segment and that requires rectification of dimensions, contours and volumes for use in the design and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial appendage that is designed either to support body weight or to improve or restore function or cosmesis, or both. Involved in the practice of prosthetics is observational gait analysis and clinical assessment of the requirements necessary to refine and mechanically fix the relative position of various parts of the prosthesis to maximize function, stability, and safety of the patient. The practice of prosthetics includes providing and continuing patient care in order to assess the prosthetic devices effect on the patients tissues and to assure proper fit and function of the prosthetic device by periodic evaluation.  (6) Private insurance company means any insurance company, or management company hired by an insurance company, who is any of the following:  (i) based in the state of Rhode Island; or  (ii) provides coverage for citizens for the state of Rhode Island; or  (iii) allows subscribing patients to seek prosthetic or orthotic services in the state of Rhode Island.  (b) Every individual or group health insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after January 1, 2006, which provides medical coverage that includes coverage for physician services in a physicians office and every policy, which provides major medical or similar comprehensive type coverage shall provide coverage for benefits for orthotic and prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C. sections 1395K, 13951 and 1395M and 42 CFR 414.202, 414.210, 414.228, and 410.100 as applicable to this section.  (c) A health insurance contract, plan or policy may require prior authorization for orthotic and prosthetic devices in the same manner that prior authorization is required for any other covered benefit.  (d) Covered benefits for orthotic or prosthetic devices shall be limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insureds treating physician.  (e) The repair and replacement of orthotic or prosthetic devices also shall be covered subject to co-payments and deductibles, unless necessitated by misuse or loss.  (f) An insurer may require, if coverage is provided through a managed care plan, that benefits mandated pursuant to this section be covered benefits only if the orthotic or prosthetic devices are provided by a vendor and orthotic or prosthetic services are rendered by a provider who is licensed by the state of Rhode Island to provide orthotics and prosthetics.  History of Section.P.L. 2006 ch. 210,  3; P.L. 2006, ch. 380,  3. 
 27-20-53. Tobacco cessation programs. (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, which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided that if such medical coverage does not include prescription drug coverage, such contract, plan or policy shall not be required to include coverage for FDA approved smoking cessation medications.  (b) As used in this section, smoking cessation treatment includes the use of an over-the-counter (OTC) or prescription US 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 (12) hour evidence based smoking cessation counseling sessions provided by a qualified practitioner for each covered individual. Smoking cessation treatment may be redefined through regulation promulgated by the health insurance commissioner in accordance with the most current clinical practice guidelines sponsored by the United States department of health and human services or its component agencies.  (c) Health insurance contracts, plans, or policies to which this section applies, may impose copayments and/or deductibles for the benefits mandated by this section consistent with the contracts, plans or policies copayments and/or deductibles for physician services and medications. Nothing contained in this section shall impact the reimbursement, medical necessity or utilization review, managed care, or case management practices of these health insurance contracts, plans or policies.  (d) This section shall not apply to insurance coverage providing benefits for:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Limited benefit health;  (7) Specified disease indemnity;  (8) Sickness or bodily injury or death by accident or both; and  (9) Other limited benefit policies.  History of Section.P.L. 2006, ch. 262,  3; P.L. 2006, ch. 293,  3; P.L. 2008, ch. 475,  85; P.L. 2009, ch. 187,  3; P.L. 2009, ch. 291,  3. 
 27-20-54. Mandatory coverage for scalp hair prosthesis. (a) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2007, which provides coverage for any other prosthesis shall provide coverage for expenses for scalp hair prosthesis worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia; provided, however, that such coverage shall be subject to the same limitations and guidelines as other prosthesis, and that coverage shall not exceed an amount of three hundred fifty dollars ($350) per covered member per year, exclusive of any deductible.  (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 2006, ch. 538,  3. 
 27-20-55. Licensed ambulance service. (a) No individual or group health insurance contract, plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009 shall provide for a co-payment for ground ambulance services in excess of fifty dollars ($50.00).  (b) As used in this section, the term ground ambulance services shall mean those services provided by an ambulance service licensed to operate in Rhode Island in accordance with  23-4.1-6. The term excludes air and water ambulance services and ambulance services provided outside of Rhode Island.  (c) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 2008, ch. 68,  3; P.L. 2008, ch. 70,  3. 
 27-20-56. Enteral nutrition products. (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and that are medically necessary for the treatment of malabsorption caused by Crohns disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein and shall extend to all recipients regardless of age.  (b) Benefit plans offered by a medical service corporation may impose a copayment and/or deductible for the benefits mandated by this section, however, in no instance shall the copayment or deductible amount be greater than the copayment of deductible amount imposed for prescription enteral formulas or nutritional aids. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization. Reimbursement shall be provided according to the respective principles and policies of the accident and sickness insurer. Nothing contained in this section precludes the accident and sickness insurer from conducting managed care, medical necessity, or utilization review.  (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited-benefit policies.  History of Section.P.L. 2008, ch. 253,  3; P.L. 2014, ch. 269,  3; P.L. 2014, ch. 519,  3. 
 27-20-57. Prohibition on preexisting condition exclusions. (a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title and/or chapter:  (1) Shall not limit or exclude coverage for an individual under the age of nineteen (19) by imposing a preexisting condition exclusion on that individual.  (2) For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude coverage for any individual by imposing a preexisting condition exclusion on that individual.  (b) As used in this section:  (1) Preexisting condition exclusion means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition (whether physical or mental) was present before the effective date of coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, diagnosis, care or treatment was recommended or received before the effective date of coverage.  (2) Preexisting condition exclusion means any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individuals health status before the individuals effective date of coverage, or if the coverage is denied, the date of denial, under the health benefit plan, such as a condition (whether physical or mental) identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period.  (c) This section shall not apply to grandfathered health plans providing individual health insurance coverage.  (d) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  History of Section.P.L. 2012, ch. 256,  8; P.L. 2012, ch. 262,  8. 
 27-20-58. Prohibition on rescission of coverage. (a)(1) Coverage under a health benefit plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be subject to rescission after the individual is covered under the plan, unless:  (A) The individual or a person seeking coverage on behalf of the individual, performs an act, practice or omission that constitutes fraud; or  (B) The individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage.  (2) For purposes of paragraph (1)(A), a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health carrier.  (b) At least thirty (30) days advance written notice shall be provided to each plan enrollee or, for individual health insurance coverage, primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of, in the case of group health insurance coverage, whether the rescission applies to the entire group or only to an individual within the group.  (c) This section applies to grandfathered health plans.  History of Section.P.L. 2012, ch. 256,  8; P.L. 2012, ch. 262,  8. 
 27-20-59. Annual and lifetime limits. (a) Annual limits.  (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health insurance carrier and health benefit plan subject to the jurisdiction of the commissioner under this chapter may establish an annual limit on the dollar amount of benefits that are essential health benefits provided the restricted annual limit is not less than the following:  (A) For a plan or policy year beginning after September 22, 2011, but before September 23, 2012  one million two hundred fifty thousand dollars ($1,250,000); and  (B) For a plan or policy year beginning after September 22, 2012, but before January 1, 2014  two million dollars ($2,000,000).  (2) For plan or policy years beginning on or after January 1, 2014, a health insurance carrier and health benefit plan shall not establish any annual limit on the dollar amount of essential health benefits for any individual, except:  (A) A health flexible spending arrangement, as defined in section 106(c)(2)(i) of the federal Internal Revenue Code, a medical savings account, as defined in section 220 of the federal Internal Revenue Code, and a health savings account, as defined in section 223 of the federal Internal Revenue Code are not subject to the requirements of subdivisions (1) and (2) of this subsection.  (B) The provisions of this subsection shall not prevent a health insurance carrier from placing annual dollar limits for any individual on specific covered benefits that are not essential health benefits to the extent that such limits are otherwise permitted under applicable federal law or the laws and regulations of this state.  (3) In determining whether an individual has received benefits that meet or exceed the allowable limits, as provided in subdivision (1) of this subsection, a health insurance carrier shall take into account only essential health benefits.  (b) Lifetime limits.(1) A health insurance carrier and health benefit plan offering group or individual health insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits for any individual.  (2) Notwithstanding subdivision (1) above, a health insurance carrier and health benefit plan is not prohibited from placing lifetime dollar limits for any individual on specific covered benefits that are not essential health benefits, as designated pursuant to a state determination and in accordance with federal laws and regulations.  (c)(1) Except as provided in subdivision (2) of this subsection, this section applies to any health insurance carrier providing coverage under an individual or group health plan.  (2)(A) The prohibition on lifetime limits applies to grandfathered health plans.  (B) The prohibition and limits on annual limits apply to grandfathered health plans providing group health insurance coverage, but the prohibition and limits on annual limits do not apply to grandfathered health plans providing individual health insurance coverage.  (d) This section shall not apply to a plan or to policy years prior to January 1, 2014, for which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant to 45 C.F.R.  147.126(d)(3). This section also shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  (e) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this subsection shall be construed to limit the authority of the Commissioner to regulate health insurance under existing state law.  History of Section.P.L. 2012, ch. 256,  8; P.L. 2012, ch. 262,  8. 
 27-20-6.1. Uniform explanation of benefits and coverage. (a) A nonprofit medical service corporation shall provide a summary of benefits and coverage explanation and definitions to policyholders and others required by, and at the times and in the format required, by the federal regulations adopted under section 2715 of the Public Health Service Act, as amended by the federal Affordable Care Act [42 U.S.C.  300gg-15]. The forms required by this section shall be made available to the commissioner on request. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.  (b) The provisions of this section shall apply to grandfathered health plans. This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  (c) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.  History of Section.P.L. 2012, ch. 256,  8; P.L. 2012, ch. 262,  8. 
 27-20-6.2. Filing of policy forms. (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 commissioners 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 actuarys 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.  History of Section.P.L. 2012, ch. 256,  8; P.L. 2012, ch. 262,  8. 
 27-20-6. Rates charged subscribers  Reserves  Hearing by commissioner. [Effective until January 1, 2023.] (a) Public hearings: The rates proposed to be charged or a rating formula proposed to be used by any corporation organized under this chapter to its subscribers, employers, the state or any political subdivision of the state, or individuals, shall be filed by the corporation at the office of the health insurance commissioner. Within sixty (60) days after receipt of the application, the commissioner, or his or her designee, shall hold a hearing on all rates proposed for health insurance coverage offered in the individual market as defined in  27-18.5-2 upon not less than ten (10) days written notice prior to the hearing. With regard to any other rates or rating formula subject to the commissioner's jurisdiction the commissioner, or his or her designee, may hold a hearing upon not less than ten (10) days written notice prior to the hearing. The notice shall be published by the commissioner in a newspaper or newspapers having aggregate general circulation throughout the state at least ten (10) days prior to the hearing. The notice shall contain a description of the rates proposed to be charged and a copy of the notice shall be sent to the applicant and to the department of the attorney general. In addition, the applicant shall provide by mail, at least ten (10) days prior to the hearing, notice of the proposed rate increase for health insurance coverage offered in the individual market as defined in  27-18.5-2 to all subscribers subject to the proposed rate increase.  (b) Filings with the Attorney Generals Office: The applicant shall provide a copy of the filing on all rates proposed for health insurance coverage offered in the individual market as defined in  27-18.5-2 or for a Medicare supplement policy as defined in  27-18.2-1 to the Insurance Advocacy Unit of the Attorney General's Office simultaneously with the filing at the office of the health insurance commissioner.  (c) Procedures: At any hearing held under this section, the applicant shall be required to establish that the rates proposed to be charged or the rating formula proposed to be used are consistent with the proper conduct of its business and with the interest of the public.  Rates proposed to be charged by any corporation organized under this chapter shall maintain total reserves in a dollar amount sufficient to pay claims and operating expenses for not less than one month. Those reserves shall be computed as of each December 31st, and a report setting forth the computation shall be submitted to the commissioner together with the corporation's Rhode Island annual statement to the insurance commissioner of the state of Rhode Island. Any documents presented in support of a filing of proposed rates under this section shall be made available for inspection by any party entitled to participate in a hearing or admitted as an intervenor in a hearing on such conditions as the commissioner may prescribe provided pursuant to this section at a time and at a place as the commissioner may deem reasonable. The commissioner, or his or her designee, upon the hearing, may administer oaths, examine and cross examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence, or other documents which the director deems relevant. The commissioner shall issue a decision as soon as is reasonably possible following completion of the hearing. The decision may approve, disapprove, or modify the rates proposed to be charged by the applicant. Applicants requesting changes in rates shall underwrite the reasonable expenses of the commissioner in connection with the hearing, including any costs related to advertisements, stenographic reporting, and expert witnesses fees.  (d) The term designee, as used in this section, shall mean a person who is impartial; a member in good standing of the Rhode Island bar; and a person who is sufficiently acquainted with the rules of evidence as used in the superior court of the state so as to enable that person to conduct a hearing as designee of the commissioner. The reasonable per diem cost of the designee, as appointed by the commissioner, shall be paid by the applicant requesting changes in the rates.  History of Section.P.L. 1945, ch. 1598,  3; G.L. 1956,  27-20-6; P.L. 1969, ch. 33,  2; P.L. 1970, ch. 53,  1; P.L. 1976, ch. 156,  2; P.L. 1991, ch. 93,  2; P.L. 1991, ch. 192,  2; P.L. 2000, ch. 200,  21; P.L. 2000, ch. 229,  21; P.L. 2005, ch. 43,  3; P.L. 2005, ch. 86,  3; P.L. 2016, ch. 145,  2; P.L. 2016, ch. 156,  2.   27-20-6. Rates charged subscribers  Reserves  Hearing by commissioner. [Effective January 1, 2023.] (a) General: The rates proposed to be charged or a rating formula proposed to be used by any corporation organized under this chapter to its subscribers, employers, the state or any political subdivision of the state, or individuals, shall be filed by the corporation at the office of the health insurance commissioner (the commissioner).  (b) Public hearings: Within ten (10) days after receipt of a filing, the commissioner shall determine, subject to the provisions of subsection (f) of this section, whether they intend to hold a public meeting or a public hearing at which time notice of such determination shall be sent to the insurance advocacy unit of the attorney general. Any such public hearing shall commence within sixty (60) days after receipt of the application, upon not less than ten (10) days written notice prior to the hearing, published by the commissioner in a newspaper or newspapers having aggregate general circulation throughout the state, at least ten (10) days prior to the hearing. The notice shall contain a description of the rates proposed to be charged and a copy of the notice shall be sent to the applicant and to the department of the attorney general. In the event there is a public hearing, the attorney general may engage the services of any expert or consultant necessary to assist in reviewing the filing, including having the ability to seek additional relevant information from the filer. All public hearings held pursuant to this section shall be held in accordance with the provisions of chapter 35 of title 42.  (c) Filings with the attorney generals office: The applicant shall provide a copy of the filing on all rates proposed for health insurance coverage offered in the individual market as defined in  27-18.5-2 or for a Medicare supplement policy as defined in  27-18.2-1 to the insurance advocacy unit of the attorney generals office simultaneously with the filing at the office of the health insurance commissioner.  (d) Procedures:(1) The applicant shall be required to establish that the rates proposed to be charged are consistent with the proper conduct of its business and with the interest of the public.  (2) Any documents presented in support of a filing of proposed rates under this section shall be made available for public examination at a time and place that the commissioner may deem reasonable.  (3) If a public hearing is held pursuant to subsection (b) of this section, the commissioner, or designee, upon the hearing, may administer oaths, examine and cross-examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence, or other documents they deem relevant. Any designee who shall conduct a hearing pursuant to this section shall report their findings, in writing, to the commissioner, within a reasonable time following the conclusion of the hearing, with a recommendation for approval, disapproval, or modification of the rates proposed to be charged by the applicant. The commissioner shall make and issue a decision not later than ten (10) days following the issuance of the recommended decision or, if the commissioner hears the application without the appointment of a designee, as soon as is reasonably possible following the completion of the hearing on the proposed rate change. The decision may approve, disapprove, or modify the rates proposed to be charged by the applicant.   (e) The term designee, as used in this section, shall mean a person who is impartial; a member in good standing of the Rhode Island bar; and a person who is sufficiently acquainted with the rules of evidence as used in the superior court of the state so as to enable that person to conduct a hearing as designee of the commissioner. The reasonable per diem cost of the designee, as appointed by the commissioner, shall be paid by the applicant requesting changes in the rates.  (f) Notwithstanding any provision of this section to the contrary, the commissioner shall hold a public hearing in any instance where the applicant covers ten thousand (10,000) or more enrolled individuals in the individual market, and the rates proposed in the filing for the annual rate increase for products offered in the individual market produce an overall average-rate increase of ten percent (10%) or more. The commissioner shall require that any filing for a rate increase for products offered in the individual market shall include the calculation of the overall average-rate increase in order to determine whether a public hearing is required.  (1) For the purposes of this section, the calculation of the overall average-rate increase shall be based on the overall average-increase percent weighted by member premiums, excluding the effects of age scale increases. To calculate the overall average-rate increase, the applicant shall multiply the proposed rate increase by product, times the total monthly renewing premium for each product, and then divide the product by the sum of monthly renewing premiums for all products. The commissioner shall require this calculation to be provided as part of the applicants individual market rate filing.  (g) In the event that subsection (f) of this section, in combination with  42-62-13(b), would result in more than one public hearing in any given calendar year, the commissioner may defer one or more public hearing(s) for an applicant resulting from subsection (f) of this section or  42-62-13(b) until the subsequent calendar year, with the provision that one of the deferred applicants shall be required to have a public hearing in the subsequent year, whether or not the applicants filing satisfies the requirements of subsection (f) of this section or  42-62-13(b) in that subsequent calendar year.  (h) The commissioner shall notify the attorney general of the filing(s) to be deferred and the attorney general shall be given the opportunity to provide written comments and recommendations to the commissioner regarding any such filing(s) deferred in accordance with subsection (g) of this section.  (i) Notwithstanding any other provision of law to the contrary, the filing of proposed rates or a rating formula, and the holding and conducting of any public hearing in connection with these proposed rates or rating formula, shall be held in accordance with the provisions of chapter 35 of title 42.  (j) Public comment. Whether or not a public hearing is held pursuant to subsection (f) of this section, the commissioner shall solicit public comment regarding the rates proposed to be charged. Public comment shall be solicited upon not less than ten (10) days written notice prior to the date that either:  (1) A public meeting at which verbal comments may be provided; or  (2) That written comment must be received by the commissioner.  The notice shall contain a description of the rates proposed to be charged, or the formula proposed to be used, and a copy of the notice shall be sent to the applicant and to the insurance advocacy unit of the department of the attorney general. The attorney general shall be permitted to conduct discovery in relation to the actuarial analyses and actuarial assumptions of the filer regarding any filing in the individual market as defined in  27-18.5-2. Any documents presented in support of the filing under this section shall be made available for public examination at a time and place that the commissioner may deem reasonable.  (k) The applicant shall bear reasonable expenses of the commissioner in connection with a filing made pursuant to this section, including any costs related to advertisements, stenographic reporting, and expert fees, regardless of whether a public hearing is held. The applicant shall bear reasonable expenses of the attorney general in relation to any public hearing conducted pursuant to this section. The applicant shall bear reasonable expenses of the attorney general in relation to any filing in the individual market that is not subject to a public hearing.  History of Section.P.L. 1945, ch. 1598,  3; G.L. 1956,  27-20-6; P.L. 1969, ch. 33,  2; P.L. 1970, ch. 53,  1; P.L. 1976, ch. 156,  2; P.L. 1991, ch. 93,  2; P.L. 1991, ch. 192,  2; P.L. 2000, ch. 200,  21; P.L. 2000, ch. 229,  21; P.L. 2005, ch. 43,  3; P.L. 2005, ch. 86,  3; P.L. 2016, ch. 145,  2; P.L. 2016, ch. 156,  2; P.L. 2022, ch. 147,  2, effective January 1, 2023; P.L. 2022, ch. 148,  2, effective January 1, 2023. 
 27-20-60. Coverage for individuals participating in approved clinical trials. (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:  (A) The study or investigation is approved or funded, which may include funding through in-kind contributions, by one or more of the following:  (i) The federal National Institutes of Health;  (ii) The federal Centers for Disease Control and Prevention;  (iii) The federal Agency for Health Care Research and Quality;  (iv) The federal Centers for Medicare & Medicaid Services;  (v) A cooperative group or center of any of the entities described in items (i) through (iv) or the U.S. Department of Defense or the U.S. Department of Veteran Affairs;  (vi) A qualified non-governmental research entity identified in the guidelines issued by the federal National Institutes of Health for center support grants; or  (vii) A study or investigation conducted by the U.S. Department of Veteran 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 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.  (B) The study or investigation is conducted under an investigational new drug application reviewed by the U.S. Food and Drug Administration; or  (C) The study or investigation is a drug trial that is exempt from having such an investigational new drug application.  (2) Participant has the meaning stated in section 3(7) of federal ERISA [29 U.S.C.  1002].  (3) 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.  (4) Qualified individual means a participant or beneficiary who meets the following conditions:  (A) 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  (B)(i) The referring healthcare professional is a participating provider and has concluded that the individuals participation in such trial would be appropriate based on the individual meeting the conditions described in subdivision (A) of this subdivision (3); or  (ii) The participant or beneficiary provides medical and scientific information establishing the individuals participation in such trial would be appropriate based on the individual meeting the conditions described in subdivision (A) of this subdivision (3).  (5) 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.  (b)(1) If a health insurance carrier offering group or individual health insurance coverage provides coverage to a qualified individual, the health carrier:  (A) Shall not deny the individual participation in an approved clinical trial.  (B) Subject to subdivision (3) of this subsection, 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  (C) Shall not discriminate against the individual on the basis of the individuals participation in the approved clinical trial.  (2)(A) Subject to subdivision (B) of this subdivision (2), 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.  (B) For purposes of subdivision (B) of this subdivision (2), routine patient costs do not include:  (i) The investigational item, device or service itself;  (ii) 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  (iii) 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 subdivision (1) of this subsection shall be construed as preventing a health carrier from requiring that a qualified individual participate in the trial through such a participating provider if the provider will accept the individual as a participant in the trial.  (4) Notwithstanding subdivision (3) of this subsection, subdivision (1) of this subsection 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 nonprofit medical service corporation offering group or individual health insurance coverage to provide benefits for routine patient care services provided outside of the coverages 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 insurance carriers coverage with respect to clinical trials.  (c) The requirements of this section shall be in addition to the requirements of  27-18-36  27-18-36.3.  (d) This section shall not apply to grandfathered health plans. This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  (e) This section shall be effective for plan years beginning on or after January 1, 2014.  History of Section.P.L. 2012, ch. 256,  8; P.L. 2012, ch. 262,  8. 
 27-20-61. Medical loss ratio reporting and rebates. (a) A nonprofit medical service corporation offering group or individual health insurance coverage of a health benefit plan, including a grandfathered health plan, shall comply with the provisions of Section 2718 of the Public Health Service Act as amended by the federal Affordable Care Act [42 U.S.C.  300gg-18], in accordance with regulations adopted thereunder.  (b) Nonprofit medical service corporations required to report medical loss ratio and rebate calculations and any other medical loss ratio and rebate information to the U.S. Department of Health and Human Services shall concurrently file such information with the commissioner.  History of Section.P.L. 2012, ch. 256,  8; P.L. 2012, ch. 262,  8. 
 27-20-62. Emergency services. (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:  (A) 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  (B) 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 nonprofit medical service corporation offering 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 nonprofit medical service corporation 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:  (A) The exclusion of or coordination of benefits;  (B) An affiliation or waiting period permitted under part 7 of federal ERISA, part A of title XXVII of the federal PHS Act, or chapter 100 of the federal Internal Revenue Code; or  (C) 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. However, 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 insurance carrier is required to pay under subdivision (1) of this subsection. A group health plan or health insurance carrier complies with the requirements of this subsection if it provides benefits with respect to an emergency service in an amount equal to the greatest of the three amounts specified in subdivisions (A), (B), and (C) of this subdivision (1) (which are adjusted for in-network cost-sharing requirements).  (A) 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 subdivision (A) 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 subdivision (A) is disregarded.  (B) The amount for the emergency service shall be 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 subdivision (B) 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.  (C) 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.  (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.  History of Section.P.L. 2012, ch. 256,  8; P.L. 2012, ch. 262,  8. 
 27-20-63. Internal and external appeal of adverse benefit determinations. (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 which are not subject to the jurisdiction of the department of health pursuant to  23-17.12 et seq. (Utilization Review Act).  (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.  History of Section.P.L. 2012, ch. 256,  8; P.L. 2012, ch. 262,  8. 
 27-20-64. Reserved.
 27-20-65. Primary care provider designation requirement. Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2013, shall require that the subscriber and each dependent designate a participating primary care provider and the insurer shall collect the designation from the insured. Designation of a primary care provider shall not be a condition of enrollment and failure to designate a primary care provider shall not constitute grounds for cancellation of coverage. For purposes of this section, primary care provider means the physician, practice or other medical provider considered by the insured to be his or her usual source of medical care.  History of Section.P.L. 2012, ch. 189,  1; P.L. 2012, ch. 202,  1. 
 27-20-66. Discretionary clauses. (a) No new or existing policy or certificate may contain any provision:  (1) Purporting to reserve sole discretion to the insurer or healthcare entity to determine eligibility for benefits or interpret the terms of a policy or certificate; or  (2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.  (b) Any such clause or language included in a contract, policy or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.  (c) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.  History of Section.P.L. 2013, ch. 85,  4; P.L. 2013, ch. 94,  4. 
 27-20-67. Orally administered anticancer medication  Cost-sharing requirement. (a) Every individual or group hospital or medical expense, insurance policy or individual or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued for delivery, or renewed in this state, on or after January 1, 2014, that offers both medical and prescription drug coverage, and provides coverage for intravenously administered anticancer medication, shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section. Notwithstanding the above, the requirements shall not be construed to impose any form of cap on cost-sharing.  (b) This section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  History of Section.P.L. 2013, ch. 323,  3; P.L. 2013, ch. 405,  3. 
 27-20-68. Consumer notification. Every nonprofit medical service corporation providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a non-duplication of benefits clause: NO DUPLICATION OF BENEFITS.  History of Section.P.L. 2013, ch. 452,  3; P.L. 2013, ch. 479,  3. 
 27-20-69. Opioid antagonists. (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.  History of Section.P.L. 2016, ch. 175,  3; P.L. 2016, ch. 192,  3. 
 27-20-7. Relationship of physician and patient  Actions against corporation. Nothing contained in this chapter or in any nonprofit medical service plan shall affect the ordinary professional relationship between the person rendering medical services under the plan and the subscriber to whom the services are rendered; and no action based upon or arising out of a relationship or relating to medical services rendered pursuant to a nonprofit medical service plan shall be maintained against the nonprofit medical service corporation operating the plan.  History of Section.P.L. 1945, ch. 1598,  3; G.L. 1956,  27-20-7. 
 27-20-70. Healthcare provider credentialing. (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 providers 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 providers 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 entitys or health plans 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.  History of Section.P.L. 2017, ch. 185,  3; P.L. 2017, ch. 254,  3. 
 27-20-71. Unfair discrimination prohibited. Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services that may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37 of title 5.  History of Section.P.L. 2017, ch. 165,  3; P.L. 2017, ch. 314,  3. 
 27-20-72. Health insurance contracts  Full year coverage for contraception. 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.  History of Section.P.L. 2018, ch. 230,  5; P.L. 2018, ch. 234,  5. 
 27-20-73. Prohibition on discrimination in organ transplants.  Pursuant to chapter 95 of title 23, any nonprofit medical service corporation that provides for anatomical gifts, organ transplants, or related treatment and services shall not:  (1) Deny coverage to a covered person solely on the basis of the persons disability;  (2) Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the health benefit plan, solely for the purpose of avoiding the requirements of this section;  (3) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide monetary or nonmonetary incentives to an attending provider, to induce the provider to provide care to an insured or enrollee in a manner inconsistent with this section; or  (4) Reduce or limit coverage benefits to a patient for the medical services or other services related to organ transplantation performed pursuant to this section as determined in consultation with the attending physician and patient.  History of Section.P.L. 2021, ch. 109,  5, effective June 30, 2021; P.L. 2021, ch. 133,  5, effective June 30, 2021. 
 27-20-74. Health insurance contracts  Copayments exemption for COVID-19 vaccinations. (a) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for COVID-19 related services, including, but not limited to: emergency services, inpatient services, provider office visits, and inpatient hospital stays, as long as the COVID-19 state of emergency remains in effect.  (b) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for the administration of the COVID-19 vaccine or a COVID-19 test.  (c) The health insurance commissioner shall promulgate any rules and regulations as the commissioner deems necessary for the efficient administration and enforcement of this section.  History of Section.P.L. 2021, ch. 145,  3, effective July 3, 2021; P.L. 2021, ch. 161,  3, effective July 3, 2021. 
 27-20-75. Perinatal doulas.  (a) As used in this section, doula or perinatal doula means a trained professional providing continuous physical, emotional, and informational support to a pregnant individual, from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.  (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 July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurers respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas area of professional competence as defined by the doula certification standard developed and maintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other healthcare provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement, except when those requirements are also applicable to other categories of healthcare providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other healthcare provider.  (c) 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 that is required to cover perinatal doula services, as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023, and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.  (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.  History of Section.P.L. 2021, ch. 209,  4, effective July 1, 2022; P.L. 2021, ch. 321,  4, effective July 1, 2022. 
 27-20-76. Gender rating. [Effective January 1, 2023.] (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 physicians office, and no policy that provides major medical or similar comprehensive-type coverage, excluding disability income, long-term care, and insurance supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall vary the premium rate for a health coverage plan based on the gender of the individual policy holders, enrollees, subscribers, or members.  (b) This section shall not apply to insurance coverage providing benefits for any of the following:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Limited benefit health;  (7) Specified disease indemnity;  (8) Sickness of bodily injury or death by accident or both; and  (9) Other limited benefit policies.  History of Section.P.L. 2021, ch. 88,  3, effective January 1, 2023; P.L. 2021, ch. 89,  3, effective January 1, 2023. 
 27-20-77. Coverage for biomarker testing. (a) As used in this section:  (1) Biomarker means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Biomarkers include, but are not limited to, gene mutations or protein expression.  (2) Biomarker testing is the analysis of a patients tissue, blood, or other biospecimen for the presence of a biomarker. Biomarker testing includes, but is not limited to, single-analyte tests, multi-plex panel tests, and whole genome sequencing.  (3) Clinical utility means the test result provides information that is used in the formulation of a treatment or monitoring strategy that informs a patients outcome and impacts the clinical decision. The most appropriate test may include both information that is actionable and some information that cannot be immediately used in the formulation of a clinical decision.  (4) Consensus statements as used here are statements developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure and with a conflict of interest policy. These statements are aimed at specific clinical circumstances and base the statements on the best available evidence for the purpose of optimizing the outcomes of clinical care.  (5) Nationally recognized clinical practice guidelines as used here are evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy. Clinical practice guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options and include recommendations intended to optimize patient care.  (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2024, shall provide coverage for the services of biomarker testing in accordance with each health insurers respective principles and mechanisms of reimbursement, credentialing, and contracting. Biomarker testing must be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollees disease or condition to guide treatment decisions, when the test provides clinical utility as demonstrated by medical and scientific evidence, including, but not limited to:  (1) Labeled indications for an FDA-approved or -cleared test or indicated tests for an FDA-approved drug;  (2) Centers for Medicare Services (CMS) national coverage determinations or Medicare Administrative Contractor (MAC) local coverage determinations; or  (3) Nationally recognized clinical practice guidelines and consensus statements.  (c) Coverage as defined in subsection (b) is provided in a manner that limits disruptions in care including the need for multiple biopsies or biospecimen samples.  (d) The patient and prescribing practitioner shall have access to clear, readily accessible, and convenient processes to request an exception to a coverage policy of a health insurer, nonprofit health service plan, and health maintenance organization. The process shall be made readily accessible on the health insurers, nonprofit health service plans, or health maintenance organizations website.  History of Section.P.L. 2022, ch. 151,  3, effective June 27, 2022; P.L. 2022, ch. 152,  3, effective June 27, 2022. 
 27-20-78. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.] (a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobin therapy.  (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall be coded as autoimmune encephalitis until the American Medical Association and the Centers for Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome.  (c) The healthcare benefits outlined in this section apply only to services delivered within the state of Rhode Island; provided, that all health insurance carriers shall be required to provide coverage for those benefits mandated by this section outside of the state of Rhode Island where it can be established through a pre-authorization process that the required services are not available in the state of Rhode Island from a provider in the health insurance carriers network.  (d) Each health insurance carrier shall collect and provide to the office of the health insurance commissioner, in a form and frequency acceptable to the commissioner, information and data reflecting the costs and the savings of adding the benefit coverage provided in this section. On or before January 1, 2025, the office of the health insurance commissioner shall report to the general assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage provided in this section produces a net savings to health insurance carriers and to policy holders.  (e) This section shall sunset and be repealed effective December 31, 2025.  History of Section.P.L. 2022, ch. 422,  3, effective June 30, 2022; P.L. 2022, ch. 423,  3, effective June 30, 2022. 
 27-20-8. Annual and quarterly statements. (a) Every nonprofit medical service corporation shall annually, on or before the first day of March in each year, file in the office of the commissioner of insurance a statement, verified by at least two (2) of the principal officers of the corporation, of its condition on the thirty-first day of December then next preceding, which statement shall be in general form and context as approved by the National Association of Insurance Commissioners and contain any matters as the director of business regulation shall prescribe and shall be available for inspection by the public.  (b) Every nonprofit medical service corporation shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners guidelines and procedures, and shall be available for inspection by the public.  (c) The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.  History of Section.P.L. 1945, ch. 1598,  4; G.L. 1956,  27-20-8; P.L. 1994, ch. 404,  2; P.L. 1996, ch. 188,  10. 
 27-20-9. Examination of affairs of corporation. It shall be the duty of the director of business regulation to make an examination of the financial condition and methods of doing business of every nonprofit medical service corporation. The examination shall be performed, and the associated costs shall be borne by the company, in accordance with all of the provisions of chapter 13.1 of this title.  History of Section.P.L. 1945, ch. 1598,  5; G.L. 1956,  27-20-9; P.L. 1960, ch. 71, art. 1,  11; P.L. 1967, ch. 154,  2; P.L. 1994, ch. 404,  2. 
 27-21-1  27-21-16. Repealed.
 27-22-1  27-22-16. Repealed.
 27-23-1  27-23-4. Repealed.
 27-24-1  27-24-45. Repealed.
 27-25-1. Fraternal benefit societies. Any incorporated society, order, or supreme lodge, without capital stock, including one exempted under the provisions of  27-25-38(a)(2), whether incorporated or not, conducted solely for the benefit of its members and their beneficiaries and not for profit, operated on a lodge system with ritualistic form of work, having a representative form of government, and which provides benefits in accordance with this chapter, is declared to be a fraternal benefit society.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-10. Organization. A domestic society shall be formed as follows: (1) Seven (7) or more citizens of the United States, a majority of whom are citizens of this state, who desire to form a fraternal benefit society, may make, sign, and acknowledge before some officer competent to take acknowledgment of deeds, articles of incorporation, in which shall be stated:  (i) The proposed corporate name of the society, which shall not so closely resemble the name of any society or insurance company as to be misleading or confusing;  (ii) The purposes for which it is being formed and the mode in which its corporate powers are to be exercised. Those purposes shall not include more liberal powers than are granted by this chapter; and  (iii) The names and residences of the incorporators and the names, residences, and official titles of all the officers, trustees, directors, or other persons who are to have and exercise the general control of the management of the affairs and funds of the society for the first year or until the ensuing election at which all of the officers shall be elected by the supreme governing body, which election shall be held not later than one year from the date of the issuance of the permanent certificate of authority;  (2) The articles of incorporation, duly certified copies of the societys bylaws and rules, copies of all proposed forms of certificates, applications for them, and circulars to be issued by the society and a bond conditioned upon the return to applicants of the advanced payments if the organization is not completed within one year, shall be filed with the commissioner of insurance, who may require any further information the commissioner deems necessary. The bond with sureties approved by the commissioner of insurance shall be in an amount, not less than three hundred thousand dollars ($300,000) nor more than one million five hundred thousand dollars ($1,500,000), as required by the commissioner of insurance. All documents filed are to be in the English language. If the purposes of the society conform to the requirements of this chapter and all of the provisions of the law have been complied with, the commissioner of insurance shall certify, retain, and file the articles of incorporation and furnish the incorporators with a preliminary certificate of authority authorizing the society to solicit members;  (3) No preliminary certificate of authority granted under the provisions of this section shall be valid after one year from its date or after a further period, not exceeding one year, as may be authorized by the commissioner of insurance upon cause shown, unless the five hundred (500) applicants have been secured and the organization has been completed as provided in this section. The articles of incorporation and all other proceedings under the articles shall become null and void in one year from the date of the preliminary certificate of authority, or at the expiration of the extended period, unless the society shall have completed its organization and received a certificate of authority to do business;  (4) Upon receipt of a preliminary certificate of authority from the commissioner of insurance, the society may solicit members for the purpose of completing its organization, shall collect from each applicant the amount of not less than one regular monthly premium in accordance with its table of rates, and shall issue to each applicant a receipt for the amount so collected. No society shall incur any liability other than for the return of the advance premium, nor issue any certificate, nor pay, allow, or offer or promise to pay or allow, any benefit to any person until:  (i) Actual bona fide applications for benefits have been secured on not less than five hundred (500) applicants, and any necessary evidence of insurability has been furnished to and approved by the society;  (ii) At least ten (10) subordinate lodges have been established into which the five hundred (500) applicants have been admitted;  (iii) There has been submitted to the commissioner of insurance, under oath of the president or secretary or corresponding officer of the society, a list of the applicants, giving their names, addresses, date each was admitted, name and number of the subordinate lodge of which each applicant is a member, amount of benefits to be granted and premiums for the benefits; and  (iv) It shall have been shown to the commissioner of insurance, by sworn statement of the treasurer or corresponding officer of the society, that at least five hundred (500) applicants have each paid in cash at least one regular monthly premium as provided in this section, which premiums in the aggregate shall amount to at least one hundred and fifty thousand dollars ($150,000). The advance premiums shall be held in trust during the period of organization and if the society has not qualified for a certificate of authority within one year, the premiums shall be returned to the applicant;  (5) The commissioner of insurance may make any examination and require any further information as the commissioner deems advisable. Upon presentation of satisfactory evidence that the society has complied with all of the provisions of law, the commissioner shall issue to the society a certificate of authority to that effect and that the society is authorized to transact business pursuant to the provisions of this chapter. The certificate of authority shall be prima facie evidence of the existence of the society at the date of the certificate. The commissioner of insurance shall cause a record of the certificate of authority to be made. A certified copy of the record may be given in evidence with like effect as the original certificate of authority; and  (6) Any incorporated society authorized to transact business in this state at the time this chapter becomes effective shall not be required to reincorporate.  History of Section.P.L. 1984, ch. 201,  2; P.L. 2002, ch. 292,  58. 
 27-25-11. Amendments to laws. (a) A domestic society may amend its laws in accordance with the provisions of those laws, by action of its supreme governing body at any regular or special meeting of that body or, if its laws provide, by referendum. A referendum may be held in accordance with the provisions of the domestic societys laws, by the vote of the voting members of the society, by the vote of delegates or representatives of voting members, or by the vote of local lodges. A society may provide for voting by mail. No amendment submitted for adoption by referendum shall be adopted unless, within six (6) months from the date of submission, a majority of the members voting shall have signified their consent to the amendment by one of the methods specified in this section.  (b) No amendment to the laws of any domestic society shall take effect unless approved by the commissioner of insurance who shall approve the amendment if the commissioner finds that it has been duly adopted and is not inconsistent with any requirement of the laws of the state or with the character, objects, and purposes of the society. Unless the commissioner of insurance shall disapprove an amendment within sixty (60) days after the filing of the amendment, it shall be considered approved. The approval or disapproval of the commissioner of insurance shall be in writing and mailed to the secretary or corresponding officer of the society at its principal office. In case the commissioner disapproves the amendment, the reasons shall be stated in the written notice.  (c) Within ninety (90) days from the approval by the commissioner of insurance, all amendments, or a synopsis of the amendments, shall be furnished to all of the members of the society either by mail or by publication, in full, in the official publication of the society. The affidavit of any officer of the society or of anyone authorized by it to mail any amendments or synopsis, stating facts which show that the amendments or a synopsis have been duly addressed and mailed, shall be prima facie evidence that the amendments or synopsis have been furnished to the addressee.  (d) Every foreign or alien society authorized to do business in this state shall file with the commissioner of insurance a duly certified copy of all amendments of, or additions to, its laws within ninety (90) days after their enactment.  (e) Printed copies of the laws, as amended, certified by the secretary or corresponding officer of the society, shall be prima facie evidence of their legal adoption.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-12. Institutions. A society may create, maintain and operate, or may establish organizations to operate, not for profit institutions to further the purposes permitted by  27-25-5(a)(2)(i). Those institutions may furnish services free or at a reasonable charge. Any real or personal property owned, held, or leased by the society for this purpose shall be reported in every annual statement.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-13. Reinsurance. (a) A domestic society may, by a reinsurance agreement, cede any individual risk or risks in whole or in part to an insurer, other than another fraternal benefit society, having the power to make reinsurance and authorized to do business in this state, or, if not so authorized, one which is approved by the commissioner of insurance, but no society may reinsure substantially all of its insurance in force without the written permission of the commissioner of insurance. It may take credit for the reserves on the ceded risks to the extent reinsured, but no credit shall be allowed as an admitted asset or as a deduction from liability, to a ceding society for reinsurance made, ceded, or renewed unless the reinsurance is payable by the assuming insurer on the basis of the liability of the ceding society under the contract or contracts reinsured without diminution because of the insolvency of the ceding society.  (b) Notwithstanding the limitation in subsection (a) of this section, a society may reinsure the risks of another society in a consolidation or merger approved by the commissioner of insurance under  27-25-14.  History of Section.P.L. 1984, ch. 201,  2; P.L. 2002, ch. 292,  58. 
 27-25-14. Consolidations and mergers. (a) A domestic society may consolidate or merge with any other society by complying with the provisions of this section. It shall file with the commissioner of insurance:  (1) A certified copy of the written contract containing, in full, the terms and conditions of the consolidation or merger;  (2) A sworn statement by the president and secretary or corresponding officers of each society showing the financial condition of the society on a date fixed by the commissioner of insurance but not earlier than December thirty-first, next preceding the date of the contract;  (3) A certificate of the officers, duly verified by their respective oaths, that the consolidation or merger has been approved by a two-thirds (23) vote of the supreme governing body of each society, the vote being conducted at a regular or special meeting of the body, or, if the societys laws so permit, by mail; and  (4) Evidence that at least sixty (60) days prior to the action of the supreme governing body of each society, the text of the contract has been furnished to all of the members of each society either by mail or by publication, in full, in the official publication of each society.  (b) If the commissioner of insurance finds that the contract is in conformity with the provisions of this section, that the financial statements are correct, and that the consolidation or merger is just and equitable to the members of each society, the commissioner shall approve the contract and issue a certificate to that effect. Upon that approval, the contract shall be in full force and effect unless any society that is a party to the contract is incorporated under the laws of any other state or territory. In that event, the consolidation or merger shall not become effective unless and until it has been approved as provided by the laws of that state or territory and a certificate of the approval filed with the commissioner of insurance of this state or, if the laws of that state or territory contain no such provision, then the consolidation or merger shall not become effective unless and until it has been approved by the commissioner of insurance of that state or territory and a certificate of the approval filed with the commissioner of insurance of this state.  (c) Upon the consolidation or merger becoming effective, all of the rights, franchises, and interest of the consolidated or merged societies in and to every species of property, real, personal, or mixed, and things in action belonging to the societies shall be vested in the society resulting from or remaining after the consolidation or merger without any other instrument, except that conveyance of real property may be evidenced by proper deeds, and the title to any real estate or interest in real estate, vested under the laws of this state in any of the societies consolidated or merged, shall not revert or be in any way impaired by reason of the consolidation or merger, but shall vest absolutely in the society resulting from or remaining after the consolidation or merger.  (d) The affidavit of any officer of the society or of anyone authorized by it to mail any notice or document, stating that the notice or document has been duly addressed and mailed, shall be prima facie evidence that the notice or document has been furnished to the addressees.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-15. Conversion of fraternal benefit society into mutual life insurance company. Any domestic fraternal benefit society may be converted and licensed as a mutual life insurance company by compliance with all of the requirements of the general laws relating to the financial requirements of mutual life insurance companies. A plan of conversion shall be prepared, in writing, by the board of directors setting forth, in full, the terms and conditions of conversion. The affirmative vote of two-thirds (23) of all members of the supreme governing body at a regular or special meeting shall be necessary for the approval of the plan. No conversion shall take effect unless and until approved by the commissioner of insurance, who may give approval if the commissioner finds that the proposed change is in conformity with the requirements of law and not prejudicial to the certificate holders of the society.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-16. Benefits. (a) A society may provide the following contractual benefits in any form:  (1) Death benefits;  (2) Endowment benefits;  (3) Annuity benefits;  (4) Temporary or permanent disability benefits;  (5) Hospital, medical, or nursing benefits;  (6) Monument or tombstone benefits to the memory of deceased members; and  (7) Any other benefits authorized for life insurers and which are not inconsistent with this chapter.  (b) A society shall specify in its rules those persons who may be issued, or covered by, the contractual benefits in subsection (a) of this section, consistent with providing benefits to members and their dependents. A society may provide benefits on the lives of children under the minimum age for adult membership upon application of an adult person.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-17. Beneficiaries. (a) The owner of a benefit contract shall have the right at all times to change the beneficiary or beneficiaries in accordance with the laws or rules of the society unless the owner waives this right by specifically requesting, in writing, that the beneficiary designation is irrevocable. A society may, through its laws or rules, limit the scope of beneficiary designations and shall provide that no revocable beneficiary shall have or obtain any vested interest in the proceeds of any certificate until the certificate has become due and payable in conformity with the provisions of the benefit contract.  (b) A society may make provision for the payment of funeral benefits to the extent of the portion of any payment under a certificate as might reasonably appear to be due to any person equitably entitled to payment by reason of having incurred expense occasioned by the burial of the member, provided the portion so paid shall not exceed the sum of two thousand dollars ($2,000).  (c) If, at the death of any person insured under a benefit contract, there is no lawful beneficiary to whom the proceeds shall be payable, the amount of the benefit, except to the extent that funeral benefits may be paid as provided in subsection (b) of this section, shall be payable to the personal representative of the deceased insured, provided that if the owner of the certificate is other than the insured, the proceeds shall be payable to the owner.  History of Section.P.L. 1984, ch. 201,  2; P.L. 1998, ch. 441,  22. 
 27-25-18. Benefits not attachable. No money or other benefit, charity, relief, or aid to be paid, provided, or rendered by any society shall be liable to attachment, garnishment, or other process, or be seized, taken, appropriated, or applied by any legal or equitable process or operation of law to pay any debt or liability of a member or beneficiary, or any other person who may have a right under a debt or liability of a member or beneficiary, either before or after payment by the society.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-19. The benefit contract. (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 which 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 owners 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 subdivision (1) of this subsection, 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 which are payable under the certificate and a provision reciting or setting forth the substance of any sections of the societys laws or rules in force at the time of issuance of the certificate which, 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 societys 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.  History of Section.P.L. 1984, ch. 201,  2; P.L. 2002, ch. 292,  58. 
 27-25-2. Lodge system. (a) A society is operating on the lodge system if it has a supreme governing body and subordinate lodges into which members are elected, initiated, or admitted in accordance with its laws, rules, and ritual. Subordinate lodges shall be required by the laws of the society to hold regular meetings at least once in each month in furtherance of the purposes of the society.  (b) A society may, at its option, organize and operate lodges for children under the minimum age for adult membership. Membership and initiation in local lodges shall not be required of the children, nor shall they have a voice or vote in the management of the society.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-20. Nonforfeiture benefits, cash surrender values, certificate loans, and other options. (a) For certificates issued prior to January 1, 1986, the value of every paid up nonforfeiture benefit and the amount of any cash surrender value, loan, or other option granted shall comply with the provisions of law applicable immediately prior to January 1, 1985.  (b) For certificates issued on or after January 1, 1986 for which reserves are computed on the commissioners 1941 standard ordinary mortality table, the commissioners 1941 standard industrial table, or the commissioners 1958 standard ordinary mortality table, or the commissioners 1980 standard mortality table, or any more recent table made applicable to life insurers, every paid up nonforfeiture benefit and the amount of any cash surrender value, loan, or other option granted shall not be less than the corresponding amount ascertained in accordance with the laws of this state applicable to life insurers issuing policies containing life benefits based upon those tables.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-21. Investments. A society shall invest its funds only in those investments authorized by the laws of this state for the investment of assets of life insurers and subject to the limitations on the investments. Any foreign or alien society permitted or seeking to do business in this state which invests its funds in accordance with the laws of the state, district, territory, country, or province in which it is incorporated, shall be held to meet the requirements of this section for the investment of funds.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-22. Funds. (a) All assets shall be held, invested, and disbursed for the use and benefit of the society, and no member or beneficiary shall have or acquire individual rights in the assets or become entitled to any apportionment on the surrender of any part of them, except as provided in the benefit contract.  (b) A society may create, maintain, invest, disburse, and apply any special fund or funds necessary to carry out any purpose permitted by the laws of the society.  (c) A society may, pursuant to resolution of its supreme governing body, establish and operate one or more separate accounts and issue contracts on a variable basis, subject to the provisions of law regulating life insurers establishing those accounts and issuing those contracts. To the extent the society deems it necessary in order to comply with any applicable federal or state laws, or any rules issued under applicable federal or state laws, the society may:  (1) Adopt special procedures for the conduct of the business and affairs of a separate account,  (2) For persons having beneficial interests in a separate account, provide special voting and other rights, including without limitation special rights and procedures relating to investment policy, investment advisory services, selection of certified public accountants, and selection of a committee to manage the business and affairs of the account, and  (3) Issue contracts on a variable basis to which  27-25-19(b) and (d) shall not apply.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-23. Exemptions. Except as provided in this chapter, societies shall be governed by this chapter and are exempt from all other insurance law provisions unless they are expressly designated therein, or unless it is specifically made applicable by this chapter.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-24. Taxation. Every society organized or licensed under this chapter is declared to be a charitable and benevolent institution, and all of its funds shall be exempt from all and every state, county, district, municipal, and school tax, other than taxes on real estate and office equipment.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-25. Valuation. (a) Standards of valuation for certificates issued prior to January 1, 1986, shall be those provided by the laws applicable immediately prior to January 1, 1985.  (b)(1) The minimum standards of valuation for certificates issued on or after January 1, 1986 shall be based on the following tables:  (i) For certificates of life insurance, the commissioners 1941 standard ordinary mortality table, the commissioners 1941 standard industrial mortality table, the commissioners 1958 standard ordinary mortality table, the commissioners 1980 standard ordinary mortality table, or any more recent table made applicable to life insurers; and  (ii) For annuity and pure endowment certificates, for total and permanent disability benefits, for accidental death benefits and for non-cancelable accident and health benefits, these tables authorized for use by life insurers in this state;  (2) All of the above shall be under valuation methods and standards, including interest assumptions, in accordance with the laws of this state applicable to life insurers issuing policies containing like benefits.  (c) The commissioner of insurance may, in his or her discretion, accept other standards for valuation if the commissioner finds that the reserves produced will not be less in the aggregate than reserves computed in accordance with the minimum valuation standard prescribed in this section. The commissioner of insurance may, in his or her discretion, vary the standards of mortality applicable to all benefit contracts on substandard lives or other extra hazardous lives by any society authorized to do business in this state.  (d) Any society, with the consent of the commissioner of insurance of the state of domicile of the society and under the conditions, if any, which the commissioner may impose, may establish and maintain reserves on its certificates in excess of the reserves required under those conditions, but the contractual rights of any benefit member shall not be affected by the reserves.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-26. Reports. (a) Reports shall be filed in accordance with the provisions of this section.  (b) Every society transacting business in this state shall annually, on or before the first day of March, unless for cause shown the time has been extended by the commissioner of insurance, file with the commissioner of insurance a true statement of its financial condition, transactions, and affairs for the preceding calendar year, and pay a fee of one hundred dollars ($100) for filing. The statement shall be in general form and context as approved by the national association of insurance commissioners for fraternal benefit societies and as supplemented by additional information required by the commissioner of insurance.  (c) As part of the annual statement required in this section, each society shall, on or before the first day of March, file with the commissioner of insurance a valuation of its certificates in force on December thirty-first last preceding, provided the commissioner of insurance may, in his or her discretion for cause shown, extend the time for filing the valuation for not more than two (2) calendar months. The valuation shall be done in accordance with the standards specified in  27-25-25. The valuation and underlying data shall be certified by a qualified actuary or, at the expense of the society, verified by the actuary of the department of insurance of the state of domicile of the society.  (d) A society neglecting to file the annual statement in the form and within the time provided by this section shall forfeit one hundred dollars ($100) for each day during which the neglect continues, and, upon notice by the commissioner of insurance to that effect, its authority to do business in this state shall cease while the default continues.  (e) A society may be required to file quarterly statements upon request by the insurance commissioner, in accordance with the National Association of Insurance Commissioners guidelines and procedures, due on or before forty-five (45) days after the quarter ending. Annual and quarterly statements shall be available for inspection by the public.  (f) The insurance commissioner shall also require compliance with chapter 12.1 of this title.  History of Section.P.L. 1984, ch. 201,  2; P.L. 1987, ch. 252,  1; P.L. 1993, ch. 138, art. 62,  10; P.L. 1994, ch. 404,  12. 
 27-25-27. Annual license. (a) The authority of all societies shall be continuous unless sooner revoked or suspended as provided in this chapter. For each license the society shall pay the commissioner of insurance one hundred dollars ($100). The society shall pay a license fee of one hundred dollars ($100) annually prior to April 30 of each year. A duly certified copy or duplicate of the license shall be prima facie evidence that the licensee is a fraternal benefit society within the meaning of this chapter.  (b) The commissioner may assess a late fee of ten dollars ($10.00) per day for each day the society is late in remitting its annual license fee.  History of Section.P.L. 1984, ch. 201,  2; P.L. 1987, ch. 196,  1; P.L. 1993, ch. 138, art. 62,  10; P.L. 1994, ch. 134,  15; P.L. 2002, ch. 292,  58. 
 27-25-28. Examination of societies  No adverse publication. (a) The commissioner of insurance, or any person he or she may appoint, may examine any domestic, foreign, or alien society transacting or applying for admission to transact business in this state in the same manner as authorized for examination of domestic, foreign, or alien insurers.  (b) The expense of each examination and of each valuation, including compensation and the actual expense of examiners, shall be paid by the society examined or whose certificates are valued in accordance with the laws of this state governing the examination of life insurers.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-29. Foreign or alien society  Admission. No foreign or alien society shall transact business in this state without a license issued by the commissioner of insurance. A society desiring admission to this state shall comply substantially with the requirements and limitations of this chapter applicable to domestic societies. A society may be licensed to transact business in this state upon filing with the commissioner of insurance:  (1) A duly certified copy of its articles of incorporation;  (2) A copy of its bylaws, certified by its secretary or corresponding officer;  (3) A power of attorney to the commissioner of insurance as prescribed in  27-25-35;  (4) A statement of its business under oath of its president and secretary or corresponding officers in a form prescribed by the commissioner of insurance, duly verified by an examination made by the supervising insurance official of its home state or other state, territory, province, or country, satisfactory to the commissioner of insurance of this state;  (5) Certification from the proper official of its home state, territory, province, or country that the society is legally incorporated and licensed to transact business in its home state, territory, province, or country;  (6) Copies of its certificate forms;  (7) A showing that its assets are invested in accordance with the provisions of this chapter; and  (8) Any other information that the commissioner of insurance may deem necessary.  History of Section.P.L. 1984, ch. 201,  2; P.L. 1998, ch. 441,  22. 
 27-25-3. Representative form of government. A society has a representative form of government when: (1) It has a supreme governing body constituted in one of the following ways:  (i) Assembly. The supreme governing body is an assembly composed of delegates elected directly by the members or at intermediate assemblies or conventions of members or their representatives, together with other delegates as may be prescribed in the societys laws. A society may provide for the election of delegates by mail. The elected delegates shall constitute a majority in number and shall not have less than two-thirds (23) of the votes and not less than the number of votes required to amend the societys laws. The assembly shall be elected and shall meet at least once every four (4) years and shall elect a board of directors to conduct the business of the society between meetings of the assembly. Vacancies on the board of directors between elections may be filled in the manner prescribed by the societys laws; or  (ii) Direct election. The supreme governing body is a board composed of persons elected by the members, either directly or by their representatives in intermediate assemblies, and any other persons prescribed in the societys laws. A society may provide for the election of the board by mail. Each term of a board member may not exceed four (4) years. Vacancies on the board between elections may be filled in the manner prescribed by the societys laws. Those persons elected to the board shall constitute a majority in number and not less than the number of votes required to amend the societys laws. A person filling the unexpired term of an elected board member shall be considered an elected member. The board shall meet at least quarterly to conduct the business of the society;  (2) The officers of the society are elected either by the supreme governing body or by the board of directors;  (3) Only benefit members are eligible for election to the supreme governing body, the board of directors, or any intermediate assembly; and  (4) Each voting member shall have one vote; no vote may be cast by proxy.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-30. Injunction  Liquidation  Receivership of domestic society. (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 (30) day period in which to comply with the commissioners 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.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-31. Suspension, revocation, or refusal of license of foreign or alien society. (a) When the commissioner of insurance upon investigation finds that a foreign or alien society transacting or applying to transact business in this state: (1) has exceeded its powers; (2) has failed to comply with any of the provisions of this chapter; (3) is not fulfilling its contracts in good faith; or (4) is conducting its business fraudulently or in a manner hazardous to its members or creditors or the public; 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 (30) day period in which to comply with the commissioners 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 its license should not be suspended, revoked or refused. If on that date the society does not present good and sufficient reason why its authority to do business in this state should not be suspended, revoked, or refused, the commissioner may suspend or refuse the license of the society to do business in this state until satisfactory evidence is furnished to the commissioner that the suspension or refusal should be withdrawn or the commissioner may revoke the authority of the society to do business in this state.  (b) Nothing contained in this section shall be taken or construed as preventing the society from continuing in good faith all contracts made in this state during the time the society was legally authorized to transact business in this state.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-32. Injunction. No application or petition for injunction against any domestic, foreign, or alien society, or lodge of a society, shall be recognized in any court of this state unless made by the attorney general upon the request of the commissioner of insurance.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-33. Licensing of insurance producers. (a) Insurance producers of societies shall be licensed in accordance with the provisions of the laws regulating the licensing, revocation, suspension, or termination of license of resident and nonresident insurance producers.  (b) No examination or license shall be required of any regular salaried officer, employee, or member of a licensed society who devotes substantially all of his or her services to activities other than the solicitation of fraternal insurance contracts from the public, and who receives for the solicitation of the contracts no commission or other compensation directly dependent upon the amount of business obtained.  (c) Any insurance producer, representative, or member of a society who devotes, or intends to devote, less than fifty percent (50%) of his or her time to the solicitation and procurement of insurance contracts for the society or who was in the service of a society on January 1, 1985, shall be exempt from the requirements of subsection (a) of this section. Any person who in the preceding calendar year has solicited and procured life insurance contracts on behalf of any society in an amount of insurance in excess of fifty thousand dollars ($50,000) or, in the case of any other kind or kinds of insurance which the society might write, on the persons of more than twenty-five (25) individuals and who has received or will receive a commission or other compensation for those contracts, shall be presumed to be devoting, or intending to devote, fifty percent (50%) of his or her time to the solicitation or procurement of insurance contracts for the society.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-34. Unfair methods of competition and unfair and deceptive acts and practices. Every society authorized to do business in this state shall be subject to the laws and regulations of the commissioner of insurance prohibiting unfair trade practices, including laws and regulations concerning discrimination, rebating, and misrepresentation; provided, however, that nothing in the provisions shall be construed as applying to or affecting the right of any society to determine its eligibility requirements for membership, or be construed as applying to or affecting the offering of benefits exclusively to members or persons eligible for membership in the society by a subsidiary corporation or affiliated organization of the society.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-35. Service of process. (a) Every society authorized to do business in this state shall appoint in writing the commissioner of insurance and each successor in office to be its true and lawful attorney upon whom all lawful process in any action or proceeding against it shall be served, and shall agree in the writing that any lawful process against it which is served on the attorney shall be of the same legal force and validity as if served upon the society, and that the authority shall continue in force so long as any liability remains outstanding in this state. Copies of the appointment, certified by the commissioner of insurance, shall be deemed sufficient evidence and shall be admitted in evidence with the same force and effect as the original might be admitted.  (b) Service shall only be made upon the commissioner of insurance, or if absent, upon the person in charge of the commissioners office. It shall be made in duplicate and shall constitute sufficient service upon the society. When legal process against a society is served upon the commissioner of insurance, the commissioner shall forward one of the duplicate copies by registered mail, prepaid, directed to the secretary or corresponding officer. No service shall require a society to file its answer, pleading, or defense in less than thirty (30) days from the date of mailing the copy of the service to a society. Legal process shall not be served upon a society except in the manner provided in this section. At the time of serving any process upon the commissioner of insurance, the plaintiff or complainant in the action shall pay to the commissioner of insurance a fee of five dollars ($5.00).  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-36. Review. All decisions and findings of the commissioner of insurance made under the provisions of this chapter shall be subject to review by proper proceedings in any court of competent jurisdiction in this state.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-37. Penalties. (a) Any person who willfully makes a false or fraudulent statement in or relating to an application for membership or for the purpose of obtaining money from or a benefit in any society, shall upon conviction be fined not less than one hundred dollars ($100) nor more than five hundred dollars ($500) or imprisonment for not less than thirty (30) days nor more than one year, or both.  (b) Any person who willfully makes a false or fraudulent statement in any verified report or declaration under oath required or authorized by this chapter, or of any material fact or thing contained in a sworn statement concerning the death or disability of an insured for the purpose of procuring payment of a benefit named in the certificate, shall be guilty of perjury and shall be subject to the penalties prescribed by law.  (c) Any person who solicits membership for, or in any manner assists in procuring membership in, any society not licensed to do business in this state shall upon conviction be fined not less than fifty dollars ($50.00) nor more than two hundred dollars ($200).  (d) Any person guilty of a willful violation of, or neglect or refusal to comply with, the provisions of this chapter for which a penalty is not prescribed, shall upon conviction, be subject to a fine not exceeding five hundred dollars ($500).  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-38. Exemption of certain societies. (a) Nothing contained in this chapter shall be construed as to affect or apply to:  (1) Grand or subordinate lodges of societies, orders, or associations now doing business in this state that provide benefits exclusively through local or subordinate lodges;  (2) Domestic societies that limit membership to employees of a particular city or town, designated firm, business house, or corporation that provide for a death benefit of not more than fifteen hundred dollars ($1,500) or disability benefits of not more than twelve hundred dollars ($1,200) to any person in any one year, or both; or  (3) Domestic societies or associations of a purely religious, charitable, or benevolent description, that provide for a death benefit of not more than fifteen hundred dollars ($1,500) or for disability benefits of not more than twelve hundred dollars ($1,200) to any one person in any one year, or both.  (4) Any association, whether a fraternal benefit society or not, that was organized before 1880 and whose members are officers or enlisted, regular or reserve, active, retired, or honorably discharged members of the armed forces or sea services of the United States, and a principal purpose of which is to provide insurance and other benefits to its members and their dependents or beneficiaries.  (b) Any society or association described in subdivision (a)(3) or (a)(4) of this section that provides for death or disability benefits for which benefit certificates are issued, and any society or association included in subdivision (a)(4) of this section that has more than fifteen hundred (1,500) members, shall not be exempted from the provisions of this chapter, but shall comply with all of its requirements.  (c) No society that, by the provisions of this section, is exempt from the requirements of this chapter, except any society described in subdivision (a)(2) of this section, shall give or allow, or promise to give or allow, to any person any compensation for procuring new members.  (d) Every society that provides for benefits in case of death or disability resulting solely from accident, and that does not obligate itself to pay natural death or sick benefits, shall have all of the privileges and be subject to all the applicable provisions and regulations of this chapter, except that the provisions of this chapter relating to medical examination, valuations of benefit certificates, and incontestability, shall not apply to the society.  (e) The commissioner of insurance may require from any society or association, by examination or otherwise, any information that will enable the commissioner to determine whether the society or association is exempt from the provisions of this chapter.  (f) Each association that is exempted from insurance regulation under subdivision (a)(4) of this section shall annually, on or before the first day of May, file with the commissioner a true and complete financial statement, audited by an independent, certified public accountant or accounting firm, of its financial condition, transactions, and affairs for the preceding calendar year and pay a fee of ten dollars ($10.00) for filing the same. Such an association may be required to file quarterly financial statements upon request by the insurance commissioner, due on or before forty-five (45) days after the quarter ending. Annual and quarterly statements shall be available for inspection by the public. If, in the opinion of the commissioner, such an association has not maintained assets sufficient to meet its liabilities and the minimum capital and surplus requirements set forth in  27-2-5, the commissioner may order such association to increase its capital and surplus. If the association is unable to satisfy such order, the commissioner may order such association to cease and desist from assuming any additional liabilities in this state until such time as the association is able to satisfy the capital and surplus requirements ordered by the commissioner. Such orders shall be subject to judicial review pursuant to  27-25-36.  (g) Societies exempted under the provisions of this section shall also be exempt from all other provisions of the insurance laws of this state.  History of Section.P.L. 1984, ch. 201,  2; P.L. 2013, ch. 117,  1; P.L. 2013, ch. 119,  1; P.L. 2014, ch. 105,  1; P.L. 2014, ch. 122,  1. 
 27-25-39. Reciprocal fees and charges. Whenever by the laws of any other state of the United States any fees, charges, taxes, deposits of money or of securities, or other obligations or prohibitions are imposed on fraternal benefit societies incorporated or organized under the laws of this state or on the agents or insurance producers of fraternal benefit societies, so long as those laws continue in force, the fees, charges, taxes, deposits, and obligations shall be imposed on the fraternal benefit societies doing business in this state which are incorporated or organized under the laws of the other state and on their agents or insurance producers.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-4. Definitions. Whenever used in this chapter: (1) Benefit contract means the agreement for provision of benefits authorized by  27-25-16, as that agreement is described in  27-25-19(a);  (2) Benefit member means an adult member who is designated by the laws or rules of the society to be a benefit member under a benefit contract;  (3) Certificate means the document issued as written evidence of the benefit contract;  (4) Laws means the societys articles of incorporation, constitution, and by-laws, however designated;  (5) Lodge means subordinate member units of the society, known as camps, courts, councils, branches, or by any other designation;  (6) Premiums means premiums, rates, dues, or other required contributions by whatever name known, which are payable under the certificate;  (7) Rules means all rules, regulations, or resolutions adopted by the supreme governing body or board of directors which are intended to have general application to the members of the society; and  (8) Society means fraternal benefit society, unless otherwise indicated.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-40. Payments of commissions to other than agent or insurance producer forbidden. No society doing business in this state shall pay any commission or other compensation to any person for any services in obtaining in this state any new contract of life, accident, or health insurance, or any new annuity contract, except to a licensed insurance agent or producer of the society and except an agent or insurance producer exempted from licensing by this chapter.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-41. Payment of benefits other than insurance benefits. (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.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-42. Severability. If any provision of this chapter or the application of a provision to any circumstance is held invalid, the remainder of the chapter or the application of the provision to other circumstances shall not be affected by that invalidity.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-43. Short title. This chapter shall be known and may be cited as the Rhode Island Fraternal Code. History of Section.P.L. 1984, ch. 201,  2. 
 27-25-44. Fraternal benefit society assessment. (a) Notwithstanding any other provisions of law, each domestic fraternal benefit society shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.  (b) Each societys assessment shall be determined in accordance with the following ratio: (1) by dividing the societys total direct premiums, including annuities, less policyholder dividends by total direct premiums, including annuities, less policyholder dividends of all domestic insurance companies plus the total direct premiums of domestic companies licensed or regulated pursuant to chapters 19, 20, 20.1, 20.2, 20.3, 25, and 41 of this title, and chapter 62 of title 42, and then by (2) multiplying the resulting ratio times two hundred thousand dollars ($200,000).  (c) The minimum assessment charged shall be the greater of the sum determined by subsection (b) of this section or one thousand dollars ($1,000).  History of Section.P.L. 1990, ch. 65, art. 29,  7; P.L. 2002, ch. 292,  58. 
 27-25-5. Purposes and powers. (a) A society shall operate for the benefit of members and their beneficiaries by:  (1) Providing benefits as specified in  27-25-16; and  (2)(i) Operating for one or more social, intellectual, educational, charitable, benevolent, moral, fraternal, patriotic, or religious purposes for the benefit of its members, which may also be extended to others;  (ii) These purposes may be carried out directly by the society, or indirectly through subsidiary corporations or affiliate organizations.  (b) Every society shall have the power to adopt laws and rules for the government of the society, the admission of its members, and the management of its affairs. It shall have the power to change, alter, add to, or amend those laws and rules, and shall have any other powers as are necessary and incidental to carrying into effect the objects and purposes of the society.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-6. Qualifications for membership. (a) A society shall specify in its laws or rules:  (1) Eligibility standards for each and every class of membership; provided that if benefits are provided on the lives of children, the minimum age for adult membership shall be set at not less than age fifteen (15) and not greater than age twenty-one (21);  (2) The process for admission to membership for each membership class; and  (3) The rights and privileges of each membership class; provided that only benefit members shall have the right to vote on the management of the insurance affairs of the society.  (b) A society may also admit social members who shall have no voice or vote in the management of the insurance affairs of the society.  (c) Membership rights in the society are personal to the member and are not assignable.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-7. Location of office and meetings  Communications to members  Grievance procedures. (a) The principal office of any domestic society shall be located in this state. The meetings of its supreme governing body may be held in any state, district, province, or territory in which the society has at least one subordinate lodge, or in any other location determined by the supreme governing body, and all business transacted at the meetings shall be as valid in all respects as if the meetings were held in this state. The minutes of the proceedings of the supreme governing body and of the board of directors shall be in the English language.  (b) A society may provide in its laws for an official publication in which any notice, report, or statement required by law to be given to members, including notice of election, may be published. The required reports, notices, and statements shall be printed conspicuously in the publication. If the records of a society show that two (2) or more members have the same mailing address, an official publication mailed to one member is deemed to be mailed to all members at the same address unless a member requests a separate copy.  (c) Not later than June 1 of each year, a synopsis of the societys annual statement providing an explanation of the facts concerning the condition of the society disclosed in the statement shall be printed and mailed to each benefit member of the society or, in lieu of that, the synopsis may be published in the societys official publication.  (d) A society may provide in its laws or rules for grievance or complaint procedures for members.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-8. No personal liability. (a) The officers and members of the supreme governing body or any subordinate body of a society shall not be personally liable for any benefits provided by a society.  (b)(1) Any person may be indemnified and reimbursed by any society for expenses reasonably incurred by, and liabilities imposed upon, that person in connection with or arising out of any action, suit, or proceeding, whether civil, criminal, administrative, or investigative, or threat of those actions, in which the person may be involved by reason of the fact that he or she is or was a director, officer, employee, or agent of the society or of any firm, corporation, or organization which he or she served in any capacity at the request of the society. A person shall not be so indemnified or reimbursed (i) in relation to any matter in the action, suit, or proceeding as to which he or she shall finally be adjudged to be or have been guilty of breach of a duty as a director, officer, employee, or agent of the society or (ii) in relation to any matter in the action, suit, or proceeding, or threat of an action, suit, or proceeding, which has been made the subject of a compromise settlement; unless in either case the person acted in good faith for a purpose the person reasonably believed to be in or not opposed to the best interest of the society and, in a criminal action or proceeding, in addition, had no reasonable cause to believe that his or her conduct was unlawful;  (2) The determination whether the conduct of the person met the standard required in order to justify indemnification and reimbursement in relation to any matter described in subdivision (1) of this subsection may only be made by the supreme governing body or board of directors by a majority vote of a quorum consisting of persons who were not parties to the action, suit, or proceeding, or by a court of competent jurisdiction. The termination of any action, suit, or proceeding by judgment, order, settlement, conviction, or upon a plea of no contest, as to the person, shall not in itself create a conclusive presumption that the person did not meet the standard of conduct required in order to justify indemnification and reimbursement. The right of indemnification and reimbursement described in this subsection shall not be exclusive of other rights to which the person may be entitled as a matter of law and shall inure to the benefit of his or her heirs, executors, and administrators.  (c) A society shall have the power to purchase and maintain insurance on behalf of any person who is or was a director, officer, employee, or agent of the society, or who is or was serving at the request of the society as a director, officer, employee, or agent of any other firm, corporation, or organization against any liability asserted against the person and incurred by him or her in that capacity or arising out of his or her status as a director, officer, employee or agent of the society, whether or not the society would have the power to indemnify the person against the liability under this section.  History of Section.P.L. 1984, ch. 201,  2. 
 27-25-9. Waiver. 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.  History of Section.P.L. 1984, ch. 201,  2. 
 27-26-1  27-26-18. Repealed.
 27-27-1  27-27-7. Repealed.
 27-28-1  27-28-24. Repealed.
 27-29.1-1. Definitions. For purposes of this chapter, the following terms shall mean: (1) Director shall mean the director of the department of business regulation.  (2) Eligible bidder shall mean a retail pharmacy, community pharmacy or pharmacy department registered pursuant to chapter 19 of title 5, irrespective of corporate structure or number of locations at which it conducts business, located within the geographical service area of a carrier and willing to bid for participation in a restricted pharmacy network contract.  (3) Insurer shall mean an insurance carrier as defined in chapters 18, 19, 20 and 41 of title 27.  (4) Insured shall mean any person who is entitled to have pharmacy services paid by an insurer pursuant to a policy, certificate, contract or agreement of insurance or coverage.  (5) Non-restricted pharmacy network shall mean a network that permits any pharmacy to participate on substantially uniform terms and conditions established by an insurer or pharmacy benefits manager.  (6) Pharmacy benefits manager shall mean any person or entity that is not licensed in Rhode Island as an insurer and that develops or manages pharmacy benefits, pharmacy network contracts, or the pharmacy benefit bid process.  (7) Restricted pharmacy network shall mean an arrangement for the provision of pharmaceutical drug services to insureds which under the terms of an insurers policy, certificate, contract or agreement of insurance or coverage requires an insured or creates a financial incentive for an insured to obtain prescription drug services from one or more participating pharmacies that have entered into a specific contractual relationship with the carrier.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2; P.L. 2008, ch. 475,  89. 
 27-29.1-10. Costs of enforcement. The total cost of the enforcement of  27-29.1-3 and 27-29.1-8 shall be borne by the pharmacy benefits manager(s) and/or the insurer(s) against whom the complaint is made on an equal basis and shall include the following expenses:  (1) One hundred fifty percent (150%) of the total salaries and benefits paid to the personnel of the department of business regulation engaged in the enforcement less any salary reimbursement;  (2) All reasonable technology costs related to the enforcement process. Technology costs shall include the actual cost of software and hardware utilized in the enforcement process and the cost of training personnel in the proper use of the software or hardware;  (3) All necessary and reasonable education and training costs incurred by the state to maintain the proficiency and competence of the enforcing personnel. All these costs shall be incurred in accordance with the appropriate state of Rhode Island regulations, guidelines and procedures.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2. 
 27-29.1-11. Evaluation report. The health insurance commissioner, pursuant to  42-14.5-1, shall evaluate the impact of nonrestricted pharmacy networks on health insurance costs in Rhode Island and shall submit report of findings to the joint legislative committee on health care oversight on or before May 1, 2005.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2. 
 27-29.1-2. Requirement for availability and accessibility of pharmacy services. In accordance with  23-17.13-3, an insurer must demonstrate to the director of health the willingness and potential ability to assure that pharmacy services will be provided in a manner to assure both availability and accessibility of adequate personnel and facilities and in a manner enhancing availability, accessibility, and continuity of service.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2. 
 27-29.1-3. Fair competition  Requirements for carriers offering pharmacy networks. (a) An insurer that offers insureds a restricted pharmacy network shall, in soliciting, arranging, competitively bidding, contracting for, and operating such a network, comply with the following requirements for the purpose of promoting fair and competitive bidding, regardless of when the restricted pharmacy network was established:  (1) Conduct and complete an open bidding process before March 1, 2005 and at least once every three (3) years thereafter;  (2) Provide notice to eligible bidders of the insurers intent to solicit bids for participation in a restricted pharmacy network;  (3) Inform eligible bidders of the date such bids will be solicited;  (4) Provide eligible bidders with information on an identical, equal and uniform basis, including, but not limited to, bid procedure information, financial and utilization information needed to make an informed competitive bid, criteria to be used in awarding a restricted pharmacy network contract and proposed contractual requirements for the restricted pharmacy network;  (5) Provide eligible bidders with at least thirty (30) days to prepare and submit bids between the bid solicitation date and the bid submission deadline;  (6) Open all bids:  (i) At a previously specified time, which shall not be more than thirty (30) days after the bid submission deadline; and  (ii) In a public manner, provided, that certain, information contained in said bids may be held as confidential from public review consistent with regulations promulgated by the director regarding the disclosure of proprietary data or information submitted by any bidders; and  (7) Select a successful bidder using solely the criteria provided to eligible bidders pursuant to subsection (a)(4) above, applied in a uniform manner.  (b) An insurer shall neither exclude nor favor any individual pharmacy, or group or class of pharmacies, in the design of a competitive bid involving restricted or nonrestricted pharmacy networks in compliance with the requirements of this section. An entity and its affiliates that assists an insurer in the development of the bid, design, bid specifications or the bid process, or assists in the review or evaluation of said bids, shall be prohibited from bidding on such a contract.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2. 
 27-29.1-4. Mandate to offer a nonrestricted pharmacy network. Every health care insurer that delivers or issues for delivery or renews in this state a contract, plan, or policy that provides coverage for pharmaceuticals delivered on an outpatient basis through a restricted pharmacy network, shall:  (a) Also offer insurance purchasers an optional benefit plan that includes a nonrestricted pharmacy network; and  (b) Subject to a determination by the US Department of Health and Human Services Centers for Medicare and Medicaid Services on the consistency of this subsection with Medicare law and related regulations, offer only nonrestricted pharmacy networks in any Medicare Supplement or Medicare+Choice Plans.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2. 
 27-29.1-5. Participation of independent community pharmacies. (a) Any pharmacies licensed in the state of Rhode Island that are not owned or controlled, directly or indirectly by an entity that owns pharmacies licensed in two (2) or more jurisdictions other than Rhode Island, which are not participating in an insurers restricted pharmacy network contract shall nevertheless have the right to provide prescription drug services to the insurers insureds and be paid by the insurer as if the pharmacy were participating in the insurers restricted pharmacy network, provided that such non-network independent pharmacies agree:  (1) To accept as the insurers payments in full the price required of pharmacies in the insurers restricted pharmacy network;  (2) To bill to the insured up to and not in excess of any copayment, coinsurance, deductible, other amount required of an insured by the insurer, or for other uncovered services;  (3) To be reimbursed on the same methodological basis, including, but not limited to, capitation or other risk-sharing methodology, as required of pharmacies, in the insurers restricted pharmacy network;  (4) To participate in the insurers utilization review and quality assurance programs, including utilization and drug management reports as required of pharmacies in the carriers restricted pharmacy network;  (5) To provide computerized online eligibility determinations and claims submissions as required of pharmacies in the insurers restricted pharmacy network;  (6) To participate in the insurers satisfaction surveys and complaint resolution programs for its insureds;  (7) To protect the insurers proprietary information and an insureds confidentiality and privacy;  (8) To abide by the insurers performance standards with respect to waiting times, fill rates and inventory management, including formulary restrictions;  (9) To comply with the insurers claims audit provisions; and  (10) To certify, using audit results or accountant statements, the fiscal soundness of the non-network pharmacy.  (b) An insurer may waive any of the aforementioned agreements in arranging for the provision of pharmaceutical drug benefits to insureds through a non-network pharmacy. An insurer shall not impose any agreements, terms or conditions on any non-network independent community pharmacy, or on any association of pharmacies, which are more restrictive than those required of pharmacies in the insurers restricted pharmacy network. The failure of a non-network pharmacy to abide by the aforementioned agreements may, at the option of the insurer, serve as the basis for cancellation of the non-network pharmacys participation.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2; P.L. 2008, ch. 475,  89. 
 27-29.1-6. Applicability and allowances. (a) Nothing in this section shall preclude an insurer from entering into an agreement to allow non-network providers, other than independent community pharmacies, the ability to participate with the insurers plans under terms and conditions set forth by the insurer.  (b) The provisions of this chapter shall not apply to arrangements for the provision of pharmaceutical drug benefits to insureds between an insurer or a pharmacy benefits manager, and a mail order pharmacy, or a hospital-based pharmacy which is not a retail pharmacy.  (c) Nothing in this section shall be construed to require the provision of pharmacy benefits to insureds through a restricted pharmacy network nor any other arrangement for the provision of prescription drug benefits.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2. 
 27-29.1-7. Regulation of pharmacy benefits managers. Pharmacy benefits managers shall be included within the definition of third-party administrator under chapter 20.7 of this title and shall be regulated as such. The annual report filed by third-party administrators with the department of business regulation shall include: contractual language that provides a complete description of the financial arrangements between the third-party administrator and each of the insurers covering benefit contracts delivered in Rhode Island; and if the third-party administrator is owned by or affiliated with another entity or entities, it shall include an organization chart and brief description which shows the relationships among all affiliates within a holding company or otherwise affiliated. Such reporting shall be in a format required by the director and filed with the department as a public record as defined and regulated under chapter 2 of title 38.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2. 
 27-29.1-8. Enforcement. The department of business regulation shall have authority to enforce the provisions of  27-29.1-3  27-29.1-7, subject to the provisions of chapter 35 of title 42.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2. 
 27-29.1-9. Severability. If any provision of  27-29.1-1  27-29.1-8, or the application of those sections to any person or circumstances is held invalid, the invalidity shall not affect other provisions or applications of  27-29.1-1  27-29.1-8 which can be given effect without the invalid provision or application; to this end the provisions of  27-29.1-1  27-29.1-8 are declared to be severable.  History of Section.P.L. 2004, ch. 363,  2; P.L. 2004, ch. 368,  2; P.L. 2004, ch. 602,  2. 
 27-29.2-1. Legislative Findings  Freedom of choice. The general assembly hereby finds that all patients who are in need of an orthosis or prosthesis in the state of Rhode Island shall have the freedom of choice to select any orthotist or prosthetist licensed by the state to practice orthotics or prosthetics.  History of Section.P.L. 2006, ch. 200,  1; P.L. 2006, ch. 205,  1. 
 27-29.2-2. Definitions. As used in this chapter: (1) Orthosis means a custom fabricated brace or support that is designed based on medical necessity. Orthosis does not include prefabricated or direct-formed orthotic devices, or any of the following assistive technology devices: Commercially available knee orthoses used following injury or surgery; spastic muscle-tone inhibiting orthoses; upper extremity adaptive equipment; finger splints; hand splints; wrists gauntlets; face masks used following burns; wheelchair seating that is an integral part of the wheelchair and not worn by the patient independent of the wheelchair; fabric or elastic supports; corsets; low-temperature formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; and other similar devises as determined by the director of the department of business regulation such as those commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility.  (2) Orthotics means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of an orthosis for the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury or deformity. The practice of orthotics encompasses evaluation, treatment and consultation with basic observational gait and postural analysis. Orthotists assess and design orthoses to maximize function and provide not only the support but the alignment necessary to either prevent or correct deformity or to improve the safety and efficiency of mobility or locomotion, or both. Orthotic practice includes, providing continuing patient care in order to assess its effect on the patients tissues and to assure proper fit and function of the orthotic device by periodic evaluation.  (3) Prosthesis means an artificial limb that is alignable or, in lower extremity applications, capable of weight bearing. Prosthesis means an artificial medical device that is not surgically implanted and that is used to replace a missing limb, appendage, or other external human body part including an artificial limb, hand, or foot. The term does not include artificial eyes, ears, noses, dental appliances, osotmy products, or devices such as eyelashes or wigs.  (4) Prosthetics means the science and practice of evaluating, measuring, designing, fabricating, assembling, fitting, aligning, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of a prosthesis through the replacement of external parts of a human body lost due to amputation or congenital deformities or absences. The practice of prosthetics also includes the generation of an image, form, or mold that replicates the patients body or body segment and that requires rectification of dimensions, contours and volumes for use in the design and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial appendage that is designed either to support body weight or to improve or restore function or cosmesis, or both. Involved in the practice of prosthetics is observational gait analysis and clinical assessment of the requirements necessary to refine and mechanically fix the relative position of various parts of the prosthesis to maximize function, stability, and safety of the patient. The practice of prosthetics includes providing and continuing patient care in order to assess the prosthetic devices effect on the patients tissues and to assure proper fit and function of the prosthetic device by periodic evaluation.  History of Section.P.L. 2006, ch. 200,  1; P.L. 2006, ch. 205,  1; P.L. 2008, ch. 475,  90. 
 27-29.2-3. Exclusion. This chapter shall not apply to the policies and procedures of the Veterans Affairs Medical Center of Rhode Island or Veterans Affairs Medical Center Prosthetics and Orthotics Clinics.  History of Section.P.L. 2006, ch. 200,  1; P.L. 2006, ch. 205,  1. 
 27-29.2-4. Application. This chapter shall apply to every individual or group health insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after July 1, 2007, which provides medical coverage that includes coverage for physician services in a physicians office and every policy which provides major medical or similar comprehensive-type coverage; provided, however, this chapter 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.  History of Section.P.L. 2006, ch. 200,  1; P.L. 2006, ch. 205,  1. 
 27-29-1. Declaration of purpose. The purpose of this chapter is to regulate trade practices in the business of insurance in accordance with the intent of Congress as expressed in 15 U.S.C.  1011 et seq., by defining, or providing for the determination of, all trade practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices, and by prohibiting the trade practices so defined or determined. Nothing in this chapter shall be construed to create or imply a private cause of action for a violation of this chapter.  History of Section.P.L. 1958, ch. 53,  1; P.L. 1993, ch. 180,  24; P.L. 2011, ch. 363,  4. 
 27-29-10. Provisions of chapter additional to existing law. The powers vested in the insurance commissioner by this chapter shall be additional to any other powers to enforce any penalties, fines, or forfeitures authorized by law with respect to the methods, acts, and practices declared to be unfair or deceptive.  History of Section.P.L. 1958, ch. 53,  10. 
 27-29-11. Immunity from prosecution. If any person shall ask to be excused from attending and testifying or from producing any books, papers, records, correspondence or other documents at any hearing on the ground that the testimony or evidence required may tend to incriminate or subject the person to a penalty or forfeiture, and shall notwithstanding be directed to give the testimony or produce the evidence, the person shall nonetheless comply with the direction, but shall not after this be prosecuted or subjected to any penalty or forfeiture on account of any transaction, matter, or thing concerning on which the person may testify or produce evidence, and no testimony given or evidence produced shall be received against the person upon any criminal action, investigation, or proceeding. However, no person testifying shall be exempt from prosecution or punishment for any perjury committed while testifying and the testimony or evidence given or produced shall be admissible against the person upon any criminal action, investigation, or proceeding concerning that perjury, nor shall the person be exempt from the refusal, revocation, or suspension of any license, permission, or authority conferred, or to be conferred, pursuant to the insurance law of this state. Any person may execute, acknowledge, and file in the office of the commissioner a statement expressly waiving this immunity or privilege in respect to any transaction, matter, or thing specified in the statement and thereupon the testimony of the person or the evidence in relation to the transaction, matter, or thing may be received or produced before any judge or justice, court, tribunal, grand jury, or otherwise, and if received or produced the person shall not be entitled to any immunity or privilege on account of any testimony the person may give or evidence produced.  History of Section.P.L. 1993, ch. 180,  25; G.L. 1956,  27-29-12; P.L. 2002, ch. 292,  59. 
 27-29-12. Regulations. The commissioner of insurance may adopt reasonable rules and regulations for the implementation and administration of this chapter.  History of Section.P.L. 1993, ch. 180,  25; G.L. 1956,  27-29-13. 
 27-29-13.1. Late payment of premium. 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.  History of Section.P.L. 2005, ch. 69,  1; P.L. 2005, ch. 79,  1. 
 27-29-13.2. Cancellation provisions for return of unearned premium. Every insurance policy issued and approved for use in Rhode Island shall provide clear language on the method of calculation of the unearned premium portion, if any, to be returned to the insured if the policy is cancelled. Insurance policies shall not state refer to manuals to determine the amount of unearned premium to be returned. For all cancellations, the actual percentage retained by the insurer shall be discernible in the policy cancellation provisions. If a policy is canceled using a short-rate table, the insurer shall provide the short-rate table within the cancellation provisions of the insurance policy so that an insured can make an informed decision when cancelling a policy midterm. If a policy premium is fully earned or minimum earned on issuance of the policy, the quote and policy provisions shall clearly state that fact. Insurers shall not impose cancellation fees when insurance policies are cancelled using short-rate tables.  History of Section.P.L. 2005, ch. 69,  1; P.L. 2005, ch. 79,  1; P.L. 2009, ch. 303,  6; P.L. 2009, ch. 304,  6; P.L. 2016, ch. 376,  5; P.L. 2016, ch. 392,  5. 
 27-29-13.3. Fraud warning. Notwithstanding any similar requirements in title 28, every claim form and application for insurance, regardless of the form of transmission, shall contain the following statement or a substantially similar statement; provided, that this section shall not apply to any claim form for health insurance which is on a form promulgated by the Centers for Medicare and Medicaid Services, or in electronic format pursuant to 45 C.F.R. Part 162. Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.  History of Section.P.L. 2009, ch. 303,  7; P.L. 2009, ch. 304,  7. 
 27-29-13. Payment of premium  Cancellation. Notwithstanding the provisions of chapter 40 of this title, private passenger motor vehicle insurance policyholders on either six (6) month or twelve (12) month policies shall have the option of paying any policy premiums in installment payments; provided that for a twelve (12) month policy the insurer may require a payment of fifteen percent (15%) of the annual premium at time of issuance with the balance to be paid thereafter in nine (9) subsequent and equal monthly installments thereafter for a six (6) month policy, the insurer may require a payment of thirty-five percent (35%) of the premium at time of issuance with the balance to be paid in three (3) subsequent and equal monthly installments thereafter. The insurer may levy a service charge of up to five dollars ($5.00) per installment period against those policyholders who choose the installment option. 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. A late fee may not be imposed unless payment is received more than five (5) business days following the date payment is due. Policyholders shall be entitled to receive no less than thirty (30) days notice before a cancellation of an automobile insurance policy for any reason except nonpayment of premium, in which instance policyholders shall be entitled to receive no less than ten (10) days notice.  History of Section.P.L. 1994, ch. 115,  1; P.L. 1994, ch. 261,  1; G.L. 1956,  27-29-14; P.L. 2003, ch. 315,  1; P.L. 2003, ch. 334,  1. 
 27-29-14. Confidentiality of insurance information. 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.  History of Section.P.L. 1996, ch. 405,  1; G.L. 1956,  27-29-15. 
 27-29-15. Severability. If any provision of this chapter, or the application of a provision to any person or circumstances shall be 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.  History of Section.P.L. 1958, ch. 53,  11; G.L. 1956,  27-29-11. 
 27-29-16. Repealed.
 27-29-17.1. Definitions. For the purpose of  27-29-17  27-29-17.4: (1) Commissioner means the commissioner of insurance.  (2) Expiration date means the date upon which coverage under a policy ends. It also means, for a policy written for a term longer than one year or with no fixed expiration date, each annual anniversary date of such policy.  (3) Nonrenewal means termination of a policy at its expiration date.  (4) Renewal or to renew means the issuance of or the offer by an insurer to issue a policy succeeding a policy previously issued and delivered by the same insurer or an insurer within the same group of insurers, or the issuance of a certificate or notice extending the term of an existing policy for a specified period beyond its expiration date.  History of Section.P.L. 2003, ch. 231,  1; P.L. 2003, ch. 251,  1; P.L. 2008, ch. 475,  88. 
 27-29-17.2. Notice of nonrenewal. (a) An insurer may nonrenew a policy; provided, however, no nonrenewal of any policy of insurance to which this section applies shall be effective unless an insurer shall first give, mail, or deliver to the first named insured at the address shown on the policy, and to the insurance producer of record, written notice that the insurer will not renew the policy. Such notice shall be given, mailed or delivered at least sixty (60) days before the expiration date. If the notice is given, mailed or delivered less than sixty (60) days before the expiration, coverage shall remain in effect until sixty (60) days after notice is given, mailed or delivered. Earned premium for any period of coverage that extends beyond the expiration date shall be considered pro-rata based upon the previous years rate. For purposes of this section, the transfer of a policyholder between companies within the same insurance group is not a refusal to renew. In addition, changes in deductibles, changes in premium, changes in the amount of insurance, or reductions in policy limits or coverage shall not be deemed to be refusals to renew.  (b) Notice of nonrenewal shall not be required where:  (1) The insurer or a company within the same insurance group has offered to issue a renewal policy; or  (2) The named insured has obtained replacement coverage or has agreed in writing to obtain replacement coverage.  History of Section.P.L. 2003, ch. 231,  1; P.L. 2003, ch. 251,  1. 
 27-29-17.3. Notice of premium or coverage changes. (a) An insurer shall provide to the first-named insured at the mailing address shown on the policy, and to the insurance producer of record, written notice of any premium increase in excess of ten percent (10%) and shall also provide the exact renewal premium, at least sixty (60) days prior to the expiration date of the policy unless the premium increase is the result of an audit or the increase is the result of an increase in exposure at the request of the insured. Not less than sixty (60) days written notice, as provided herein, shall be required for any coverage elimination, reduction, diminution or increased deductible not at the request of the insured and in this case the notice shall itemize and describe the coverage changes and shall be separate from the renewal policy. If the insurer fails to provide such notice, the coverage provided to the named insured shall remain in effect until notice is provided or until the effective date of replacement coverage obtained by the named insured, whichever occurs first. For the purposes of this section, notice is considered given sixty (60) days following date of giving of the notice. If the named insured elects not to renew, any earned premium for the period of extension of the terminated policy shall be calculated pro-rata at the lower of the current or previous years rate. If the insured accepts the renewal, the premium increase, if any, and other changes shall be effective the day following the prior policys expiration or anniversary date.  (b) This section shall not apply to changes based upon the altered nature or extent of the risk insured.  (c) For the purposes of this section, notice to the insurance producer of record shall not apply to an insurance producer of record who:  (1) Is an employee of the insurer; or  (2) Is a non-employee exclusive agent of the insurer; provided, however, notice, as required by this section, shall in all applicable cases, be provided to the named insured.  History of Section.P.L. 2003, ch. 231,  1; P.L. 2003, ch. 251,  1; P.L. 2011, ch. 103,  1; P.L. 2011, ch. 153,  1. 
 27-29-17.4. Proof of notice. (a) A company issuing any policy of insurance which is subject to nonrenewal, a premium increase, a change in deductible, reduction in limits or changes in coverage shall effect the same by serving the notice of it as provided by the policy. The notice shall be delivered in hand to the named insured, or be left at his or her last address as shown by the companys records, or, if its records contain no last address, at his or her last business, residence, or other address known to the company. A company may alternatively forward notice to that address by first class mail and maintain proof of mailing of the notice to the insured by the United States Postal Service certificate of mailing in the ordinary course of the insurers business, and this proof of mailing shall be sufficient proof of notice.  (b) If a policy is made payable to a mortgagee or any person other than the named insured, notice shall be given as provided in subsection (a) of this section to the payee and to the named insured.  (c) The insurance producer of record who insured the policy shall also be given notice of any nonrenewal or any premium increase, a change in deductible, or a change in coverage, in the same manner as provided in subsection (a) of this section.  History of Section.P.L. 2003, ch. 231,  1; P.L. 2003, ch. 251,  1. 
 27-29-17.5. Insureds right to loss information. (a) Upon request by the first named insured or such insureds authorized agent or broker, the insurer shall provide the following loss information, for the period of time coverage has been provided by the insurer or for five (5) years whichever is less, within fourteen (14) days of such request:  (1) Information on closed claims, including date and descriptions of occurrence, and payments; and  (2) Information on open claims, including date and description of occurrence, and amounts of any payments and loss reserves.  (b) Nothing in this section shall affect the confidentiality requirements pursuant to chapter 37.3 of title 5 and to insurance regulations 99 (privacy of consumer financial information) and 100 (privacy of consumer health information) as promulgated by the department of business regulation.  (c) This section shall not apply to life, accident, health, personal automobile, homeowners, dwelling and boat, personal recreational vehicles, personal excess liability, personal umbrella, or reinsurance policies.  (d) Notwithstanding any other provision of this section, loss reserve information for claims subject to a documented coverage dispute between the insurer and the insured need not be provided to the first named insured or such insureds authorized agent or broker.  History of Section.P.L. 2011, ch. 103,  2; P.L. 2011, ch. 153,  2; P.L. 2012, ch. 191,  1; P.L. 2012, ch. 198,  1. 
 27-29-17. Application. Sections 27-29-17  27-29-17.4 shall apply to commercial property insurance policies, commercial liability insurance policies, commercial package policies, commercial excess or umbrella policies and commercial auto policies. These sections shall not apply to reinsurance, aviation insurance, workers compensation and employers liability insurance, multistate location risks, or policies subject to retrospective rating plans.  History of Section.P.L. 2003, ch. 231,  1; P.L. 2003, ch. 251,  1; P.L. 2011, ch. 103,  1; P.L. 2011, ch. 153,  1. 
 27-29-2. Definitions. When used in this chapter: (1) Commissioner means director of the department of business regulation;  (2) Consultant means an individual, partnership, or corporation who, for a fee, holds himself, herself, or itself out to the public as engaged in the business of offering any advice, counsel, opinion, or service with respect to the benefits, advantages or disadvantages promised under any policy of insurance that could be issued in this state;  (3) Domestic partnership means two (2) people who are in an exclusive, intimate, and committed relationship with each other, and who certify by affidavit that their relationship meets the following qualifications:  (i) Both persons are at least eighteen (18) years of age and are mentally competent to contract;  (ii) Neither person is currently married to someone else;  (iii) The persons are not related by blood to a degree that would prohibit marriage in the state of Rhode Island;  (iv) The persons reside together and have resided together for at least one year prior to the date of the certified affidavit;  (v) The persons are financially interdependent as evidenced by two (2) of the following:  (A) A domestic partnership agreement or relationship contract;  (B) A joint mortgage or joint ownership of a primary residence;  (C) Two (2) of the following:  (I) Joint ownership of a motor vehicle;  (II) A joint checking account;  (III) A joint credit account;  (IV) A joint lease; and/or  (D) One person has been designated as a beneficiary for the other persons will, retirement contract, or life insurance;  (4) Insured means the party named on a policy or certificate as the individuals with legal rights to the benefits provided by the policy;  (5) Insurer means any person, reciprocal exchange, interinsurer, Lloyds insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance, including agents, brokers, insurance producers, adjusters, and third-party administrators. Notwithstanding any other provision of law, insurer shall also mean a nonprofit hospital and/or medical service corporation, a nonprofit dental service corporation, a nonprofit optometric service corporation, a nonprofit legal service corporation, a health maintenance organization as defined in the general laws, or any other entity providing a plan of health benefits. For the purposes of this act, the entities in this subdivision shall be deemed to be engaged in the business of insurance and subject to this chapter;  (6) License means any license, certificate of authority, certificate of compliance, or other formal approval or authorization granted by the department of business regulation, division of insurance;  (7) Person means any natural or artificial entity, including but not limited to: an individual, corporation, association, partnership, trust, or any other legal entity; and  (8) Policy or certificate means any contract of insurance, indemnity, medical, health, or hospital service, suretyship, or annuity issued, proposed for issuance, or intended for issuance, by any insurer.  History of Section.P.L. 1958, ch. 53,  2; P.L. 1993, ch. 180,  24; P.L. 2017, ch. 197,  1; P.L. 2017, ch. 317,  1. 
 27-29-3. Prohibited trade practices. No person shall engage in this state in any trade practice which is defined in this chapter as, or determined pursuant to this chapter to be, an unfair method of competition or an unfair or deceptive act or practice in the business of insurance.  History of Section.P.L. 1958, ch. 53,  3. 
 27-29-4.1. Cancellation of insurance prohibited. No insurance company authorized to do business in this state shall cancel or refuse to issue any type of insurance coverage for an owner occupied dwelling or personal property of every nature and description solely because of the area in which the property is situated.  History of Section.P.L. 1972, ch. 28,  1. 
 27-29-4.2. Penalty. For each violation of  27-29-4.1, the offending insurance company shall be fined a sum of five hundred dollars ($500) by the department of business regulation.  History of Section.P.L. 1972, ch. 28,  1. 
 27-29-4.3. Refusal to issue policy due to nonoccupancy. No insurance company authorized to do business in this state shall refuse to issue or charge an increased premium for a standard fire insurance policy for an occupied dwelling solely because of the fact that the building has formerly been unoccupied or vacant.  History of Section.P.L. 1978, ch. 331,  2. 
 27-29-4.4. Auto body repair labor rate surveys. (a) Every insurance carrier authorized to sell motor vehicle liability insurance in the state shall conduct an auto body repair labor rate survey, subject to, and in accordance with, the following provisions:  (1) When used in this section the following definitions shall apply:  (i) Auto body labor rate survey is an analysis of information gathered from auto body repair shops regarding the rates of labor that repair shops charge in a certain geographic area.  (ii) Prevailing auto body labor rate means the rate determined and set by an insurer as a result of conducting an auto body labor rate survey in a particular geographic area and used by insurers as a basis for determining the cost to settle automobile property damage claims.  (iii) Independent auto body repair facility means any auto body repair facility that does not have a formal agreement and/or written contract with an insurer to provide auto body repair services to insureds and/or claimants.  (iv) Direct repair program means any methods through which an insurer refers, suggests, or recommends a specific auto body repair facility, with whom the insurer has a formal agreement and/or contract to provide auto body repair services, to insureds and/or claimants.  (v) Contract rate means any labor rate to which an auto body repair facility and an insurer have agreed in a formal agreement and/or written contract.  (2) Each insurer must annually conduct a separate and distinct written auto body labor rate survey for each classification of auto body shops as established by the department of business regulation pursuant to  5-38-5, to determine a separate and distinct prevailing auto body labor rate for each classification of fully licensed auto body repair facilities.  (3) Insurers may not use an auto body labor rate survey; contract rates from auto body repair facilities with which it has a formal agreement or contract to provide auto body repair services to insureds and/or claimants; rates paid as a result of subrogation, rates obtained from auto body repair facilities in a different classification than that being surveyed, or rates from a repair shop facility holding a limited or special use license.  (4) Each auto body labor rate survey shall include the following:  (i) The name and address of each shop surveyed in the labor survey;  (ii) The total number of shops surveyed;  (iii) The prevailing rate established by the insurer for each classification of full collision licensed auto body repair facilities; and  (iv) A description of the formula or method used to calculate or determine the specific prevailing rate reported.  (5) Each insurer must report the results of their auto body labor rate survey to the department of business regulation insurance division.  (6) The department of business regulation must promulgate regulations related to auto body labor rate surveys by October 1, 2006, establishing the following:  (i) A questionnaire that must be used by all insurers in their labor rate survey;  (ii) Date of reporting; and  (iii) Number or percentage of shops to be surveyed.  (7) The department of business regulation shall review all surveys submitted for compliance with this section and any rules and regulations promulgated by the department.  (b) Nothing contained in this section shall require an insurer to establish the prevailing rate for each classification of full collision licensed auto body repair facilities based solely on the survey results.  History of Section.P.L. 2006, ch. 173,  1; P.L. 2015, ch. 142,  2; P.L. 2015, ch. 154,  2; P.L. 2016, ch. 511, art. 1,  10. 
 27-29-4.5. Penalty. An insurers 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).  History of Section.P.L. 2006, ch. 173,  1. 
 27-29-4.6. Reimbursement fee. The director of the department of business regulation may assess an insurer for reimbursement of the departments actual expenses for the investigation and hearing of significant auto body shop matters relating to insurers. In addition, an assessment may be sought in the event that an insurer does not prevail after a final judicial appeal.  History of Section.P.L. 2008, ch. 100, art. 33,  3. 
 27-29-4.7. Additional unfair methods of competition. (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 paragraphs (iii) and (iv) herein 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.  History of Section.P.L. 2012, ch. 296,  2; P.L. 2012, ch. 326,  2. 
 27-29-4. Unfair methods of competition and unfair or deceptive acts or practices defined. The following are defined as unfair methods of competition and unfair and deceptive acts or practices in the business of insurance:  (1) Misrepresentations and false advertising of policies or contracts. Making, issuing, circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, or statement, sales presentation, omission, or comparison misrepresenting the terms of any policy issued or to be issued or the benefits, conditions, or advantages promised by any policy or the dividends or share of the surplus to be received on any policy, or making any false or misleading statement as to the dividends or share of surplus previously paid on any policy, or making any misleading representation or any misrepresentation as to the financial condition of any insurer, or as to the legal reserve system upon which any life insurer operates, or using any name or title of any policy or class of policies misrepresenting the true nature of that policy or class of policies, or making any misrepresentation to any policyholder insured in any company including any intentional misquote of a premium rate, for the purpose of inducing or tending to induce the policyholder to lapse, forfeit, or surrender his or her insurance, or misrepresenting for the purpose of effecting a pledge or assignment of or effecting a loan against any policy, or misrepresenting any policy as being share or stock;  (2) False information and advertising generally. Making, publishing, disseminating, circulating, or placing before the public or causing, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public in a newspaper, magazine, or other publication, or in the form of a notice, circular, pamphlet, letter, or poster, or over any radio or television station, or in any other way, an advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance or with respect to any person in the conduct of his or her insurance business that is untrue, deceptive, or misleading;  (3) Defamation. Making, publishing, disseminating, or circulating, directly or indirectly, or aiding, abetting, or encouraging the making, publishing, disseminating, or circulating of any oral or written statement or any pamphlet, circular, article of literature that is false or maliciously critical of or derogatory to the financial condition of an insurer, and that is calculated to injure any person engaged in the business of insurance;  (4) Boycott, coercion, and intimidation. Entering into any agreement to commit, or by any concerted action committing, any act of boycott, coercion, or intimidation resulting in or tending to result in unreasonable restraint of, or monopoly in, the business of insurance;  (5) False financial statements.(i) Knowingly filing with any supervisory or other public official, or knowingly making, publishing, disseminating, circulating, or delivering to any person, or placing before the public or causing directly or indirectly, to be made, published, disseminated, circulated, delivered to any person, or placed before the public any false material statement of financial condition of an insurer; or  (ii) Knowingly making any false entry of a material fact in any book, report, or statement of any insurer or knowingly omitting to make a true entry of any material fact pertaining to the business of the insurer in any book, report, or statement of the insurer;   (6) Stock operations and advisory board contracts. Issuing or delivering or permitting agents, officers, or employees to issue or deliver agency company stock or other capital stock, or benefit certificates or shares in any common law corporation, or securities of any special or advisory board contracts or other contracts of any kind promising returns and profits as an inducement to insurance;  (7) Unfair discrimination.(i) Making or permitting any unfair discrimination between individuals of the same class and equal expectation of life in the rates charged for any policy of life insurance or of life annuity or in the dividends or other benefits payable on any such policy or life annuity, or in any other of the terms and conditions of the policy;  (ii) Making or permitting any unfair discrimination between individuals of the same class and of essentially the same hazard in the amount of premium, policy fees, or rates charged for any policy or contract of accident or health insurance or in the benefits payable under any policy or contract, or in any of the terms or conditions of that policy, or in any other manner;  (iii) Making or permitting any unfair discrimination between individuals or risks of the same class and of essentially the same hazards by refusing to issue, refusing to renew, canceling, or limiting the amount of insurance coverage on a property or casualty risk because of the geographic location of the risk, unless:  (A) The refusal, cancellation, or limitation is for a business purpose that is not a pretext for unfair discrimination; or  (B) The refusal, cancellation, or limitation is required by law or regulation;  (iv) Making or permitting any unfair discrimination between individuals or risks of the same class and of essentially the same hazards by refusing to issue, refusing to renew, canceling, or limiting the amount of insurance coverage on a residential property risk, or the personal property contained in the residential property risk, because of the age of the residential property, unless:  (A) The refusal, cancellation, or limitation is for a business purpose that is not a pretext for unfair discrimination; or  (B) The refusal, cancellation, or limitation is required by law or regulation;  (v) Refusing to insure, refusing to continue to insure, or limiting the amount of coverage available to an individual because of the sex or marital status of the individual; nothing in this subsection shall prohibit an insurer from taking marital status into account for the purpose of defining persons eligible for dependent benefits;  (vi) To terminate, or to modify coverage, or to refuse to issue or refuse to renew any property or casualty policy solely because the applicant or insured or any employee of either is mentally or physically impaired; provided, that this subsection shall not apply to accident and health insurance sold by a casualty insurer and, provided that this subsection shall not be interpreted to modify any other provision of law relating to the termination, modification, issuance or renewal of any insurance policy or contract; or  (vii) Making or permitting any unfair discrimination by treating persons in a domestic partnership as defined in  27-29-2, differently than persons in a marriage for the purposes of premiums, policy fees, or rates charged for policies of casualty, fire, homeowners, accident and sickness, marine, or automobile insurance;   (8) Rebates.(i) Except as otherwise expressly provided by law, knowingly permitting or offering to make or making any policy or agreement as to the policy other than as plainly expressed in the policy issued on it, or paying or allowing or giving or offering to pay, allow, or give, directly or indirectly, as inducement to the policy, any rebate of premiums payable on the policy, or any special favor or advantage in the dividends or other benefits on the policy, or any valuable consideration or inducement not specified in the policy, or giving, selling, or purchasing or offering to give, sell, or purchase as inducement to the policy, or in connection with the policy, any stocks, bonds, or other securities of any insurance company or other corporation, association, or partnership, or any dividends or profits accrued on the security, or anything of value not specified in the policy;  (ii) Nothing in subsection (7) of this section or subsection (8)(i) of this section shall be construed as including within the definition of discrimination or rebates any of the following practices:  (A) In the case of any contract of life insurance policies or life annuity, annuities paying bonuses to policyholders or abating their premiums in whole or in part out of surplus accumulated from nonparticipating insurance; provided, that any bonuses or abatement of premiums shall be fair and equitable to policyholders and for the best interests of the company and its policyholders;  (B) In the case of life insurance policies issued on the industrial debit plan, making allowance to policyholders who have continuously for a specified period made premium payments directly to an office of the insurer in an amount that fairly represents the saving in collection expenses;  (C) Readjustment of the rate of premium for a group insurance policy based on the loss or expense experience under it, at the end of the first or any subsequent policy year of insurance under the policy, which may be made retroactive only for the policy year;  (D) Engaging in an arrangement that would not violate  106 of the Bank Holding Company Act Amendments of 1972 (12 U.S.C.  1972), as interpreted by the Board of Governors of the Federal Reserve System, or  5(q) of the Home Owners Loan Act, 12 U.S.C.  1464(q);  (E) The offer or provision by insurers or producers, by or through employees, affiliates, or third-party representatives, of value-added products or services at no or reduced cost when such products or services are not specified in the policy of insurance if the product or service:  (I) Relates to the insurance coverage; and  (II) Is primarily designed to satisfy one or more of the following:  (aa) Provide loss mitigation or loss control;  (bb) Reduce claim costs or claim settlement costs;  (cc) Provide education about liability risks or risk of loss to persons or property;  (dd) Monitor or assess risk, identify sources of risk, or develop strategies for eliminating or reducing risk;  (ee) Enhance health;  (ff) Enhance financial wellness through items such as education or financial planning services;  (gg) Provide post-loss services;  (hh) Incent behavioral changes to improve the health or reduce the risk of death or disability of a customer (defined for purposes of this subsection as policyholder, potential policyholder, certificate holder, potential certificate holder, insured, potential insured, or applicant); or  (ii) Assist in the administration of the employee or retiree benefit insurance coverage.  (III) The cost to the insurer or producer offering the product or service to any given customer must be reasonable in comparison to that customers premiums or insurance coverage for the policy class.  (IV) If the insurer or producer is providing the product or service offered, the insurer or producer must ensure that the customer is provided with contact information to assist the customer with questions regarding the product or service.  (V) The commissioner may adopt regulations when implementing the permitted practices set forth in this statute to ensure consumer protection. Such regulations, consistent with applicable law, may address, among other issues, consumer data protections and privacy, consumer disclosure, and unfair discrimination.  (VI) The availability of the value-added product or service must be based on documented objective criteria and offered in a manner that is not unfairly discriminatory. The documented criteria must be maintained by the insurer or producer and produced upon request by the department.  (VII) If an insurer or producer does not have sufficient evidence, but has a good-faith belief that the product or service meets the criteria in subsection (8)(ii)(E)(II) of this section, the insurer or producer may provide the product or service in a manner that is not unfairly discriminatory as part of a pilot or testing program for no more than one year. An insurer or producer must notify the department of such a pilot or testing program offered to consumers in this state prior to launching and may proceed with the program unless the department objects within twenty-one (21) days of notice;  (F)(I) Offering or giving non-cash gifts, items, or services, including meals to or charitable donations on behalf of a customer, in connection with the marketing, sale, purchase, or retention of contracts of insurance, as long as the cost does not exceed an amount determined to be reasonable by the commissioner per policy year per term. The offer must be made in a manner that is not unfairly discriminatory. The customer may not be required to purchase, continue to purchase, or renew a policy in exchange for the gift, item, or service.  (II) Offering or giving non-cash gifts, items, or services including meals to or charitable donations on behalf of a customer, to commercial or institutional customers in connection with the marketing, sale, purchase, or retention of contracts of insurance, as long as the cost is reasonable in comparison to the premium or proposed premium and the cost of the gift or service is not included in any amounts charged to another person or entity. The offer must be made in a manner that is not unfairly discriminatory. The customer may not be required to purchase, continue to purchase, or renew a policy in exchange for the gift, item, or service.  (III) Conducting raffles or drawings to the extent permitted by state law, as long as there is no financial cost to entrants to participate, the drawing or raffle does not obligate participants to purchase insurance, the prizes are not valued in excess of a reasonable amount determined by the commissioner, and the drawing or raffle is open to the public. The raffle or drawing must be offered in a manner that is not unfairly discriminatory. The customer may not be required to purchase, continue to purchase, or renew a policy in exchange for the gift, item, or service;  (iii) An insurer, producer or representative of either may not offer or provide insurance as an inducement to the purchase of another policy or otherwise use the words free, no cost, or words of similar import, in an advertisement.   (9) Free choice of insurance producer or insurer.(i) When any person, firm, or corporation engaged in the business of lending money on the security of real or personal property, or in the business of negotiating, purchasing, selling, or holding loans on the security of real property, or in the business of building, selling, or financing the sale or purchase of real property, or any trustee, director, officer, agent, or other employee of that person, firm, or corporation, requires that property insurance be procured for the property, the borrower, debtor, or purchaser shall have free choice of insurance producer and insurer through or by which the insurance is to be placed or written, subject only to the right of the builder, creditor, lender, or seller:  (A) To require evidence, to be produced at a reasonable time prior to commencement or renewal of risk, that the insurance providing reasonable coverage has been obtained in an amount equal to the amount required by the builder, creditor, lender, or seller;  (B) To require insurance in an insurer authorized to do business and having a licensed resident insurance producer agent in this state; and  (C) To refuse to accept insurance in a particular insurer on reasonable grounds related to solvency;  (ii) When any contractor or subcontractor is required to procure a surety bond or policy of insurance with respect to any building or construction contract that is about to be, or that has been bid or entered into, the contractor or subcontractor shall have free choice of insurance producer and insurer through or by which the surety bond or insurance is to be written; provided, that the owner or contractor shall have the right: (A) To require evidence, to be produced at a reasonable time prior to commencement or renewal of risk, that the insurance providing reasonable coverage has been obtained in an amount equal to the amount required by the builder, creditor, lender, or seller; (B) To require insurance in an insurer authorized to do business and having a licensed resident insurance producer in this state; and (C) To refuse to accept insurance in a particular insurer on reasonable grounds related to solvency; provided, that the owner or contractor shall have the right to approve the form, sufficiency, or manner of execution of the surety bond or policy or insurance furnished by the insurance company or insurance producer selected by the contractor or subcontractor;  (iii) No person who lends money or extends credit may:  (A) Solicit insurance for the protection of real property after a person indicates interest in securing a first mortgage credit extension until that person has received a commitment in writing from the lender as to a loan or credit extension;  (B) Unreasonably reject a policy furnished by the borrower for the protection of the property securing the creditor lien. A rejection shall not be deemed unreasonable if it is based on reasonable standards, uniformly applied, relating to the extent of coverage required and the financial soundness and the services of an insurer. The standards shall not discriminate against any particular type of insurer, nor shall the standards call for rejection of a policy because it contains coverage in addition to that required in the credit transaction;  (C) Require that any borrower, mortgagor, purchaser, insurer, or insurance producer pay a separate charge, in connection with the handling of any policy required as security for a loan on real estate, or pay a separate charge to substitute the policy of one insurer for that of another. This subsection does not include the interest that may be charged on premium loans or premium advancements in accordance with the terms of the loan or credit document;  (D) Use or disclose, without the prior written consent of the borrower, mortgagor, or purchaser taken at a time other than the making of the loan or extension of credit, information relative to a policy that is required by the credit transaction, for the purpose of replacing the insurance; or  (E) Require any procedures or conditions of duly licensed insurance producers or insurers not customarily required of those insurance producers or insurers affiliated or in any way connected with the person who lends money or extends credit;  (iv) Every person who lends money or extends credit and who solicits insurance on real and personal property subject to subsection (9)(iii) of this section shall explain to the borrower in writing that the insurance related to the credit extension may be purchased from an insurer or insurance producer of the borrowers choice, subject only to the lenders right to reject a given insurer or insurance producer as provided in subsection (9)(iii)(B) of this section. Compliance with disclosures as to insurance required by truth-in-lending laws or comparable state laws shall be compliance with this subsection;  (v) This requirement for a commitment shall not apply in cases where the premium for the required insurance is to be financed as part of the loan or extension of credit involving personal property transactions;  (vi) The commissioner shall have the power to examine and investigate those insurance-related activities of any person or insurer that the commissioner believes may be in violation of this section. Any affected person may submit to the commissioner a complaint or material pertinent to the enforcement of this section;  (vii) Nothing in this section shall prevent a person who lends money or extends credit from placing insurance on real or personal property in the event the mortgagor, borrower, or purchaser has failed to provide required insurance in accordance with the terms of the loan or credit document;  (viii) Nothing contained in this section shall apply to credit life or credit accident and health insurance;   (10) Notice of free choice of insurance producer or insurer. Every debtor, borrower, or purchaser of property with respect to which insurance of any kind on the property is required in connection with a debt or loan secured by the property or in connection with the sale of the property, shall be informed in writing by the builder, creditor, lender, or seller, of his or her right of free choice in the selection of the insurance producer and insurer through or by which the insurance is to be placed. There shall be no interference, either directly or indirectly, with the borrowers, debtors, or purchasers free choice of an insurance producer and of an insurer that complies with the requirements of this section, and the builder, creditor, lender, seller, owner, or contractor shall not refuse the policy tendered by the borrower, debtor, purchaser, contractor, or subcontractor. Upon notice of any refusal of the tendered policy, the insurance commissioner shall order the builder, creditor, lender, seller, owner, or contractor to accept the tendered policy, if the commissioner determines that the refusal is not in accordance with the requirements of this section. Failure to comply with an order of the insurance commissioner shall be deemed a violation of this section;  (11) Using insurance information to detriment of another. Whenever the instrument requires that the purchaser, mortgagor, or borrower furnish insurance of any kind on real property being conveyed or is collateral security to a loan, the mortgagee, vendor, or lender shall refrain from disclosing or using any and all insurance information to his or her or its own advantage and to the detriment of either the borrower, purchaser, mortgagor, insurance company, or agency complying with the requirements relating to insurance;  (12) Prohibited group enrollments. No insurer shall offer more than one group policy of insurance through any person unless that person is licensed, at a minimum, as an insurance producer. This prohibition shall not apply to employer-employee relationships, or to any of these enrollments;  (13) Failure to maintain complaint handling procedures. No insurer shall fail to maintain a complete record of all the complaints it received since the date of its last examination pursuant to the general laws providing for examination of insurers. This record shall indicate the total number of complaints, their classification by line of insurance, the nature of each complaint, the disposition of each complaint, and the time it took to process each complaint. For the purposes of this subsection, complaint means any written communication primarily expressing a grievance;  (14) Misrepresentation in insurance applications. Making false or fraudulent statements or representations on or relative to an application for a policy, for the purpose of obtaining a fee, commission, money, or other benefit from any insurers, insurance producer, or individual person;  (15) Requiring that repairs be made to an automobile at a specified auto body repair shop or interfering with the insureds or claimants free choice of repair facility. The insured or claimant shall be promptly informed by the insurer of his or her free choice in the selection of an auto body repair shop. Once the insured or claimant has advised the insurer that an auto body repair shop has been selected, the insurer may not recommend that a different auto body repair shop be selected to repair the automobile. An auto body repair shop may file a complaint with the department of business regulation alleging a violation of this subsection (15). Whenever the department of business regulation has reason to believe that an insurer has violated this subsection (15), the department shall conduct an investigation and may convene a hearing. A complaint filed by an auto body repair shop must be accompanied by a statement written and signed by the insured or claimant setting forth the factual basis of the complaint, and the insured or claimant must voluntarily appear and testify at any administrative proceedings on the complaint; and  (16) Requiring that motor vehicle glass repair be made at a specified motor vehicle glass repair shop or interfering with the insureds or claimants free choice of a licensed repair facility. The insured or claimant shall be promptly informed by the insurer of his or her free choice in the selection of a licensed motor vehicle glass repair shop. The insurer shall not require a person to use or employ unfair or deceptive acts or practices, threaten, coerce, or intimidate to induce a person to use or select a particular licensed motor vehicle glass repair shop to provide motor vehicle glass repair services. An insurer shall not knowingly contract with, refer motor vehicle glass repair services to, or otherwise negotiate with an unlicensed motor vehicle glass repair shop, as defined in chapter 38.5 of title 5. Once the insured or claimant has advised the insurer that a motor vehicle glass repair shop has been selected, the insurer may not recommend that a different motor vehicle glass repair shop be selected to repair the motor vehicle glass, and an insurer shall not assign or dispatch the repair work or forward a related policy or policyholders contact or repair scheduling information to a different licensed motor vehicle glass repair shop without the knowledge and consent of the insured. An insured may at any point in time elect to change the insureds choice of licensed motor vehicle glass repair shop. However, an insurer authorized to conduct business in the state may provide directly, or through other means, including electronic transmissions, specific, truthful, and non-deceptive information regarding the features and benefits available to the insured under the policy to assist the insured in selecting a licensed motor vehicle glass repair shop or scheduling a licensed motor vehicle glass repair shop to perform motor vehicle glass repair, or enter into any preferred provider agreements and/or participate in direct repair programs or direct repair networks with licensed motor vehicle glass repair shops. A motor vehicle glass repair shop may file a complaint with the department of business regulation alleging a violation of this subsection (16). Whenever the department of business regulation has reason to believe that an insurer has violated this subsection (16), the department shall conduct an investigation and may convene a hearing. A complaint filed by a motor vehicle glass repair shop must be accompanied by a statement written and signed by the insured or claimant setting forth the factual basis of the complaint, and the insured or claimant must voluntarily appear and testify at any administrative proceedings on the complaint.  History of Section.P.L. 1958, ch. 53,  4; P.L. 1966, ch. 54,  1; P.L. 1976, ch. 201,  1; P.L. 1993, ch. 180,  24; P.L. 1997, ch. 342,  1; P.L. 2004, ch. 488,  1; P.L. 2015, ch. 146,  2; P.L. 2017, ch. 197,  1; P.L. 2017, ch. 317,  1; P.L. 2022, ch. 404,  4, effective June 30, 2022; P.L. 2022, ch. 405,  4, effective June 30, 2022. 
 27-29-5. Hearings  Witnesses  Appearances  Production of books  Service of process. (a) Whenever the insurance commissioner shall have reason to believe that any person engaged in the business of insurance in this state has been engaged or is engaging in this state in any unfair method of competition or any unfair or deceptive act or practice, whether or not defined in this chapter, and that a proceeding by the commissioner in respect to the act or practice would be to the interest of the public, the commissioner shall issue and serve upon the person a statement of the charges in that respect and a notice of a hearing on the charges requiring the person to appear in person at a time and place fixed in the notice which shall not be less than ten (10) days after the date of the service of the notice, and notifying the person of his or her right to be represented by counsel at the hearing.  (b) At the time and place fixed for the hearing, the person shall have an opportunity to be heard in person and by counsel, and to show cause why an order should not be made by the insurance commissioner requiring the person to cease and desist from the acts, methods, or practices so complained of. Upon good cause shown the insurance commissioner shall permit any person to intervene, appear, and be heard at the hearing by counsel or in person.  (c) The insurance commissioner upon the hearing shall cause to be made a stenographic record of all of the evidence and all of the proceedings had at the hearing, and shall, upon request, furnish a copy of it to the person charged upon being reimbursed for the reasonable costs of the record. The insurance commissioner, upon the hearing, may administer oaths, examine and cross examine witnesses, receive oral and documentary evidence, and shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence, or other documents which are relevant to the inquiry. In case of the refusal of any person to comply with any subpoena issued under this section or of any witness to testify with respect to any matter concerning which he or she may be lawfully interrogated, the superior court of Providence County, on application of the insurance commissioner, may issue an order requiring the person or witness to comply with the subpoena and/or to testify, and any failure to obey the order of the court may be punished by the court as contempt of court; provided, that the person charged shall not be required to testify or produce books, papers, records, correspondence, or other documents, tending to incriminate him or her, and the persons refusal to testify or produce books, papers, records, correspondence, or other documents in the case shall not constitute contempt nor be the basis for an application by the insurance commissioner for an order requiring the person charged to testify or produce books, papers, records, correspondence, or other documents; and provided that a refusal of the person charged to testify or produce books, papers, records, correspondence, or other documents shall be sufficient ground for the suspension or revocation of any license the person has under the insurance laws of this state in the discretion of the insurance commissioner.  (d) Statements of charges, notices, orders, and other processes of the insurance commissioner under this chapter may be served by anyone duly authorized by the insurance commissioner, either in the manner provided by law for service of process in civil actions, or by registering and mailing a copy of it to the person affected by the statement, notice, order, or other process at his or her or its residence or principal office or place of business. The verified return by the person serving the statement, notice, order, or other process setting forth the manner of the service shall be proof of the service, and the return postcard receipt for the statement, notice, order, or other process registered and mailed as stated in this subsection shall be proof of the service of the process.  History of Section.P.L. 1958, ch. 53,  5; P.L. 1993, ch. 180,  24. 
 27-29-6. Cease and desist orders and modifications of those orders. (a) If after a hearing the insurance commissioner shall determine that the method of competition or the act or practice in question is unfair and that the person complained of has engaged in a method of competition, act, or practice in violation of this chapter, the commissioner shall reduce his or her findings to writing and shall issue and cause to be served upon the person charged with the violation an order requiring the person to cease and desist from engaging in the method of competition, act, or practice. The commissioner may, at the commissioners discretion order: (1) payment of a monetary penalty of not more than five thousand dollars ($5,000) for each violation, but not to exceed an aggregate penalty of one hundred thousand dollars ($100,000), unless the violation was committed flagrantly in a conscious disregard of this chapter, in which case the penalty shall not be more than twenty-five thousand dollars ($25,000) for each violation not to exceed an aggregate penalty of two hundred fifty thousand dollars ($250,000); or (2) suspension or revocation of the insurers license if the insurer knew or reasonably should have known that it was in violation of this chapter.  (b) Until the expiration of the time allowed under  27-29-7(a) for filing a petition for review, if no petition has been duly filed within that time, the insurance commissioner may at any time upon the notice and in the manner the commissioner shall deem proper, modify or set aside in whole or in part any order issued by the commissioner under this section.  (c) After the expiration of the time allowed for filing a petition for review, if no petition has been duly filed within that time, the insurance commissioner may at any time, after notice and opportunity for hearing, reopen and alter, modify or set aside, in whole or in part, any order issued by the commissioner under this section whenever in his or her opinion conditions of fact or of law have changed as to require that action or if the public interest shall require.  History of Section.P.L. 1958, ch. 53,  6; P.L. 1993, ch. 180,  24. 
 27-29-7. Judicial review of cease and desist orders. (a) Any person required by an order of the insurance commissioner under  27-29-6 to cease and desist from engaging in any unfair method of competition or any unfair or deceptive act or practice may obtain a review of the order by filing in the superior court of Providence County, within twenty (20) days from the date of service of the order, a written petition praying that the order of the insurance commissioner be set aside. A copy of the petition shall be served upon the insurance commissioner, after which the insurance commissioner shall certify and file in the court his or her transcript of the entire record in the proceeding, including all of the evidence taken and the report and order of the insurance commissioner. Upon the filing of the petition and transcript, the court shall have jurisdiction of the proceeding and of the question determined in it, shall determine whether the filing of the petition shall operate as a stay of the order of the insurance commissioner, and shall have the power to make and enter upon the pleadings, evidence, and proceedings set forth in the transcript a decree modifying, affirming, or reversing the order of the insurance commissioner, in whole or in part. The findings of the insurance commissioner as to the facts, if supported by the weight of the evidence, shall be conclusive.  (b) To the extent that the order of the insurance commissioner is affirmed, the court shall issue its own order commanding obedience to the terms of the order of the insurance commissioner. If either party shall apply to the court for leave to adduce additional evidence, and shall show to the satisfaction of the court that the additional evidence is material and that there were reasonable grounds for the failure to adduce the evidence in the proceeding before the insurance commissioner, the court may order the additional evidence to be taken before the insurance commissioner and to be adduced upon the hearing in the manner and upon the terms and conditions as the court may deem proper. The insurance commissioner may modify his or her findings of fact, or make new findings by reason of the additional evidence taken, and the commissioner shall file the modified or new findings which if supported by competent evidence shall be conclusive, and the commissioners recommendation, if any, for the modification or setting aside of his or her original order, with the return of the additional evidence.  (c) A cease and desist order issued by the insurance commissioner under  27-29-6 shall become final:  (1) Upon the expiration of the time allowed for filing a petition for review if no petition has been duly filed within that time, except that the insurance commissioner may after this modify or set aside his or her order to the extent provided in  27-29-6(b); or  (2) Upon the final decision of the court if the court directs that the order of the insurance commissioner be affirmed or the petition for review dismissed.  (d) No order of the insurance commissioner under this chapter or order of a court to enforce the order of the insurance commissioner shall in any way relieve or absolve any person affected by the order from any liability under any other laws of this state.  History of Section.P.L. 1958, ch. 53,  7; P.L. 1993, ch. 180,  24. 
 27-29-8. Procedure as to unfair methods of competition and unfair or deceptive acts or practices which are not defined. (a) Whenever the insurance commissioner shall have reason to believe that any person engaged in the business of insurance is engaging in this state in any method of competition or in any act or practice in the conduct of business which is not defined in  27-29-4, that the method of competition is unfair or that the act or practice is unfair or deceptive and that a proceeding by the commissioner in respect to it would be to the interest of the public, the commissioner may issue and serve upon the person a statement of the charge in that respect and a notice of a hearing on the charge to be held at a time and place fixed in the notice. The hearing shall be conducted in the same manner as the hearings provided for in  27-29-5. The insurance commissioner shall after the hearings make a report in writing in which the commissioner shall state his or her findings as to the facts, and the commissioner shall serve a copy of it upon the person.  (b) If the report charges a violation of this chapter and if the method of competition, act, or practice has not been discontinued, the insurance commissioner may, through the attorney general of this state, at any time after ten (10) days after the service of the report, cause a petition to be filed in the superior court of this state for the counties of Providence and Bristol to enjoin and restrain the person from engaging in that method, act, or practice. The court shall have jurisdiction of the proceeding and shall have the power to make and enter appropriate orders in connection with the proceedings and to issue any of the writs ancillary to its jurisdiction or necessary in its judgment to prevent injury to the public pendente lite.  (c) A transcript of the proceedings before the insurance commissioner, including all evidence taken and the report and findings, shall be filed with the petition. If either party shall apply to the court for leave to adduce additional evidence and shall show to the satisfaction of the court that the additional evidence is material and there were reasonable grounds for the failure to adduce the evidence in the proceedings before the insurance commissioner, the court may order the additional evidence to be taken before the insurance commissioner and to be adduced upon the hearing in a manner and upon those terms and conditions the court may deem proper. The insurance commissioner may modify his or her findings of fact or make new findings by reason of the additional evidence taken, and the commissioner shall file the modified or new findings with the return of the additional evidence.  (d) If the court finds that the method of competition complained of is unfair or that the act or practice complained of is unfair or deceptive, that the proceeding by the insurance commissioner with respect to it is to the interest of the public, and that the findings of the insurance commissioner are supported by the weight of the evidence, it shall issue its order enjoining and restraining the continuance of the method of competition, act, or practice.  History of Section.P.L. 1958, ch. 53,  8. 
 27-29-9. Penalty. (a) Any person who violates a cease and desist order of the insurance commissioner under  27-29-6 after it has become final, and while the order is in effect, shall, upon proof of the violation to the satisfaction of the court, forfeit and pay to the state a sum not to exceed twenty-five thousand dollars ($25,000), which may be recovered in a civil action, except that, if the violation is found to be willful, the amount of the penalty shall be a sum not to exceed two hundred fifty thousand dollars ($250,000).  (b) Any person who violates a cease and desist order of the insurance commissioner under  27-29-6 after it has become final, and while the order is in effect, may after notice and hearing and upon order of the commissioner, be subject at the discretion of the commissioner to suspension or revocation of the insurers license.  History of Section.P.L. 1958, ch. 53,  9; P.L. 1993, ch. 180,  24. 
 27-3.1-1  27-3.1-10. Repealed.
 27-3.2-1. Purpose. The purpose of this chapter is to establish requirements and standards for continuing education programs for natural persons licensed as insurance producers pursuant to this title.  History of Section.P.L. 1989, ch. 394,  1. 
 27-3.2-10. Severability. If any section, term, or provision of this chapter shall be adjudged invalid for any reason, that judgment shall not affect, impair, or invalidate any remaining section, term, or provision, which shall remain in full force and effect.  History of Section.P.L. 1989, ch. 394,  1. 
 27-3.2-2. Applicability. This chapter applies to resident and nonresident persons licensed to engage in the sale of the following lines of insurance:  (1) All lines of life insurance and health insurance;  (2) All lines of property and casualty insurance; and  (3) All other lines of insurance for which an examination is required for licensing.  History of Section.P.L. 1989, ch. 394,  1; P.L. 1995, ch. 180,  1; P.L. 1995, ch. 215,  1; P.L. 1998, ch. 122,  2. 
 27-3.2-3. Exemptions. This chapter does not apply to: (1) Those natural persons holding resident licenses to sell any kind or kinds of insurance for which an examination is not required by the law of this state;  (2) Persons holding a limited or restricted license which is exempted by the insurance commissioner;  (3) Non-resident licensees who must meet continuing education requirements established by the insurance department in their home state if the state of their residence, in the opinion of the insurance commissioner, accords substantially similar treatment to residents of this state; or  (4) Persons holding a license for twenty-five (25) years and who are age fifty-five (55) at the time of renewal. Provided, further, however, that this chapter shall also not apply to any persons who had held a license for at least twenty (20) years and were at least sixty (60) years of age at the time of renewal as of July 3, 2004.  History of Section.P.L. 1989, ch. 394,  1; P.L. 2004, ch. 298,  1; P.L. 2005, ch. 44,  1; P.L. 2005, ch. 89,  1. 
 27-3.2-4. Educational requirements. Any person holding a license issued pursuant to this title and not exempt under  27-3.2-3 shall satisfactorily complete continuing education courses in accordance with regulations promulgated by the director.  History of Section.P.L. 1989, ch. 394,  1; P.L. 1995, ch. 180,  1; P.L. 1995, ch. 215,  1; P.L. 2006, ch. 84,  3; P.L. 2006, ch. 93,  3. 
 27-3.2-5. Repealed. History of Section.P.L. 1989, ch. 394,  1; P.L. 1990, ch. 97,  1; P.L. 1990, ch. 353,  1; P.L. 1995, ch. 180,  1; P.L. 1995, ch. 215,  1; P.L. 1998, ch. 238,  1; P.L. 2002, ch. 292,  11; Repealed by P.L. 2017, ch. 196,  5, effective July 18, 2017; P.L. 2017, ch. 322,  5, effective September 27, 2017. 
 27-3.2-6. Compliance. Any person licensed pursuant to this title and not exempt under  27-3.2-3 shall comply with all of the terms and requirements of this chapter and regulations promulgated hereunder.  History of Section.P.L. 1989, ch. 394,  1; P.L. 1995, ch. 180,  1; P.L. 1995, ch. 215,  1; P.L. 2006, ch. 84,  3; P.L. 2006, ch. 93,  3. 
 27-3.2-7. Penalty. Any person failing to meet the requirements of this chapter and who has not been granted an extension of time within which to comply pursuant to  27-3.2-6(c), or who has submitted a false or fraudulent certificate of compliance, shall, after a hearing, which hearing may be waived by that person, be subjected to the suspension of all licenses issued for any kinds of insurance, and no further license shall be issued to that person for any kind or kinds of insurance until the time as that person shall have demonstrated to the satisfaction of the commissioner that he or she has complied with all of the requirements of this chapter and all other laws applicable to the license.  History of Section.P.L. 1989, ch. 394,  1. 
 27-3.2-8. Rules and regulations. The insurance commissioner may make reasonable rules and regulations necessary to effect the purposes of this chapter.  History of Section.P.L. 1989, ch. 394,  1. 
 27-3.2-9. Fees. (a) Notwithstanding any provision of the general laws to the contrary, there is established a fee of fifteen dollars ($15.00) per annum for the period commencing July 1, 2002, and ending on June 30, 2003, which shall be paid by all persons licensed pursuant to chapter 2.4 of this title, and shall be deposited as general revenues.  (b) Notwithstanding any provision of the general laws to the contrary, for the period commencing July 1, 2003, the fee shall be five dollars ($5.00) per annum, which shall be paid by all persons licensed pursuant to chapter 2.4 of this title, and shall be deposited as general revenues.  (c) The fee for approval of a course or program to qualify as a course of continuing education shall be sixty dollars ($60.00), which shall be paid at the time of application and shall be deposited as general revenues.  History of Section.P.L. 1989, ch. 394,  1; P.L. 1995, ch. 180,  1; P.L. 1995, ch. 215,  1; P.L. 1995, ch. 370, art. 40,  85; P.L. 2002, ch. 65, art. 13,  25; P.L. 2002, ch. 292,  11; P.L. 2009, ch. 68, art. 12,  8. 
 27-3.3-1  27-3.3-10. Repealed.
 27-3-1  27-3-35. Repealed.
 27-3-36. Repealed.
 27-3-37. Repealed.
 27-3-38.1. Insurance independently procured  Duty to report and pay tax. (a) Each insured in this state who procures or continues or renews insurance with an insurer not licensed to do an insurance business in this state on properties, risks or exposures located or to be performed in whole or in part in this state, other than insurance procured through a surplus lines licensee, shall, within thirty (30) days after the date the insurance was so procured, continued or renewed, file a written report with the tax administrator, upon forms prescribed by the tax administrator, showing the name and address of the insured or insureds, name and address of the insurer, the subject of the insurance, a general description of the coverage, the amount of premium currently charged and additional pertinent information reasonably requested by the tax administrator.  (b) Where the insurance covers properties, risks or exposures located or to be performed both in and out of this state, the sum payable shall be computed based on: (1) An amount equal to four percent (4%) on that portion of the gross premiums allocated to this state pursuant to  27-3-38.3; plus (2) An amount equal to the portion of the premiums allocated to other states or territories on the basis of the tax rates and fees applicable to properties, risks or exposures located or to be performed outside of this state.  (c) Pursuant to applicable sections of the general laws, the commissioner shall participate in a multi-state surplus lines compact or agreement for the purpose of collecting and disbursing to reciprocal states any funds collected pursuant to subdivision (b)(2) of this section applicable to other properties, risks or exposures located or to be performed outside of this state. To the extent that other states where portions of the properties, risks or exposures reside have failed to enter into compact or reciprocal allocation procedure with this state, the net premium tax collected shall be retained by this state.  (d) Gross premiums charged for the insurance, less any return premiums, are subject to a tax at the rate of four percent (4%). At the time of filing the report required in subsection (a) of this section, the insured shall file with the tax administrator, in the form that he or she may prescribe, a return under oath or affirmation containing information that may be deemed necessary for the determination of the tax imposed by this section. The insured shall at the same time pay the tax due to the tax administrator.  (e) If an independently procured policy covers properties, risks or exposures only partially located or to be performed in this state, the tax payable by the insured shall be computed on the portion of the premium properly attributable to the properties, risks or exposures located or to be performed in this state in the manner provided in  27-3-38.3.  (f) This section does not abrogate or modify chapter 16 of this title (Unauthorized Insurance Business), or any other provision of this title.  History of Section.P.L. 2002, ch. 65, art. 16,  1; P.L. 2011, ch. 14,  2; P.L. 2011, ch. 22,  2. 
 27-3-38.2. Definitions. As used in this chapter: (1) Admitted insurer means an insurer licensed to do an insurance business in this state.  (2) Capital as used in the financial requirements of  27-3-40, means funds paid in for stock or other evidence of ownership.  (3) Commissioner means the insurance commissioner of Rhode Island or his or her designee, deputies or staff, or the commissioner, director or superintendent of insurance in any other state.  (4) Eligible surplus lines insurer means a nonadmitted insurer with which a surplus lines licensee may place surplus lines insurance pursuant to  27-3-38.  (5) Home state means,  (i) With respect to an insured:  (A) The state in which an insured maintains its principal place of business or, in the case of an individual, the individuals principal residence; or  (B) If one hundred percent (100%) of the insured risk is located out of the state referred to in subparagraph (i), the state to which the greatest percentage of the insureds taxable premium for that insurance contract is allocated.  (ii) Principal place of business means, with respect to determining the home state of the insured.  (A) the state where the insured maintains its headquarters and where the insureds high-level officers direct, control and coordinate the business activities; or  (B) if the insureds high-level officers direct, control and coordinate the business activities in more than one state, the state in which the greatest percentage of the insureds taxable premium for that insurance contract is allocated; or  (C) if the insured maintains its headquarters or the insureds high-level officers direct, control and coordinate the business activities outside any state, the state to which the greatest percentage of the insureds taxable premium for that insurance contract is allocated.  (iii) Principal residence means, with respect to determining the home state of the insured, (i) the state where the insured resides for the greatest number of days during a calendar years; or (ii) if the insureds principal residence is located outside any state, the state to which the greatest percentage of the insureds taxable premium for that insurance contract is allocated.  (iv) Affiliated groups. If more than one insured from an affiliated group are named insureds on a single nonadmitted insurance contract, the term home state means the home state, as determined above, of the member of the affiliated group that has the largest percentage of premium attributed to it under such insurance contract.  (v) Group insurance. When the group policyholder pays one hundred percent (100%) of the premium from its own funds, the term home state means the home state, as determined above, of the group policyholder. When the group policyholder does not pay one hundred percent (100%) of the premium from its own funds, the term home state means the home state, as determined above, of the group member.  (6) Insurer means any person, corporation, association, partnership, reciprocal exchange, interinsurer, Lloyds insurer, insurance exchange syndicate, fraternal benefit society, and any other legal entity engaged in the business of insurance.  (7) NAIC means the National Association of Insurance Commissioners.  (8) Nonadmitted insurer means an insurer not licensed to do an insurance business in this state.  (9) Person means any natural person or other entity, including, but not limited to, individuals, partnerships, associations, trusts or corporations.  (10) Surplus as used in the financial requirements of  27-3-40, means funds over and above liabilities and capital of the company for the protection of policyholders.  (11) Surplus lines insurance means any property and casualty insurance in this state on properties, risks or exposures, located or to be performed in this state, permitted to be placed through a surplus lines licensee with a nonadmitted insurer eligible to accept such insurance, pursuant to  27-3-40.  (12) Surplus lines licensee means an individual, firm or corporation licensed under  27-3-38 to place insurance on properties, risks or exposures located or to be performed in this state with nonadmitted insurers eligible to accept such insurance.  History of Section.P.L. 2011, ch. 14,  3; P.L. 2011, ch. 22,  3. 
 27-3-38.3. Exception to life and health and accident exemption. The provisions of this chapter do not apply to life and health and accident, as noted in  27-3-38(a), and surplus lines brokers may not place insurance in those lines in the surplus market. An exception is hereby made to this prohibition for the procurement of disability insurance with a benefit limit in excess of a benefit limit available from an admitted insurer. For that class of business only, a broker may obtain insurance from the surplus market.  History of Section.P.L. 2019, ch. 103,  1; P.L. 2019, ch. 136,  1. 
 27-3-38. Surplus line brokers  License  Affidavit of inability to obtain insurance  Reports and records  Premium tax  Notice to purchasers. (a) The insurance commissioner may issue a surplus line brokers license to any person authorizing the licensee to procure, subject to the restrictions provided in this section, policies of insurance, except life and health and accident, except as allowed under  27-3-38.3, from eligible surplus lines insurers. Residents of this state must hold an insurance producer license to qualify for a surplus lines broker license. This license may be denied, suspended, or revoked by the insurance commissioner whenever, in the commissioners judgment, any of the bases under  27-2.4-14 exist. Before any license is issued by the insurance commissioner and before each renewal of a license, there shall be filed in his or her office a written application by the person desiring the license in the form, and containing any information, that the insurance commissioner may prescribe. For the purposes of carrying out the provisions of the Nonadmitted and Reinsurance Reform Act of 2010, the commissioner is authorized to utilize the national insurance producer database of the National Association of Insurance Commissioners (NAIC), or any other equivalent uniform national database, for the licensure of a person as a surplus lines producer and for renewal of such license. For insureds whose home state is this state, a person shall not procure a contract of surplus lines insurance with a nonadmitted insurer unless the person possesses a current surplus lines insurance license issued by the commissioner.  (b) A Rhode Island resident business entity acting as a surplus line broker may elect to obtain a surplus line broker license. Application shall be made using the uniform business entity application. Prior to approving the application, the commissioner shall find both of the following:  (1) The business entity has paid the appropriate fees.  (2) The business entity has designated a licensed surplus line broker responsible for the business entitys compliance with the insurance laws and rules of this state.  (c) When any policy of insurance is procured under the authority of that license, there shall be executed, both by the licensee and by the insured, affidavits setting forth facts showing that the insured, or a licensed Rhode Island producer, were unable, after diligent effort, to procure from no less than three (3) admitted insurers the full amount of insurance required to protect the property owned or controlled by the insured or the risks insured. Provided, however, the aforementioned affidavit shall not be required when insuring the following interest: amusement parks and devices, environmental improvement and/or remediation sites, vacant property or property under renovation, demolition operations, event cancellation due to weather, railroad liability, discontinued products, fireworks and pyrotechnics, warehousemans legal liability, excess property coverage, private flood, and contingent liability. In addition, no such affidavit is required for exempt commercial purchasers as defined by the Nonadmitted and Reinsurance Reform Act of 2010. For purposes of this section, residual market mechanisms shall not be considered authorized insurers. Prior to renewing, continuing, or extending any policy, the licensed surplus line broker must confirm that the insurer is on the insurance commissioners list of approval surplus line insurers in this state.  (d) The licensee shall keep a complete and separate record of all policies procured from approved surplus lines insurers under the license and these records shall be open to the examination of both the insurance commissioner and tax administrator at all reasonable times and shall show the exact amount of each kind of insurance permitted under this section which has been procured for each insured; the gross premiums charged by the insurers for each kind of insurance permitted under this section which were returned to each insured; the name of the insurer or insurers which issued each of these policies; the effective dates of these policies; and the terms for which these policies were issued. The licensee shall file a yearly report with the insurance commissioner on a form prescribed by the insurance commissioner showing the business procured under the surplus line license for the preceding calendar year, and the report shall be due annually on or before April 1.  (e) Every person, firm, or corporation licensed pursuant to the provisions of this section shall file with the insurance commissioner, at the time of the insurance producer license renewal, sufficient information, as determined by the insurance commissioner, whether a licensee or a person acting on the licensees behalf, has paid to the tax administrator, for all policies procured by the licensee pursuant to the license during the next preceding calendar year, a tax, computed at the rate of four percent (4%) on the gross premiums charged the insured by the insurers, less the amount of premiums returned to the insured. The tax administrator shall provide to the insurance commissioner, upon request, information needed to determine compliance with this subsection. The content and nature of the information to be disclosed shall be determined and approved by the tax administrator, shall be the minimum necessary to determine compliance, and shall be kept confidential by the insurance commissioner.  (f) Every application form for insurance from a surplus lines insurer, every affidavit form executed by the insured, and every policy (on its front and declaration pages) issued by the surplus lines insurer, shall contain in ten-point (10) type the following notice:   NOTICE THIS INSURANCE CONTRACT HAS BEEN PLACED WITH AN INSURER NOT LICENSED TO DO BUSINESS IN THE STATE OF RHODE ISLAND BUT APPROVED AS A SURPLUS LINES INSURER. THE INSURER IS NOT A MEMBER OF THE RHODE ISLAND INSURERS INSOLVENCY FUND. SHOULD THE INSURER BECOME INSOLVENT, THE PROTECTION AND BENEFITS OF THE RHODE ISLAND INSURERS INSOLVENCY FUND ARE NOT AVAILABLE.   History of Section.P.L. 1959, ch. 155,  1; P.L. 1982, ch. 147,  1; P.L. 1987, ch. 166,  11; P.L. 1996, ch. 188,  3; P.L. 2000, ch. 161,  1; P.L. 2000, ch. 183,  1; P.L. 2002, ch. 354,  1; P.L. 2006, ch. 632,  1; P.L. 2007, ch. 443,  1; P.L. 2008, ch. 144,  2; P.L. 2008, ch. 198,  2; P.L. 2009, ch. 303,  2; P.L. 2009, ch. 304,  2; P.L. 2010, ch. 23, art. 9,  15; P.L. 2011, ch. 14,  2; P.L. 2011, ch. 22,  2; P.L. 2012, ch. 415,  4; P.L. 2016, ch. 98,  2; P.L. 2016, ch. 107,  2; P.L. 2022, ch. 404,  1, effective June 30, 2022; P.L. 2022, ch. 405,  1, effective June 30, 2022. 
 27-3-39. [Repealed.] History of Section.P.L. 1959, ch. 155,  1; P.L. 1993, ch. 180,  4; P.L. 1994, ch. 404,  8; P.L. 2000, ch. 161,  1; P.L. 2011, ch. 14,  2; P.L. 2011, ch. 22,  2; repealed by P.L. 2022, ch. 404,  8, effective June 30, 2022; repealed by P.L. 2022, ch. 405,  8, effective June 30, 2022. 
 27-3-40. Limitations on placing insurance with approved surplus lines insurers. (a) Surplus lines insurance may be placed by a surplus lines broker if each insurer is authorized to write the type of insurance in its domiciliary jurisdiction;  (b) A surplus lines licensee shall not place coverage with a nonadmitted insurer, unless, at the time of placement, the nonadmitted insurer:  (1) Has established satisfactory evidence of good repute and financial integrity; and  (2) Qualifies under one of the following subparagraphs:  (i) Has capital and surplus or its equivalent under the laws of its domiciliary jurisdiction which equals the greater of:  (A) The minimum capital and surplus requirements under the law of this state; or  (B) Fifteen million dollars ($15,000,000); or  (ii) For an insurer not domiciled in the United States or its territories, the insurer is listed on the quarterly listing of alien insurers maintained by the NAIC international insurers department or its equivalent  (c) The capital and surplus requirements of paragraph (b)(2)(i) above may be satisfied by an insurer possessing less than the minimum capital and surplus upon an affirmative finding of acceptability by the commissioner. The finding shall be based upon such factors as quality of management, capital and surplus of any parent company, company underwriting profit and investment income trends, market availability and company record and reputation within the industry. In no event shall the commissioner make an affirmative finding of acceptability when the nonadmitted insurers capital and surplus is less than four million five hundred thousand dollars ($4,500,000);  (d) The commissioner is authorized to enter into a multi-state surplus lines agreement to establish additional and alternative nationwide uniform eligibility requirements that shall be applicable to nonadmitted insurers domiciled in another state or territory of the United States.  History of Section.P.L. 1959, ch. 155,  1; P.L. 1996, ch. 188,  3; P.L. 2005, ch. 287,  1; P.L. 2011, ch. 14,  2; P.L. 2011, ch. 22,  2. 
 27-3-41. Service of process. No person licensed to act as a surplus line broker in the state shall place any risk with any unauthorized insurer unless that insurer has previously, in writing, appointed that broker as an agent for the acceptance of service of process, or unless the unauthorized insurer shall have designated a Rhode Island representative as an agent for the service of process, copies of which shall be filed with the insurance commissioner. The designation of a licensed broker or other representative for the purpose stated shall be cumulative to any other methods which may be provided by law for service of process upon an unauthorized insurer.  History of Section.P.L. 1959, ch. 155,  1. 
 27-3-42. Surplus line brokers fee. No license or renewal of a license to act as a surplus line broker shall be issued under  27-3-38 and 27-3-39 [repealed] until there has been paid to the insurance commissioner, for the use of the state, a fee of fifty dollars ($50.00).  History of Section.P.L. 1959, ch. 155,  1. 
 27-3-43. Repealed.
 27-3-44. Repealed.
 27-3-45. Repealed.
 27-3-46.1, 27-3-47. Repealed.
 27-3-46. Repealed.
 27-3-47.1  27-3-48.4. Repealed.
 27-3-48.5. Repealed.
 27-3-49, 27-3-50. Repealed.
 27-3-51. Repealed.
 27-30-1. Purpose. The purpose of this chapter is to promote the public welfare by regulating consumer credit insurance. Nothing in this chapter is intended to prohibit or discourage reasonable competition. The provisions of this chapter shall be liberally construed.  History of Section.P.L. 1959, ch. 91,  1; P.L. 2009, ch. 292,  2; P.L. 2009, ch. 293,  2. 
 27-30-10. Claims. (a) All claims shall be promptly reported to the insurer or its designated claim representative, and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the insurance contract.  (b) All claims shall be paid either by draft drawn upon the insurer, by electronic funds transfer, or by check of the insurer to the order of the claimant to whom payment of the claim is due pursuant to the policy provisions, or upon direction of the claimant to one specified.  (c) No plan or arrangement shall be used by which any person, firm, or corporation other than the insurer or its designated claim representative shall be authorized to settle or adjust claims. The creditor shall not be designated as claim representative for the insurer in adjusting claims; provided, that a group policyholder may, by arrangement with the group insurer, draw drafts, checks or electronic transfers in payment of claims due to the group policyholder subject to audit and review by the insurer.  (d) All claims for consumer credit insurance shall be subject to all applicable chapters of titles 27 and 42 including chapter 9.1 of title 27.  History of Section.P.L. 1959, ch. 91,  10; P.L. 2009, ch. 292,  3; P.L. 2009, ch. 293,  3. 
 27-30-11. Existing insurance  Choice of insurer. When consumer credit insurance is required as additional security for any indebtedness the debtor shall, upon request to the creditor, have the option of furnishing the required amount of insurance through existing policies of insurance owned or controlled by the debtor of procuring and furnishing the required coverage through any insurer authorized to transact an insurance business within this state.  History of Section.P.L. 1959, ch. 91,  11; P.L. 2009, ch. 292,  3; P.L. 2009, ch. 293,  3; P.L. 2010, ch. 239,  3. 
 27-30-12. Enforcement. The commissioner may, after notice and hearing, issue rules and regulations as the commissioner deems appropriate for the supervision of this chapter. Whenever the commissioner finds that there has been a violation of this chapter or any rules or regulations issued pursuant to it, after written notice of the violation and hearing given to the insurer or other person authorized or licensed by the commissioner, he or she shall set forth the details of the findings together with an order for compliance by a specified date. The order shall be binding on the insurer and other persons authorized or licensed by the commissioner on the specified date unless sooner withdrawn by the commissioner or a stay from the order has been ordered by a court of competent jurisdiction. The commissioner may set forth by regulation prima facie reasonable premium rates, together with corresponding safe-harbor benefit provisions, which premium rates shall be conclusively presumed reasonable in relation to the benefits provided when used for policies containing such benefit provisions.  History of Section.P.L. 1959, ch. 91,  12; P.L. 2009, ch. 292,  4; P.L. 2009, ch. 293,  4. 
 27-30-13. Judicial review. Any party to the proceeding affected by any order of the commissioner shall be entitled to judicial review pursuant to chapter 35 of title 42.  History of Section.P.L. 1959, ch. 91,  13; P.L. 2009, ch. 292,  4; P.L. 2009, ch. 293,  4. 
 27-30-14. Penalties. The commissioner, in his or her discretion, may revoke or suspend the license or certificate of authority or proscribe whatever additional penalty is warranted pursuant to  42-14-16 for any violation of this chapter. The order for penalties shall provide for notice and hearing, and shall be subject to judicial review as provided in  42-35-15.  History of Section.P.L. 1959, ch. 91,  14; P.L. 2009, ch. 292,  4; P.L. 2009, ch. 293,  4. 
 27-30-15. Severability. If any provision of this chapter, or the application of the provision to any person or circumstances, shall be held invalid, the remainder of the chapter, and the application of the provision to any person or circumstances other than those as to which it is held invalid, shall not be affected by that invalidity.  History of Section.P.L. 1959, ch. 91,  15. 
 27-30-16. Duties of an insurer. Except as otherwise prohibited by law, duties imposed upon an insurer within this chapter may be carried out by a creditor if the creditor is acting as a common law or statutory agent on behalf of the insurer.  History of Section.P.L. 1959, ch. 91,  16; P.L. 2009, ch. 292,  4; P.L. 2009, ch. 293,  4. 
 27-30-17. Repealed.
 27-30-2. Scope and definitions. (a) Citation and scope.(1) This chapter may be cited as Consumer Credit Insurance Act.  (2) All consumer credit insurance sold in connection with loans or other credit transactions for personal, family or household purposes shall be subject to the provisions of this chapter except:  (i) Insurance written in connection with a credit transaction that is:  (A) Secured by a first mortgage or deed of trust; and  (B) Made to finance the purchase of real property or the construction of a dwelling thereon, or to refinance a prior credit transaction made for such a purpose;  (ii) Insurance sold as an isolated transaction on the part of the insurer and not related to an agreement or a plan for insuring debtors of the creditor.  (iii) Insurance for which no identifiable charge is made to the debtor.  (iv) Insurance on accounts receivable.   (b) Definitions. For the purpose of this chapter:  (1) Commissioner means the director of the department of business regulation or his or designee;  (2) Compensation means commissions, dividends, retrospective rate credits, service fees, expense allowances or reimbursements, gifts, furnishing of equipment, facilities, goods or services, or any other form of remuneration resulting directly from the sale of consumer credit insurance;  (3) Consumer credit insurance is a general term used in this chapter to refer to any or all credit life insurance, credit accident and health insurance, credit unemployment insurance specifically defined in this chapter;  (4) Credit accident and health insurance means insurance on a debtor to provide indemnity for payments or debt becoming due on a specific loan or other credit transaction while the debtor is disabled as defined in the policy;  (5) Credit life insurance means insurance on a debtor or debtors, pursuant to or in connection with a specific loan or other credit transaction, to provide for satisfaction of a debt, in whole or in part, upon the death of an insured debtor;  (6) Credit transaction means any transaction by the terms of which the repayment of money loaned or loan commitment made, or payment for goods, services or properties sold or leased, is to be made at a future date or dates;  (7) Credit unemployment insurance means insurance on a debtor to provide indemnity for payments or debt becoming due on a specific loan or other credit transaction while the debtor is involuntarily unemployed as defined in the policy;  (8) Creditor means the lender of money or vendor or lessor of goods, services, property, rights, or privileges, for which payment is arranged through a credit transaction or any successor to the right, title, or interest of any lender, vendor, or lessor, and an affiliate, associate, or subsidiary of any of them or any director, officer, or employee of any of them or any other person in any way associated with any of them;  (9) Debtor means a borrower of money or a purchaser or lessee of goods, services, property, rights, or privileges for which payment is arranged through a credit transaction;  (10) Gross debt means the sum of the remaining payments owed to the creditor by the debtor;  (11) Identifiable charge means a charge for a type of consumer credit insurance that is made to debtors having such insurance and not made to debtors not having such insurance; it includes a charge for insurance that is disclosed in the credit or other instrument furnished to the debtor which sets out the financial elements of the credit transaction and any difference in the finance, interest, service or other similar charge made to debtors who are in like circumstances except for the insured or non-insured status of the debtor or of the property used as security for the credit transaction;  (12) Net debt means the amount necessary to liquidate the remaining debt in a single lump-sum payment, excluding all unearned interest and other unearned finance charges;  (13) Open-end credit means credit extended by a creditor under an agreement in which:  (i) The creditor reasonably contemplates repeated transactions;  (ii) The creditor imposes a finance charge from time to time on an outstanding unpaid balance; and  (iii) The amount of credit that may be extended to the debtor during the term of the agreement (up to any set limit by the creditor) is generally made available to the extent that any outstanding balance is repaid.  History of Section.P.L. 1959, ch. 91,  2; P.L. 1972, ch. 148,  1; P.L. 1981, ch. 270,  1; P.L. 2009, ch. 292,  2; P.L. 2009, ch. 293,  2; P.L. 2011, ch. 157,  2; P.L. 2011, ch. 275,  2. 
 27-30-3. Types of consumer credit insurance. The types of consumer credit insurance defined in  27-30-2 may each be written separately or in combination with other types of consumer credit insurance on an individual policy or group policy basis. The commissioner may by regulation prohibit or limit any combination.  History of Section.P.L. 1959, ch. 91,  3; P.L. 1972, ch. 148,  2; P.L. 2009, ch. 292,  2; P.L. 2009, ch. 293,  2. 
 27-30-4. Amount of consumer credit insurance. (a) Credit life insurance.(1) The amount of credit life insurance shall at no time exceed the greater of the actual net debt or the scheduled net debt.  (2) If the coverage is written on the actual net debt, then the amount payable at the time of loss may not be less than the actual net debt less any payments more than two (2) months overdue.  (3) If the coverage is written on the scheduled net debt, then the amount payable at the time of loss shall be:  (i) If the actual net debt is less than or equal to the scheduled net debt, then the scheduled net debt;  (ii) If the actual net debt is greater than the scheduled net debt but less than or equal to the scheduled net debt plus two (2) months of payments, the actual net debt; or  (iii) If the actual net debt is greater than the scheduled net debt plus two (2) months of payments, then scheduled net debt plus two (2) months of payments.  (4) If a premium is assessed to the debtor on a monthly basis and is based on the actual net debt, then the amount payable at the time of loss shall be the actual net debt on the date of death. When such premium is computed on the basis of a balance which does not include accrued past due interest, then the amount payable at the time of loss shall not be less than the actual net debt less any accrued interest more than two (2) months past due.  (5) Notwithstanding the provisions of subdivision (1) of this subsection, insurance on agricultural loan commitments, not exceeding one year in duration, may be written up to the amount of the loan commitment, on a non-decreasing or level term plan.  (6) Notwithstanding the provisions of subdivision (1) of this subsection, insurance on educational loan commitments may be written for net unpaid indebtedness plus any unused commitment.  (7) Coverage may be written for less than the net debt by the following methods:  (i) The amount of insurance may be the lesser of a stated level amount and the amount determined by subdivision (2) of this subsection;  (ii) The amount of insurance may be the lesser of a stated level amount and the amount determined by subdivision (3) of this subsection;  (iii) The amount of insurance may be a constant percentage of the amount determined by subdivision (2) of this subsection;  (iv) The amount of insurance may be a constant percentage of the amount determined by subdivision (3) of this subsection; or  (v) In the absence of any preexisting condition exclusions, the amount of insurance payable in the event of death due to natural causes may be limited to the balance as it existed six (6) months prior to the date of death if:  (A) There has been one or more increase in the outstanding balance during the six (6) month period, other than those due to the accrual of interest or late charges; and  (B) Evidence of individual insurability has not been required during the six (6) month period.  (8) Other patterns of insurance may be used which are not inconsistent with the rest of this subsection.   (b) Credit accident and health insurance and consumer credit unemployment insurance.(1) The total amount of periodic indemnity payable by credit accident and health insurance or credit unemployment insurance in the event of disability or unemployment, as defined in the policy, shall not exceed the aggregate of the periodic scheduled unpaid installments of the gross debt; and the amount of each periodic indemnity payment shall not exceed the original gross debt divided by the number of periodic installments.  (2) Notwithstanding the provisions of subdivision (1) of this subsection, for credit accident and health insurance or credit unemployment insurance written in connection with an open-end credit agreement, the amount of insurance shall not exceed the gross debt which would accrue on that amount using the periodic indemnity. Subject to any policy maximum, the periodic indemnity must not be less than the creditors minimum repayment schedule.   History of Section.P.L. 1959, ch. 91,  4; P.L. 1961, ch. 38,  1; P.L. 2009, ch. 292,  2; P.L. 2009, ch. 293,  2. 
 27-30-5. Term of consumer credit insurance. (a) Effective date of coverage.(1) For consumer credit insurance made available to and elected by the debtor before or contemporaneous with a credit transaction to which the insurance relates, the term of insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor, except that, when evidence of individual insurability is required and such evidence is furnished more than thirty (30) days after the date when the debtor becomes obligated to the creditor, the term of the credit insurance may commence on the date on which the insurance company determines the evidence to be satisfactory.  (2) For insurance coverage made available to and elected by the debtor on a date subsequent to the date of the consumer credit transaction to which the insurance relates, the insurance shall, subject to acceptance by the insurer, commence on a date not earlier that the date the election is made by the debtor nor later than thirty (30) days following the date on which the insurance company accepts the risk for coverage, according to an objective method such as one related to a particular date within the billing or repayment cycle or a calendar month.  (3) Notwithstanding the provisions of subdivisions (1) and (2) of this subsection, when a group policy provides coverage with respect to debts existing on the policy effective date, the insurance relating to the debt shall not commence before the effective date of the group policy.  (4) In no event shall a charge for insurance be made to the debtor and retained by the creditor or insurer for any time prior to commencement of the consumer credit insurance to which the charge is related.   (b) Termination date of coverage.(1) The term of any consumer credit insurance shall not extend beyond the termination date specified in the policy. The termination date of insurance may precede, coincide with or follow the scheduled maturity date of the debt to which it relates, subject to any other requirements and restrictions of this chapter.  (2) The term of any consumer credit insurance shall not extend more than fifteen (15) days beyond the scheduled maturity date of the debt except when extended without additional cost to the debtor or except when extended pursuant to a written agreement, signed by the debtor, in connection with a variable interest rate credit transaction or a deferral, renewal, refinancing or consolidation of debt.  (3) If the debt is discharged due to renewal, financing or consolidation prior to the scheduled termination date of insurance, any insurance in force shall be terminated before any new insurance may be written in connection with the renewed, refinanced or consolidated debt.  (4) In all cases of termination of insurance prior to the scheduled termination of the insurance, an appropriate refund or credit to the debtor shall be made of any unearned insurance charge paid by the debtor for a term of insurance after the date of the termination, except that no refund is required of a charge made for insurance if the insurance is terminated by performance of the insurers obligation with respect to insurance.  (5) An insured debtor may terminate consumer credit insurance at any time by providing advance request to the insurer. The individual policy or group certificate may require that the request be in writing or that the debtor surrender the individual policy or group certificate, or both. The debtors right to terminate coverage may also be subject to the terms of the credit transaction contract.   History of Section.P.L. 1959, ch. 91,  5; P.L. 2009, ch. 292,  3; P.L. 2009, ch. 293,  3. 
 27-30-6. Disclosure to debtors and provisions of policies and certificates of insurance. (a) Pre-purchase disclosure. Before the debtor elects to purchase consumer credit insurance in connection with a credit transaction, the following shall be disclosed to the debtor in writing:  (1) That the purchase of consumer credit insurance is optional and not a condition of obtaining credit approval;  (2) If more than one kind of consumer credit insurance is being made available to the debtor, whether the debtor can purchase each kind separately or the multiple coverages only as a package;  (3) The conditions of eligibility;  (4) That, if the consumer has another insurance that covers the risk, he or she may not want or need credit insurance;  (5) That within the first thirty (30) days after receiving the individual policy or group certificate, the debtor may cancel the coverage and have all premium paid by the debtor refunded or credited. Thereafter, the debtor may cancel the policy at any time during the term of the loan and receive a refund of any unearned premium. However, only in those instances where insurance is a requirement for the extension of credit, the debtor may be required to offer evidence of alternative insurance acceptable to the creditor at the time of cancellation;  (6) A brief description of the coverage, including a description of the amount, the term, any exception, limitations and exclusions, the insured event, any waiting or elimination period, any deductible, any applicable waiver of premium provision, to whom the benefits would be paid and the premium rate for each coverage or for all coverages in a package;  (7) That if the premium or insurance charge is financed, it will be subject to finance charges at the rate applicable to the credit transaction.  (b) The disclosures required in subsection (a) above shall be provided in the following manner:  (1) In connection with the consumer credit insurance offered contemporaneously with the extension of credit or offered through direct mail advertisements, disclosure shall be made in writing and presented to the consumer in a clear and conspicuous manner;  (2) In conjunction with the offer of credit insurance subsequent to the extension of credit by other than direct mail advertisements, disclosure may be provided orally so long as written disclosures are provided to the debtor no later than the earlier of:  (i) Ten (10) days after the offer; or  (ii) The date any other written material is provided to the debtor.  (c) All consumer credit insurance sold shall be evidenced by an individual policy, or a group certificate of insurance which shall be delivered to the debtor.  (d) The individual policy or group certificate shall, in addition to other requirements of law, set forth the following:  (1) The name and home office address of the insurer;  (2) The name or names of the debtor or debtors, or, in the case of a group certificate, the identity by name or otherwise of the debtor or debtors;  (3) The premium or amount of payment by the debtor separately for each kind of coverage or for all coverages in a package, except that for open-end loans, the premium rate and the basis of premium calculation (e.g. average daily balance, prior monthly balance) shall be specified;  (4) A full description of the coverage or coverages, including the amount and term thereof, and any exceptions, limitations and exclusions;  (5) A statement that the benefits shall be paid to the creditor to reduce or extinguish the unpaid debt and, whenever the amount of insurance benefit exceeds the unpaid debt that any such excess shall be payable to a beneficiary, other than the creditor, named by the debtor, or to the debtors estate; and  (6) If the scheduled term of insurance is less than the scheduled term of the credit transaction, a statement to that effect on the face of the individual policy or group certificate in not less than ten (10) point bold face type.  (e) Unless the individual policy or group certificate of insurance is delivered to the debtor at the time the debt is incurred, or at such other time that the debtor elects to purchase coverage, a copy of the application for the policy or a notice of proposed insurance, signed by the debtor and setting forth the name and home office address of the insurer, the name or names of the debtor, the premium rate or amount of payment by the debtor for the insurance and the amount, term and a brief description of the coverage provided, shall be delivered to the debtor at the time the debt is incurred or the election to purchase coverage is made. The copy of the application for or notice of proposed insurance shall also refer exclusively to insurance coverage, and shall be separate and apart from the loan, sale or other credit statement of account, instrument or agreement, unless the information required by this subsection is prominently set forth therein. Upon acceptance of the insurance by the insurer and within thirty (30) days of the date upon which the debt is incurred or the election to purchase coverage is made, the insurer shall cause the individual policy or group certificate of insurance to be delivered to the debtor. The application or notice of proposed insurance shall state that upon acceptance by the insurer, the insurance shall become effective as provided in  27-30-5.  (f) The application, notice of proposed insurance or certificate may be used to fulfill all of the requirements of subsections (a) and (d) if it contains all the information required by those subsections.  (g) The debtor has thirty (30) days from the date that he or she receives either the individual policy or the group certificate to review the coverage purchased. At any time within the thirty (30) day period, the debtor may contact the creditor or insurer issuing the policy or certificate and request that the coverage be cancelled. The individual policy or group certificate may require the request to be in writing or that the policy or certificate be returned to the insurer or both. The debtor shall, within thirty (30) days of the request, receive a full refund or credit of all premiums or insurance charges paid by the debtor.  (h) If the named insurer does not accept the risk, the debtor shall receive a policy or certificate of insurance setting forth the name and home office address of the substituted insurer and the amount of the premium to be charged, and, if the amount of premium is less than that set forth in the notice of proposed insurance, an appropriate refund shall be made within thirty (30) days. In no insurer accepts the risk, then all premiums paid shall be refunded or credited within thirty (30) days of application to the person entitled thereto.  (i) For the purpose of subsection (e) of this section, an individual policy or group certificate delivered in conjunction with an open-end consumer credit agreement or any consumer credit insurance requested by the debtor after the date of the debt shall be deemed to be delivered at the time the debt is incurred or election to purchase coverage is made if the delivery occurs within thirty (30) days of the date the insurance is effective.  (j) An individual policy or group certificate delivered in conjunction with an open-end credit agreement shall continue from its effective date through the term of the agreement unless the individual policy or group certificate is terminated in accordance with its terms at an earlier date.  History of Section.P.L. 1959, ch. 91,  6; P.L. 2009, ch. 292,  3; P.L. 2009, ch. 293,  3. 
 27-30-7. Filing, approval, and withdrawal of forms. (a) All policies, certificates of insurance, notices of proposed insurance, disclosure notices, applications for insurance, endorsements, and riders delivered or issued for delivery in this state and the schedules of premium rates pertaining thereto shall be filed with the commissioner before being used.  (b) The commissioner shall, within thirty (30) days after the filing of any such policies, certificates of insurance, notices of proposed insurance, disclosure notices, application for insurance, endorsements, and riders, disapprove any such form if the benefits provided are not reasonable in relation to the premium charged, or if it contains provisions which are unjust, unfair, inequitable, misleading, deceptive or encourage misrepresentation of the coverage, or are contrary to any provision of the general laws or public laws of this state relating to insurance or of any rule or regulation promulgated thereunder. If the commissioner does not disapprove a filing within thirty (30) days, it may be deemed approved.  (c) If the commissioner notifies the insurer that the form is disapproved, it is unlawful thereafter for the insurer to issue or use the form. In such notice, the commissioner shall specify the reason for disapproval and state that a hearing will be granted within twenty (20) days after request in writing by the insurer. No such policy, certificate of insurance, notice of proposed insurance, disclosure notices, nor any application, endorsement or rider, shall be issued or used until the expiration of thirty (30) days after it has been so filed, unless the commissioner shall give prior written approval.  (d) The commissioner may, at any time after a hearing, held not less than twenty (20) days after written notice to the insurer, withdraw approval of any such form on any ground set forth in subsection (b) of this section. The written notice of the hearing shall state the reasons for the proposed withdrawal.  (e) It is not lawful for the insurer to issue forms or use them after the effective date of the withdrawal.  (f) If a group policy of consumer credit insurance:  (1) Has been delivered in this state before the effective date of this chapter; or  (2) Has been or will be delivered in another state before or after the effective date of this chapter then the insurer shall be required to file only the group certificate and notice of proposed insurance delivered or issued for delivery in this state as specified in  27-30-6(c) and (e) and such forms shall be approved by the commissioner if they conform with the requirements specified in these subsections and if the schedules of premium rates applicable to the insurance evidenced by such certificate or notice are not in excess of the insurers schedules of premium rates filed with the commissioner; provided, however the premium rate in effect on existing group policies may be continued until the first policy anniversary date following the date this chapter becomes operative as provided in  27-30-12. However, all other forms specified in subsection 27-30-7(a) shall also be filed as specified in this section unless the group policy has been or is delivered in another state which has adopted statutes, regulations or other provisions similar to this statute. In that event, the forms should be filed for informational purposes. However, the insurer shall be prohibited from using any form filed for informational purposes if the commissioner subsequently determines that the form is not in substantive compliance with the requirements of this statute.  (g) Any order or final determination of the commissioner under the provisions of this section shall be subject to judicial review in accordance with chapter 35 of title 42.  History of Section.P.L. 1959, ch. 91,  7; P.L. 2009, ch. 292,  3; P.L. 2009, ch. 293,  3. 
 27-30-8. Premiums and refunds. (a) An insurer may revise its schedules of premium rates from time to time, and shall file the revised schedules with the commissioner. No insurer shall issue any consumer credit insurance policy for which the premium rate exceeds that determined by the schedules of the insurer as then on file with the commissioner. The commissioner shall have the authority to promulgate regulations to assure that the premium rates are reasonable in relation to the benefits provided, including the authority to regulate the compensation component of the premium rates. In determining whether the premium rates are reasonable in relation to the benefits provided, the Commissioner shall consider and provide for: actual and expected loss experience, general and administrative expenses, loss settlement and adjustment expenses, reasonable creditor compensation, investment income, the manner in which premiums are charged, and other acquisition costs, reserves, taxes, regulatory license fees and fund assessments, reasonable insurer profit and other relevant data, consistent with generally accepted actuarial standards.  (b) Each individual policy or group certificate shall provide for a refund in the event of termination of the insurance prior to the scheduled maturity date of the insurance and upon notice to the insurer from the debtor with the debtors contact information. The refund of an amount paid by the debtor for insurance shall be paid or credited promptly to the person entitled thereto; provided, however, that the commissioner shall prescribe a minimum refund and no refund which would be less than such minimum need be made. Refund formulas which any insurer desires to use must develop refunds which are at least as favorable to the debtor as refunds equal to the premium cost of scheduled benefits subsequent to the date of cancellation or termination, computed at the schedule of premium rates in effect on the date of issue. The formula to be used in computing such refund shall be filed with and approved by the commissioner.  (c) If a creditor requires a debtor to make any payment for consumer credit insurance and an individual policy or group certificate of insurance is not issued, the creditor shall immediately give written notice to the debtor and shall promptly make an appropriate credit to the account or issue a refund.  (d) The amount charged to debtor for any consumer credit insurance shall not exceed the premiums charged by the insurer, as computed at the time the charge to the debtor is determined.  History of Section.P.L. 1959, ch. 91,  8; P.L. 2009, ch. 292,  3; P.L. 2009, ch. 293,  3. 
 27-30-9. Issuance of policies. 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.  History of Section.P.L. 1959, ch. 91,  9; P.L. 2009, ch. 292,  3; P.L. 2009, ch. 293,  3. 
 27-31-1  27-31-18. Repealed.
 27-32-1. Separate accounts authorized. (a) Any domestic life insurance company may establish one or more separate accounts, and may allocate to the account or accounts any amounts paid to it which are to be applied under the terms of an individual or group contract or agreement to provide annuity or life insurance benefits, or under the terms of a funding agreement, which contract or agreement or funding agreement may also provide other benefits incidental thereto, payable in fixed or in variable dollar amounts or in both.  (b) Notwithstanding any other provision of law, any domestic life insurance company which establishes one or more separate accounts as provided in this section may provide to the holders of interests in any separate account voting rights with respect to the management of the separate account and the investment of assets in it, may establish for the separate account a committee, board, or other body, the members of which: (1) may be elected solely by holders having voting rights, and (2) may or may not be affiliated with the life insurance company, and may provide for compliance with any applicable state and federal law in order that contracts assigned to separate accounts may be lawfully sold or offered for sale. If and to the extent provided in the applicable agreement, the assets in a separate account shall not be chargeable with liabilities arising out of any other business of the company.  History of Section.P.L. 1966, ch. 161,  1; P.L. 1968, ch. 253,  2; P.L. 1975, ch. 84,  2; P.L. 2001, ch. 247,  3; P.L. 2001, ch. 367,  3. 
 27-32-2. Investments of accounts. The amounts allocated to each account and accumulations on the account may be invested and reinvested in any class of investments that may be authorized in the agreement without regard to any requirements or limitations prescribed by the laws of this state governing the investments of life insurance companies.  History of Section.P.L. 1966, ch. 161,  1. 
 27-32-3. Gains or losses allocated to each account. The income, if any, and gains and losses, realized or unrealized on each account shall be credited to or charged against the amounts allocated to the account in accordance with the agreement, without regard to other income, gains, or losses of the company.  History of Section.P.L. 1966, ch. 161,  1. 
 27-32-4. Valuation of accounts. Assets allocated to a separate account shall be valued at their market value on the date of valuation, or if there is no readily available market, then in accordance with the terms of the applicable written agreement; provided, that the portion of the assets of a separate account at least equal to the companys reserve liability with regard to guaranteed benefits and funds, if any, shall be valued in accordance with the rules applicable to the companys assets.  History of Section.P.L. 1966, ch. 161,  1. 
 27-32-5. Benefits on variable basis. If the agreement provides for the payment of benefits in variable amounts, it shall contain a statement of the essential features of the procedure to be followed by the company in determining the dollar amount of the variable benefits. Any agreement and any certificate issued under it shall state that the dollar amount may decrease or increase and shall contain on its first page a statement that the benefits under it are on a variable basis.  History of Section.P.L. 1966, ch. 161,  1. 
 27-32-6. Prerequisites to delivery of contract  Qualification of company. No domestic life insurance company, and no other life insurance company admitted to transact business in this state, shall be authorized to deliver within this state any agreement providing benefits in variable amounts until the company has satisfied the insurance commissioner that its condition or methods of operation in connection with the issuance of those agreements will not render its operation hazardous to the public or its policyholders in this state. In determining the qualification of a company requesting authority to deliver the contracts within this state, the insurance commissioner shall consider, among other things:  (1) The history and financial condition of the company;  (2) The character, responsibility, and general fitness of the officers and directors of the company; and  (3) In the case of a company other than a domestic company, whether the regulation provided by the jurisdiction of its incorporation provides a degree of protection to policyholders and the public which is substantially equal to that provided by this chapter and the rules and regulations issued pursuant to this chapter.  History of Section.P.L. 1966, ch. 161,  1. 
 27-32-7. Regulation of issuance and sale of agreements  Rules and regulations. Notwithstanding any other provisions of law, the insurance commissioner shall have sole authority to regulate the issuance and sale of the agreements and to issue reasonable rules and regulations necessary to carry out the purposes and provisions of this chapter. Provided, the insurance commissioner shall license any person selling annuities.  History of Section.P.L. 1966, ch. 161,  1; P.L. 1996, ch. 354,  1. 
 27-32-8.1. Individual variable life insurance. Any individual variable life insurance contract delivered or issued for delivery in this state shall contain nonforfeiture provisions appropriate to this type of contract as approved by the director of business regulation.  History of Section.P.L. 1977, ch. 75,  1; P.L. 2002, ch. 292,  60. 
 27-32-8. Application of insurance laws to separate accounts. Except as otherwise provided in this chapter, all pertinent provisions of the insurance laws of this state shall apply to separate accounts and agreements relating to them.  History of Section.P.L. 1966, ch. 161,  1. 
 27-32-9. Severability. If any provision of this chapter or application of it to any person or circumstance is held invalid, this invalidity shall not affect other provisions or applications of the chapter, which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared severable.  History of Section.P.L. 1966, ch. 161,  1. 
 27-33-1. Purposes. The purposes of this chapter are: (1) to make basic property insurance available to qualified applicants who have been unable to secure the insurance in the normal market, and (2) to create a fund to discharge the obligations of the state to the secretary of the Department of Housing and Urban Development, referred to in this chapter as the secretary, under 12 U.S.C.  1749bbb-9, referred to in this chapter as the Act, as and when those obligations shall occur, in order that insurers writing property insurance in this state may not for lack of a fund be rendered ineligible for reinsurance as provided under the Act.  History of Section.P.L. 1969, ch. 211,  1. 
 27-33-10. Basic property insurance defined. Basic property insurance for the purposes of this chapter means fire, extended coverage, vandalism, malicious mischief, broad and special form dwelling coverage commonly referred to as DP-2 and DP-3, and sprinkler leakage insurance. It shall also include homeowners package coverages which include dwelling and tenant forms, as well as the general liability coverages for one (1) to four (4) family owner and nonowner occupied dwellings, either by endorsement or as a stand-alone policy. The FAIR Plan shall be authorized to make rate filings using the standard that rates shall not be excessive, inadequate or unfairly discriminatory, giving due consideration to the past and prospective loss and expense experience for basic property insurance, written in this state, trends in the frequency and severity of losses, the investment income of the FAIR Plan, and such other information as the director of business regulation may require. All rates shall be calculated to be self-supporting consistent with sound actuarial principles. Rates for basic property insurance shall be approved by the department of business regulation, notwithstanding any limits on rate approval authority. Nothing in this section shall be deemed to affect the duty of licensed insurers in the state of Rhode Island to participate, as needed, on a direct basis, in the program pursuant to  27-33-2 and 27-33-11 and any rules and regulations promulgated thereunder, and to pay their proportionate share of losses and expenses incurred by the program upon assessment by the program.  History of Section.P.L. 1971, ch. 271,  1; P.L. 1972, ch. 165,  1; P.L. 1981, ch. 83,  1; P.L. 2003, ch. 335,  1; P.L. 2003, ch. 357,  1; P.L. 2006, ch. 158,  1; P.L. 2006, ch. 204,  1. 
 27-33-11. Rules and regulations. The director of business regulation may issue rules, regulations, and orders necessary to carry out the purposes of this chapter. The director is specifically empowered to require that basic property insurance as defined in  27-33-10 and any other insurance that may be required or suggested by the federal insurance administrator for inclusion be made available under the FAIR plan. Any regulation requiring coverage described in this section, which has been promulgated by the insurance commissioner, is ratified and confirmed.  History of Section.P.L. 1971, ch. 271,  1; P.L. 1998, ch. 441,  23. 
 27-33-2. Participation. Each domestic insurer and all insurers licensed to write those classes of insurance listed in  27-8-1 and 27-8-3 in the state, on a direct basis, shall participate in the basic property insurance and placement program established in this state in furtherance of 12 U.S.C.  1749bbb et seq., commonly known as the FAIR (Fair Access to Insurance Requirements) plan. Failure to comply with this provision may be grounds for revocation, suspension, or nonrenewal of any license.  History of Section.P.L. 1969, ch. 211,  1. 
 27-33-3. Inspection and statements. There shall be no liability on the part of, and no cause of action of any nature shall arise against insurers, any inspection bureau, placement facility, or underwriting association, or their directors, agents, or employees, or the director of business regulation or his or her authorized representatives, for any inspections undertaken or statements made by any of them concerning the property to be insured, and any reports and communications in connection with any inspections or statements shall not be considered public documents.  History of Section.P.L. 1969, ch. 211,  1. 
 27-33-4. Creation of fund. There is created a fund to be known as the federal riot reinsurance reimbursement fund, referred to in this chapter as the fund, which shall be operated under the joint control of the general treasurer and the director of business regulation. The fund shall consist of all of the payments made to the fund by insurers in accordance with the provisions of this chapter. The tax administrator shall have the same power to enforce the collection of the assessments provided under this chapter as any other obligations due the state.  History of Section.P.L. 1969, ch. 211,  1. 
 27-33-5. Reimbursement of the secretary. 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.  History of Section.P.L. 1969, ch. 211,  1. 
 27-33-6. Post assessment funding. Whenever the secretary shall, in accordance with the Act, present to the state a request for reimbursement under the Act, the fund shall immediately assess all insurers that, during the calendar year with respect to which reimbursement is requested by the secretary, were chartered or licensed or engaged in writing those classes of insurance listed in  27-8-1 and 27-8-3. The amount of each insurers assessment shall be calculated by multiplying the amount of the reimbursement requested by the secretary by a fraction the numerator of which is the insurers premiums actually written in this state in that calendar year and the denominator of which is the aggregate of the written premiums for all insurers. Insurers may add to the premiums applicable to the lines on which the assessment is levied, an amount to be approved by the insurance commissioner, sufficient to recover within not more than three (3) years any amounts assessed under this section during the preceding calendar year together with the amount of costs and expenses reasonably attributable to the assessments and recovery of them.  History of Section.P.L. 1969, ch. 211,  1. 
 27-33-7. Authorization of payment. The fund shall reimburse the secretary, up to amounts actually collected by it, upon drafts or vouchers duly authorized by the general treasurer with the approval of the director of business regulation.  History of Section.P.L. 1969, ch. 211,  1. 
 27-33-8. Insolvency. In the event any insurer fails, by reason of insolvency, to pay any assessment, the fund shall cause the reimbursement ratios, computed under  27-33-6, to be immediately recalculated, excluding from them the insolvent insurer, so that its assessment is in effect, assumed and redistributed among the remaining insurers.  History of Section.P.L. 1969, ch. 211,  1. 
 27-33-9. Alternate preassessment funding. In the event of a determination by the secretary that the provisions of this chapter are not sufficient to meet the requirements of 12 U.S.C.  1749bbb-9, the fund shall, with respect to the calendar year in which the determination is made and for each calendar year after that, assess premiums written in this state an amount equal to the maximum for which the fund would be liable to the secretary for that calendar year. As soon as practicable after the close of a calendar year, the fund shall, in accordance with the formula provided in  27-33-6, calculate the actual liability for reimbursement to the secretary for that calendar year. The difference between the actual liability calculated and the amount previously assessed and paid with respect to that calendar year under this section shall be credited by the fund toward any assessment for any subsequent calendar year.  History of Section.P.L. 1969, ch. 211,  1. 
 27-34.1-1  27-34.1-20. Repealed.
 27-34.2-1. Purpose. The purpose of this chapter is to promote the public interest, to promote the availability of long term care insurance policies, to protect applicants for long term care insurance, as defined, from unfair or deceptive sales or enrollment practices, to establish standards for long term care insurance, to facilitate public understanding and comparison of long term care insurance policies, and to facilitate flexibility and innovation in the development of long term care insurance coverage.  History of Section.P.L. 1988, ch. 201,  1; P.L. 2007, ch. 239,  1. 
 27-34.2-10. Enforcement and penalties. (a)(1) If the director for any reason has cause to believe that any violation of this chapter has occurred or is threatened, the director may give notice to any persons who appear to be involved in the suspected violation to arrange a conference with the alleged violators or their authorized representatives for the purposes of attempting to ascertain the facts relating to the suspected violation, and, in the event it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing the violations;  (2) Proceedings under this subsection are to be governed by chapter 35 of title 42.  (b)(1) The director may issue an order directing any persons to cease and desist from engaging in any act or practice in violation of the provisions of this chapter;  (2) Within thirty (30) days after service of the order to cease and desist, the respondent may request a hearing on the question of whether acts or practices in violation of this chapter have occurred. The hearings shall be conducted pursuant to  42-35-9  42-35-13 and judicial review shall be available as provided by  42-35-15 and 42-35-16.  (c) The director may, upon a finding that provisions of this chapter have been violated, levy an administrative penalty in an amount not less than five hundred dollars ($500) nor more than fifty thousand dollars ($50,000), if reasonable notice in writing is given of the intent to levy the penalty and the persons alleged to have violated this chapter have a reasonable time in which to remedy the defect in its operations which gave rise to the penalty citation.  History of Section.P.L. 1988, ch. 201,  1. 
 27-34.2-11. Repealed.
 27-34.2-12. Unintentional policy lapse. (a) Each insurer offering long term care insurance shall, as a protection against unintentional lapse comply with the following:  (1)(i) No individual long term care policy or certificate shall be issued until the insurer has received from the applicant either: a written designation of at least one person, in addition to the applicant, who is to receive notice of lapse or termination of the policy or certificate for nonpayment of premium, or a written waiver dated and signed by the applicant electing not to designate additional persons to receive notice. The applicant has the right to designate at least one person who is to receive the notice of termination, in addition to the insured. Designation shall not constitute acceptance of any liability on the third party for services provided to the insured. The form used for the written designation must provide space clearly designated for listing at least one person. The designation shall include each persons full name and home address. In the case of an applicant who elects not to designate an additional person, the waiver shall state: Protection against unintended lapse. I understand that I have the right to designate at least one person other than myself to receive notice of lapse or termination of this long term care insurance policy for nonpayment of premium. I understand that notice will not be given until thirty (30) days after premium is due and unpaid. I elect NOT to designate any person to receive such notice.  (ii) The insurer shall notify the insured of the right to change this written designation, no less than once every two (2) years;  (2) When the policyholder or certificate holder pays a premium for a long term care insurance policy or certificate through a payroll or pension deduction plan, the requirements continued in subsection (1)(i) need not be met until sixty (60) days after the policyholder or certificate holder is no longer on the payment plan. The application or enrollment form for those policies or certificates shall clearly indicate the payment plan selected by the applicant;  (3) No individual long term care policy or certificate shall lapse or be terminated for nonpayment of premium unless the insurer, at least thirty (30) days before the effective date of the lapse or termination, has given notice to the insured and to those persons designated pursuant to subdivision (1) of this section at the address provided by the insured for purposes of receiving notice of lapse or termination. Notice shall be given by first class United States mail, postage prepaid; and notice may not be given until thirty (30) days after a premium is due and unpaid. Notice shall be deemed to have been given as of five (5) days after the date of mailing.  (b) Reinstatement. In addition to the requirement in subsection (a), a long-term care insurance policy or certificate shall include a provision that provides for reinstatement of coverage, in the event of lapse if the insurer is provided proof that the policyholder or certificate holder was cognitively impaired or had a loss of functional capacity before the grace period contained in the policy expired. This option shall be available to the insured if requested within five (5) months after termination and shall allow for the collection of past due premium, where appropriate. The standard of proof of cognitive impairment or loss of functional capacity shall not be more stringent than the benefit eligibility criteria on cognitive impairment or the loss of functional capacity contained in the policy and certificate.  History of Section.P.L. 1993, ch. 443,  2; P.L. 1993, ch. 457,  2; G.L. 1956,  27-34.2-13; P.L. 2007, ch. 239,  1. 
 27-34.2-13. Requirement to offer inflation protection. (a) No insurer may offer a long term care insurance policy unless the insurer also offers to the policyholder in addition to any other inflation protection the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations which are meaningful to account for reasonably anticipated increases in the costs of long term care services covered by the policy. Insurers must offer to each policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than one of the following:  (1) Increase benefit levels annually in a manner so that the increases are compounded annually at a rate not less than five percent (5%);  (2) Guarantees the insured individual the right to periodically increase benefit levels without providing evidence of insurability or health status so long as the option for the previous period has not been declined. The amount of the additional benefit shall be no less than the benefit compounded annually at a rate of at least five percent (5%) for the first period beginning with the purchase of the existing benefit and extending until the year in which the offer is made; or  (3) Covers a specified percentage of actual or reasonable charges and does not include a maximum specified indemnity amount or limit.  (b) Where the policy issued is to a group, the required offer in subsection (a) of this section shall be made to the group policyholder, except, if the policy is issued to a group defined in  27-34.2-4(4) other than to a continuing care retirement community, the offering shall be made to each proposed certificate holder.  (c) The offer in subsection (a) of this section shall not be required of life insurance policies or riders containing long term care benefits.  (d) Insurers shall include the following information in or with the outline of coverage:  (1) A graphic comparison of the benefit levels of a policy that increases benefits over the policy period with a policy that does not increase benefits. The graphic comparison shall show benefit levels over at least a twenty (20) year period; and  (2)(i) Any expected premium increases or additional premiums to pay for automatic or optional benefit increases;  (ii) An insurer may use a reasonable hypothetical, or a graphic demonstration, for the purposes of this disclosure.  (e) Inflation protection benefit increases under a policy which contains those benefits shall continue without regard to an insureds age, claim status, or claim history, or the length of time the person has been insured under the policy.  (f) An offer of inflation protection which provides for automatic benefit increases shall include an offer of a premium which the insurer expects to remain constant. The offer shall disclose in a conspicuous manner that the premium may change in the future unless the premium is guaranteed to remain constant.  (g)(1) Inflation protection as provided in subdivision (a)(1) of this section shall be included in a long term care insurance policy unless the policyholder chooses another type of inflation protection or the insurer obtains a rejection of inflation protection signed by the policyholder as required in this subsection. The signed rejection may be on the application or a separate form;  (2) The rejection shall be considered a part of the application and shall state:    I have reviewed the outline of coverage and the graphs that compare the benefits and premiums of this policy with and without inflation protection. Specifically, I have reviewed Plans..... , and I reject inflation protection.   History of Section.P.L. 1993, ch. 443,  2; P.L. 1993, ch. 457,  2; G.L. 1956,  27-34.2-14. 
 27-34.2-14. Standards for marketing. (a) Every insurer, healthcare services plan, or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall:  (1) Establish marketing procedures to assure that any comparison of policies by its agents or other insurance producers and agent training requirements will be fair and accurate;  (2) Establish marketing procedures to assure excessive insurance is not sold or issued;  (3) Display prominently by type, stamp or other appropriate means, on the first page of the outline of coverage and policy the following:  (3) Notice to buyer: This policy may not cover all of the costs associated with long-term care incurred by the buyer during the period of coverage. The buyer is advised to carefully review all policy limitations.  (4) Inquire and make every reasonable effort to identify whether a prospective applicant or enrollee for long-term care insurance already has long-term care insurance and the types and amounts of any insurance; and  (5) Every insurer or entity marketing long-term care insurance shall establish auditable procedures for verifying compliance with this subsection.  (6) If the state in which the policy or certificate is to be delivered or issued for delivery has a senior insurance counseling program approved by the commissioner, the insurer shall, at solicitation, provide written notice to the prospective policyholder and certificateholder that the program is available and the name, address and telephone number of the program.  (7) For long-term care health insurance policies and certificates, use the terms noncancellable or level premium only when the policy or certificate provides that the insured has the right to continue the long-term care insurance in force by the timely payment of premiums during which period the insurer has no right to unilaterally make any change in any provision of the insurance or in the premium rate.  (8) Provide an explanation of contingent benefit upon lapse and, if applicable, the additional contingent benefit upon lapse provided to policies with fixed or limited premium paying periods.  (b) In addition to the practices prohibited in chapter 29 of this title, the following acts and practices are prohibited:  (1) Twisting. Knowingly making any misleading representation or incomplete or fraudulent comparison of 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 with another insurer;  (2) High pressure tactics. Employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance; and  (3) Cold lead advertising. Making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance producer or insurance company.  (4) Misrepresentation of a material fact when selling or offering to sell a long-term care insurance policy.  (c) With respect to the obligations set forth in this section, the primary responsibility of an association as described in  27-34.2-4(4)(ii), when endorsing or selling long-term care insurance shall be to educate its members concerning long-term care issued in general so that its members can make informed decisions. Associations shall provide objective information regarding long-term care insurance policies or certificates endorsed or sold by those associations to ensure that members of the associations are fully informed of the benefits and limitations in the policies or certificates that are being endorsed or sold.  (d) The insurer shall file with the insurance department the following material:  (1) The policy and certificate;  (2) A corresponding outline of coverage; and  (3) All advertisements requested by the insurance department.  (e) The association shall disclose in any long-term care insurance solicitation:  (1) The specific nature and amount of the compensation arrangements, including all fees, commissions, administrative fees and other forms of financial support, that the association receives from endorsement or sale of the policy or certificate to its members; and  (2) A brief description or outline of the process under which the policies and the insurer issuing the policies were selected.  (f) If the association and the insurer have interlocking directories or trustee arrangements, the association shall disclose that fact to its members.  (g) The board of directors of associations selling or endorsing long-term care insurance policies or certificates shall review and approve the insurance policies as well as the compensation arrangements made with the insurer.  (h) The association shall also:  (1) At the time of the associations decision to endorse, engage the services of a person with expertise in long-term care insurance not affiliated with the insurer to conduct an examination of the policies, including benefits, features, and rates and update the examination thereafter in the event of material change.  (2) Actively monitor the marketing efforts of the insurer and its insurance producers; and  (3) Review and approve all marketing materials or other insurance communications used to promote sales or sent to members regarding the policies or certificates.  (4) Subdivisions (h)(1), (h)(2) and (h)(3) shall not apply to qualified long-term care insurance contracts.  (i) No group long-term care insurance policy or certificate may be issued to an association unless the insurer files with the director the information required in this section.  (j) The insurer shall not issue a long-term care policy or certificate to an association or continue to market the policy or certificate unless the insurer certifies annually that the association has complied with the requirements set forth in this section.  History of Section.P.L. 1993, ch. 443,  2; P.L. 1993, ch. 457,  2; G.L. 1956,  27-34.2-15; P.L. 2007, ch. 239,  1; P.L. 2013, ch. 18,  1; P.L. 2013, ch. 21,  1. 
 27-34.2-15. Requirement to deliver shoppers guide. (a) A long term care insurance shoppers guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the director, shall be provided to all prospective applicants of a long term care insurance policy or certificate.  (b) In the case of insurance producer solicitations, an insurance producer must deliver the shoppers guide prior to the presentation of an application or enrollment form.  (c) In the case of direct response solicitations, the shoppers guide must be presented in conjunction with any application or enrollment form.  (d) Life insurance policies or riders containing accelerated long term care benefits are not required to furnish the shoppers guide, but shall furnish the required policy summary.  History of Section.P.L. 1993, ch. 443,  2; P.L. 1993, ch. 457,  2; G.L. 1956,  27-34.2-16. 
 27-34.2-16. Authority to promulgate regulations. The director shall issue reasonable regulations to promote premium adequacy and to protect the policymaker in the event of substantial rate increases, and to establish minimum standards for producer education, marketing practices, producer compensation, producer testing, penalties and reporting practices for long-term care insurance.  History of Section.P.L. 1993, ch. 443,  2; P.L. 1993, ch. 457,  2; G.L. 1956,  27-34.2-17; P.L. 2007, ch. 239,  1. 
 27-34.2-17. Repealed.
 27-34.2-18. Pre-certification for Medicaid protection of resources. The department of business regulation shall pre-certify long term care insurance policies which meet all other applicable requirements imposed by this chapter and which:  (1) Offer the option of home and community based services in addition to nursing home care;  (2) In all home care plans, include case management services which services shall include, but need not be limited to, the development of a comprehensive individualized assessment and care plan and, as needed, the coordination of appropriate services and the monitoring of the delivery of those services;  (3) Provide inflation protection;  (4) Provide for the keeping of records and an explanation of benefit reports on insurance payments which count toward Medicaid resource exclusion; and  (5) Provide the management information and reports necessary to document the extent of Medicaid resources protection offered and to evaluate the Rhode Island partnership for long term care. No policy shall be precertified if it requires prior hospitalization or a prior stay in a nursing home as a condition of providing benefits. The department of business regulation may adopt regulations to carry out the precertification provisions of this section.  History of Section.P.L. 1993, ch. 454,  2; G.L. 1956,  27-34.2-19. 
 27-34.2-19. Nonforfeiture benefits. (a) Except as provided in subsection (b), a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificateholder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. In the event the policyholder or certificateholder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period of time following a substantial increase in premium rates.  (b) When a group long-term care insurance policy is issued, the offer required in subsection (a) shall be made to the group policyholder. However, if the policy is issued as group long-term care insurance as defined in subdivision 27-34.2-4(4)(v), other than to a continuing care retirement community or other similar entity, the offering shall be made to each proposed certificateholder.  (c) The commissioner shall promulgate regulations specifying the type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding contingent benefit upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse as described in subsection 1.  History of Section.P.L. 1997, ch. 153,  2; P.L. 1997, ch. 161,  2; G.L. 1956,  27-34.2-20; P.L. 2007, ch. 239,  1. 
 27-34.2-2. Scope. Long term care insurance is deemed to be accident and health insurance and is classified as such for the purposes of chapter 34.1 of this title, the Rhode Island Life and Health Insurance Guaranty Association Act. The requirements of this chapter apply to policies delivered or issued for delivery in this state, except as provided in  27-34.2-5. This chapter is not intended to supercede the obligations of entities subject to this chapter to comply with the substance of other applicable insurance laws insofar as they do not conflict with this chapter. The benefits required for long term care insurance shall only be the benefits specified in this chapter and in regulations promulgated under  27-34.2-16.  History of Section.P.L. 1988, ch. 201,  1; P.L. 1993, ch. 443,  1; P.L. 1993, ch. 457,  1; P.L. 2002, ch. 292,  78; P.L. 2008, ch. 18,  1; P.L. 2008, ch. 22,  1. 
 27-34.2-20. Severability. If any provision of this chapter or the application of any provision to any person or circumstances is for any reason held to be invalid, the remainder of the chapter and the application of the provision to other persons or circumstances shall not be affected by that invalidity.  History of Section.P.L. 1988, ch. 201,  1; G.L. 1956,  27-34.2-11. 
 27-34.2-21. Producer training requirements. (a) On or after January 1, 2008, an individual may not sell, solicit or negotiate long-term care insurance unless the individual is licensed as an insurance producer for accident and health or sickness or life and has completed a one-time training course. The training shall meet the requirements set forth in this section.  (b) An individual already licensed and selling, soliciting or negotiating long-term care insurance on July 3, 2007 may not continue to sell, solicit or negotiate long-term care insurance unless the individual has completed a one-time training course as set forth in the section, within one year from July 3, 2007.  (c) In addition to the one-time training course required in this section, an individual who sells, solicits or negotiates long-term care insurance shall complete ongoing training as set forth in this section.  (d) The training requirements of this section may be approved as continuing education courses.  (e) The one-time training required by this section shall be no less than eight (8) hours and the ongoing training required by this section shall be no less than four (4) hours every twenty-four (24) months.  (f) The training required under paragraph (a) shall consist of topics related to long-term care insurance, long-term care services and, if applicable, qualified state long-term care insurance. Partnership programs, including, but not limited to:  (1) State and federal regulations and requirements and the relationship between qualified state long-term care insurance partnership programs and other public and private coverage of long-term services, including Medicaid;  (2) Available long-term care services and providers;  (3) Changes or improvements in long-term care services or providers;  (4) Alternatives to the purchase of private long-term care insurance;  (5) The effect of inflation on benefits and the importance of inflation protection; and  (6) Consumer suitability standards and guidelines.  (g) The training required by this section shall not include training that is insurer or company product specific or that includes any sales or marketing information, materials, or training, other than those required by state or federal law.  (h) Insurers subject to this act shall obtain verification that a producer receives training required by this section before a producer is permitted to sell, solicit or negotiate the insurers long-term care insurance products, maintain records subject to the states record retention requirements, and make that verification available to the commissioner upon request.  (i) Insurers subject to this act shall maintain records with respect to the training of its producers concerning the distribution of its partnership policies that will allow the state insurance department to provide assurance to the state Medicaid agency that producers have received the training contained in this section and that producers have demonstrated an understanding of the partnership policies and their relationship to public and private coverage of long-term care, including Medicaid, in this state. These records shall be maintained in accordance with the states record retention requirements and shall be made available to the commissioner upon request.  (j) The satisfaction of these training requirements in any state shall be deemed to satisfy the training requirements in this state.  History of Section.P.L. 2007, ch. 239,  2; P.L. 2008, ch. 475,  91. 
 27-34.2-22. Discretionary clauses. (a) No new or existing policy or certificate may contain any provision:  (1) Purporting to reserve sole discretion to the insurance company to determine eligibility for benefits or interpret the terms of a policy or certificate; or  (2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.  (b) Any such clause or language included in a contract, policy or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.  (c) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.  History of Section.P.L. 2013, ch. 85,  6; P.L. 2013, ch. 94,  6. 
 27-34.2-3. Short title. This chapter may be known and cited as the Long Term Care Insurance Act. History of Section.P.L. 1988, ch. 201,  1. 
 27-34.2-4. Definitions. Unless the context requires otherwise, the following definitions apply throughout the chapter:  (1) Applicant means:  (i) In the case of an individual long term care insurance policy, the person who seeks to contract for benefits; and  (ii) In the case of a group long term care insurance policy, the proposed certificate holder;  (2) Certificate means, for the purposes of this chapter, any certificate issued under a group long term care insurance policy, which policy has been delivered or issued for delivery in this state, except as provided for in  27-34.2-5;  (3) Director means the director of business regulation;  (4) Group long term care insurance means a long term care insurance policy which is delivered or issued for delivery in this state and issued to:  (i) One or more employers or labor organizations, or to a trust, or to the trustees of a fund established by one or more employers or labor organizations, or a combination of employers and labor organizations, for employees or former employees or a combination of employees and former employees, or for members or former members, or a combination of members and former members, of the labor organizations; or  (ii) Any professional, trade, or occupational association for its members or former or retired members, or combination of members and former members, if that association:  (A) Is composed of individuals all of whom are or were actively engaged in the same profession, trade, or occupation; and  (B) Has been maintained in good faith for purposes other than obtaining insurance; or  (iii) An association, a trust, or the trustee(s) of a fund established, created, or maintained for the benefit of members of one or more associations. Prior to advertising, marketing, or offering that policy within this state, the association or associations, or the insurer of the association or associations, shall file evidence with the director that the association or associations have at the outset a minimum of one hundred (100) persons and have been organized and maintained in good faith for purposes other than that of obtaining insurance, have been in active existence for at least one year, and have a constitution and bylaws which provide that:  (A) The association or associations hold regular meetings not less than annually to further purposes of the members;  (B) Except for credit unions, the association or associations collect dues or solicit contributions from members; and  (C) The members have voting privileges and representation on the governing board and committees;  (iv) Thirty (30) days after that filing the association or associations will be deemed to satisfy those organizational requirements, unless the director makes a finding that the association or associations do not satisfy those organizational requirements; or  (v) A group other than as described in paragraphs (i), (ii) and (iii) of this subdivision, subject to a finding by the director that:  (A) The issuance of the group policy is not contrary to the best interest of the public;  (B) The issuance of the group policy would result in economies of acquisition or administration; and  (C) The benefits are reasonable in relation to the premiums charged;  (5) Issuer means any domestic or foreign insurance company as defined in this title of these general laws or any other entity legally authorized to issue or deliver long term care insurance contracts pursuant to the provisions of this chapter.  (6)(i) Long term care insurance means any insurance policy or rider advertised, marketed, offered, or designed to provide coverage for not less than twelve (12) consecutive months for each covered person on an expense incurred, indemnity, prepaid, or other basis, for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital. This term includes group and individual annuities and life insurance policies or riders which provide directly or which supplement long term care insurance. This term also includes a policy or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity. Long term care insurance may be issued by insurers, fraternal benefit societies, nonprofit health, hospital, and medical service corporations, prepaid health plans, health maintenance organizations, or any similar organization to the extent that they are authorized to issue life or health insurance. Long term care insurance shall not include any insurance policy which was offered primarily to provide basic Medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident only coverage, specified disease or specified accident coverage, or limited benefit health coverage. This list of excluded coverages is illustrative and is not intended to be all inclusive;  (ii) With regard to life insurance, this term does not include life insurance policies which accelerate the death benefit specifically for one or more of the qualifying events of terminal illness, medical conditions requiring extraordinary medical intervention, or permanent institutional confinement, and which provide the option of a lump sum payment for those benefits and in which neither the benefits nor the eligibility for the benefits is conditioned upon the receipt of long term care. Notwithstanding any other provision contained in this chapter, any product advertised, marketed, or offered as long term care insurance shall be subject to the provisions of this chapter;  (7) Policy means, for the purposes of this chapter, any policy, contract, subscriber agreement, rider, or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit health, hospital, or medical service corporation, prepaid health plan, health maintenance organization, or any similar organization.  (8)(i) Qualified long-term care insurance contract or federally tax-qualified long-term care insurance contract means an individual or group insurance contract that meets the requirements of  7702B(b) of the Internal Revenue Code of 1986, as amended, et seq., as follows:  (A) The only insurance protection provided under the contract is coverage of qualified long-term care services. A contract shall not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate;  (B) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act (Medicare), as amended, or would be so reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subparagraph do not apply to expenses that are reimbursable under Title XVIII of the Social Security Act only as a secondary payor. A contract shall not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate;  (C) The contract is guaranteed renewable, within the meaning of  7702B(b)(1)(C) of the Internal Revenue Code of 1986, as amended, et seq.;  (D) The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subdivision 27-34.2-4(8)(i)(E);  (E) All refunds of premiums, and all policyholder dividends or similar amounts, under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract; and  (F) The contract meets the consumer protection provisions set forth in  7702B(g) of the Internal Revenue Code of 1986, as amended, et seq.  (ii) Qualified long-term care insurance contract or federally tax-qualified long term care insurance contract also means the portion of a life insurance contract that provides long-term care insurance coverage by rider or as part of the contract and that satisfied the requirements of  7702(B)(b) and (e) of the Internal Revenue Code of 1986, as amended, et seq.  History of Section.P.L. 1988, ch. 201,  1; P.L. 1990, ch. 205,  1; P.L. 1993, ch. 443,  1; P.L. 1993, ch. 457,  1; P.L. 1997, ch. 153,  1; P.L. 1997, ch. 161,  1; P.L. 2007, ch. 239,  1. 
 27-34.2-5. Extraterritorial jurisdiction  Group long term care insurance. No group long term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in  27-34.2-4(4)(v), unless this state or another state having statutory and regulatory long term care insurance requirements substantially similar to those adopted in this state has made a determination that those requirements have been met.  History of Section.P.L. 1988, ch. 201,  1. 
 27-34.2-6. Disclosure and performance standards for long-term-care insurance. (a) The director may adopt regulations that establish:  (1) Standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term-care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions of terms; and  (2) Reasonable rules and regulations that are necessary, proper, or advisable to the administration of this chapter including the procedure for the filing or submission of policies subject to this chapter. This provision may not abridge any other authority granted the director by law.  (b) No long-term-care insurance policy may:  (1) Be cancelled, nonrenewed, or terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; or  (2) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; or  (3) Provide coverage for skilled nursing care only or provide more coverage for skilled care in a facility than coverage for lower levels of care.  (c) A long-term-care policy must provide:  (1) Home healthcare benefits that are at least fifty percent (50%) of those provided for care in a nursing facility. The evaluation of the amount of coverage shall be based on aggregate days of care covered for home health care when compared to days of care covered for nursing home care; and  (2) Home healthcare benefits that meet the National Association of Insurance Commissioners minimum standards for home healthcare benefits in long-term-care insurance policies.  (d)(1) No long-term-care insurance policy or certificate other than a policy or certificate issued to a group as defined in  27-34.2-4(4)(i) shall use a definition of preexisting condition which is more restrictive than the following: preexisting condition means a condition for which medical advice or treatment was recommended by, or received from a provider of healthcare services, within six (6) months preceding the effective date of coverage of an insured person;  (2) No long-term-care insurance policy or certificate other than a policy or certificate issued to a group as defined in  27-34.2-4(4)(i) may exclude coverage for a loss or confinement that is the result of a preexisting condition, unless the loss or confinement begins within six (6) months following the effective date of coverage of an insured person;  (3) The director may extend the limitation periods set forth in subsections (d)(1) and (d)(2) of this section as to specific age group categories in specific policy forms upon findings that the extension is in the best interest of the public;  (4) The definition of preexisting condition does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurers established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subsection (d)(2) of this section expires. No long-term-care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subsection (d)(2) of this section, unless the waiver or rider has been specifically approved by the director as set forth in  27-34.2-8. This shall not permit exclusion or limitation of benefits on the basis of Alzheimers disease, other dementias, or organic brain disorders.  (e)(1) No long-term-care insurance policy may be delivered or issued for delivery in this state if the policy:  (i) Conditions eligibility for any benefits on a prior hospitalization or institutionalization requirement;  (ii) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or  (iii) Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care, or recuperative benefits on a prior institutionalization requirement.  (2) A long-term-care insurance policy or rider shall not condition eligibility for non-institutional benefits on the prior or continuing receipt of skilled care services.  (3) No long-term insurance policy or rider that provides benefits only following institutionalization shall condition such benefits upon admission to a facility for the same or related conditions within a period of less than thirty (30) days after discharge from the institution.  (f) The commissioner may adopt regulations establishing loss ratio standards for long-term-care insurance policies provided that a specific reference to long-term-care insurance policies is contained in the regulation.  (g)(1) Long-term-care insurance applicants shall have the right to return the policy, certificate, or rider to the company or an agent/insurance producer of the company within thirty (30) 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) Long-term-care 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. This requirement shall not apply to certificates issued pursuant to a policy issued to a group defined in  27-34.2-4. The following free look statement or language substantially similar shall be included:  You have thirty (30) 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 administration office. Or you may return it to the agent/insurance producer that you bought it from. You must return it within thirty (30) 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 returned policy, certificate, or rider will be void as if it had never been issued.  (h)(1) An outline of coverage shall be delivered to a prospective applicant for long-term-care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpose;  (2) The commissioner shall prescribe a standard format, including style, arrangement, and overall appearance, and the content of an outline of coverage;  (3) In the case of insurance producer solicitations, an insurance producer must deliver the outline of coverage prior to the presentation of an application or enrollment form;  (4) In the case of direct response solicitations, the outline of coverage must be presented in conjunction with any application or enrollment form;  (5) In the case of a policy issued to a group defined in  27-34.2-4(4)(i), an outline of coverage shall not be required to be delivered, provided that the information described in subsections (h)(6)(i)  (h)(6)(vi) of this section is contained in other materials relating to enrollment. Upon request, these other materials shall be made available to the commissioner;  (6) The outline of coverage shall include:  (i) A description of the principal benefits and coverage provided in the policy;  (ii) A description of the eligibility triggers for benefits and how those triggers are met;  (iii) A statement of the principal exclusions, reductions, and limitations contained in the policy;  (iv) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premiums. Continuation or conversion provisions of group coverage shall be specifically described;  (v) A statement that the outline of coverage is only a summary, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions;  (vi) A description of the terms under which the policy or certificate may be returned and the premium refunded;  (vii) A brief description of the relationship of cost of care and benefits; and  (viii) A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term-care insurance contract under  7702B(b) of the Internal Revenue Code of 1986, as amended, et seq.  (i) A certificate issued pursuant to a group long-term-care insurance policy which policy is delivered or issued for delivery in this state shall include:  (1) A description of the principal benefits and coverage provided in the policy;  (2) A statement of the principal exclusions, reductions, and limitations contained in the policy; and  (3) A statement that the group master policy determines governing contractual provisions.  (j) If an application for a long-term-care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant no later than thirty (30) days after the date of approval.  (k) At the time of policy delivery, a policy summary shall be delivered for an individual life insurance or annuity policy that provides long-term-care benefits within the policy or by rider. In the case of direct response solicitations, the insurer shall deliver the policy summary upon the applicants request, but regardless of request shall make the delivery no later than at the time of policy delivery. In addition to complying with all applicable requirements, the summary shall also include:  (1) An explanation of how the long-term-care benefit interacts with other components of the policy;  (2) An illustration of the amount of benefits, the length of benefits, and the guaranteed lifetime benefits, including a statement that any long-term-care inflation projection option required by  27-34.2-13, is not available under the policy for each covered person;  (3) Any exclusions, reductions, and limitations on long-term-care benefits;  (4) A statement that any long-term-care inflation protection option required by 230-RICR-20-35-1 is not available under this policy. If inflation protection was not required to be offered, or if inflation protection was required to be offered but was rejected, a statement that inflation protection is not available under this policy that provides long-term-care benefits, and an explanation of other options available under the policy, if any, to increase the funds available to pay for the long-term-care benefits.  (5) If applicable to the policy type, the summary shall also include:  (i) A disclosure of the effects of exercising other rights under the policy;  (ii) A disclosure of guarantees, fees or other costs related to long-term-care costs of insurance charges in the base policy and any riders; and  (iii) Current and projected periodic and maximum lifetime benefits.  (6) The provisions of the policy summary listed above may be incorporated into a basic illustration or into the life insurance policy summary that is required to be delivered in accordance with chapter 4 of this title and the rules and regulations promulgated under  27-4-23.  (l) Any time a long-term benefit, funded through a life insurance vehicle by the acceleration of the death benefit, is in benefit payment status, a monthly report shall be provided to the policyholder. The report shall include:  (1) Any long-term-care benefits paid out during the month;  (2) Any costs or changes that apply or will apply to the policy or any riders;  (3) An explanation of any changes in the policy, e.g., death benefits or cash values, due to long-term-care benefits being paid out; and  (4) The amount of long-term-care benefits existing or remaining.  (m) Any policy or rider advertised, marketed, or offered as long-term-care or nursing home insurance shall comply with the provisions of this chapter.  (n) If a claim under a long-term-care insurance contract is denied, the issuer shall, within sixty (60) days of the date of a written request by the policyholder or certificate holder, or a representative thereof:  (1) Provide a written explanation of the reasons for the denial; and  (2) Make available all information directly related to the denial.  (o) Any policy, certificate, or rider advertised, marketed or offered as long-term care or nursing home insurance, as defined in  27-34.2-4, shall comply with the provisions of this chapter.  History of Section.P.L. 1988, ch. 201,  1; P.L. 1989, ch. 542,  82; P.L. 1990, ch. 205,  1; P.L. 1992, ch. 182,  1; P.L. 1993, ch. 443,  1; P.L. 1993, ch. 457,  1; P.L. 2007, ch. 239,  1; P.L. 2022, ch. 404,  5, effective June 30, 2022; P.L. 2022, ch. 405,  5, effective June 30, 2022. 
 27-34.2-7.1. Incontestability period. (a) For a policy or certificate that has been in force for less than six (6) months an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage.  (b) For a policy or certificate that has been in force for at least six (6) months, but less than two (2) years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought.  (c) After a policy or certificate has been in force for two (2) years it is not contestable upon the grounds of misrepresentation alone; the policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insureds health.  (d) A long-term care insurance policy or certificate may be field issued if the compensation to the field issuer is not based on the number of policies or certificates issued. For the purposes of this section, field issued means a policy or certificate issued by a producer or a third-party administrator pursuant to the underwriting authority granted to the producer or third-party administrator by an insurer and using the insurers underwriting guidelines.  (e) If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.  (f) In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by chapter 4 of this title. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.  History of Section.P.L. 2007, ch. 239,  2. 
 27-34.2-7. Repealed.
 27-34.2-8. Discretionary powers of director. The director may upon written request issue an order to modify or suspend a specific provision or provisions of regulations adopted pursuant to this chapter, and may upon written request permit the use of waivers or riders, with respect to a specific long term care insurance policy or certificate upon a written finding that:  (1) The modification or suspension would be in the best interest of the insureds;  (2) The purposes to be achieved could not be effectively or efficiently achieved without the modification or suspension; and  (3)(i) The modification or suspension is necessary to the development of an innovative and reasonable approach for insuring long term care;  (ii) The policy or certificate is to be issued to residents of a life care or continuing care retirement community or some other residential community for the elderly and the modification or suspension is reasonably related to the special needs or nature of the community; or  (iii) The modification or suspension is necessary to permit long term care insurance to be sold as part of, or in conjunction with, another insurance product.  History of Section.P.L. 1988, ch. 201,  1. 
 27-34.2-9. Administrative procedures. Regulations adopted pursuant to this chapter shall be in accordance with the provisions of chapter 35 of title 42.  History of Section.P.L. 1988, ch. 201,  1. 
 27-34.3-1. Short title. This chapter shall be known and may be cited as the Rhode Island Life and Health Insurance Guaranty Association Act.  History of Section.P.L. 1995, ch. 114,  1. 
 27-34.3-10. Plan of operation. (a)(1) The plan of operation as previously established and approved under this section shall continue to be effective. The association may amend the plan of operation when necessary or suitable to assure the fair, reasonable and equitable administration of the association. Amendments shall become effective upon the commissioners written approval.  (2) If at any time the association fails to submit suitable amendments to the plan, the commissioner shall, after notice and hearing, adopt and promulgate any reasonable rules necessary or advisable to effectuate the provisions of this chapter. The rules shall continue in force until modified by the commissioner or superseded by amendments to the plan submitted by the association and approved by the commissioner.  (b) All member insurers shall comply with the plan of operation.  (c) The plan of operation shall, in addition to requirements enumerated in this chapter:  (1) Establish procedures for handling the assets of the association;  (2) Establish the amount and method of reimbursing members of the board of directors under  27-34.3-7;  (3) Establish regular places and times for meetings including telephone conference calls of the board of directors;  (4) Establish procedures for records to be kept of all financial transactions of the association, its agents, and the board of directors;  (5) Establish the procedures by which selections for the board of directors will be made and submitted to the commissioner;  (6) Establish any additional procedures for assessments under  27-34.3-9;  (7) Contain additional provisions necessary or proper for the execution of the powers and duties of the association.  (8) Establish procedures whereby a director may be removed for cause, including in the case where a member insurer director becomes an impaired or insolvent insurer; and  (9) Require the board of directors to establish a policy and procedures for addressing conflicts of interests.  (d) The plan of operation may provide that any or all powers and duties of the association, except those under  27-34.3-8(l)(3) and  27-34.3-9, are delegated to a corporation, association, or other organization which performs or will perform functions similar to those of this association, or its equivalent, in two (2) or more states. This corporation, association, or organization shall be reimbursed for any payments made on behalf of the association and shall be paid for its performance of any function of the association. A delegation under this subsection shall take effect only with the approval of both the board of directors and the commissioner, and may be made only to a corporation, association, or organization which extends protection not substantially less favorable and effective than that provided by this chapter.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1; P.L. 2009, ch. 158,  1; P.L. 2009, ch. 169,  1. 
 27-34.3-11. Duties and powers of the commissioner. In addition to the duties and powers enumerated in this chapter, (a) The commissioner shall:  (1) Upon request of the board of directors, provide the association with a statement of the premiums in this and any other appropriate states for each member insurer;  (2) When an impairment is declared and the amount of the impairment is determined, serve a demand upon the impaired insurer to make good the impairment within a reasonable time; notice to the impaired insurer shall constitute notice to its shareholders, if any; the failure of the insurer to promptly comply with a demand shall not excuse the association from the performance of its powers and duties under this chapter.  (3) [Deleted by P.L. 2009, ch. 158,  1 and by P.L. 2009, ch. 169,  1].  (4) Maintain the confidentiality and privileged status of confidential association information provided to the commissioner or department of business regulation.  (b) The commissioner may suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this state of any member insurer which fails to pay an assessment when due or fails to comply with the plan of operation. As an alternative the commissioner may levy a forfeiture on any member insurer which fails to pay an assessment when due. The forfeiture shall not exceed five percent (5%) of the unpaid assessment per month, but no forfeiture shall be less than one hundred dollars ($100) per month.  (c) A final action of the board of directors or the association may be appealed to the commissioner by any member insurer if the appeal is taken within sixty (60) days of its receipt of notice of the final action being appealed. A final action or order of the commissioner shall be subject to judicial review.  (d) The liquidator, rehabilitator, or conservator of any impaired or insolvent insurer may notify all interested persons of the effect of this chapter.  (e) The commissioner shall not participate in the associations adjudication of a protest by an insurer pursuant to  27-34.3-9(i).  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1; P.L. 2009, ch. 158,  1; P.L. 2009, ch. 169,  1; P.L. 2012, ch. 296,  3; P.L. 2012, ch. 326,  3. 
 27-34.3-12. Prevention of insolvencies. To aid in the detection and prevention of insurer insolvencies or impairments: (a) It shall be the duty of the commissioner:  (1) To notify the commissioners of all the other states, territories of the United States and the District of Columbia within thirty (30) days following the action taken or the date the action occurs, when the commissioner takes any of the following actions against a member insurer:  (i) Revocation of license;  (ii) Suspension of license; or  (iii) Makes a formal order that the company restrict its premium writing, obtain additional contributions to surplus, withdraw from the state, reinsure all or any part of its business, or increase capital, surplus, or any other account for the security of policy owners or creditors.  (2) To report to the board of directors when the commissioner has taken any of the actions set forth in paragraph (1) of this subdivision or has received a report from any other commissioner indicating that this action has been taken in another state. The report to the board of directors shall contain all significant details of the action taken or the report received from another commissioner.  (3) To report to the board of directors when the commissioner has reasonable cause to believe from any examination, whether completed or in process, of any member company that the company may be an impaired or insolvent insurer.  (4) To furnish to the board of directors the NAIC insurance regulatory information system (IRIS) ratios and listings of companies not included in the ratios developed by the national association of insurance commissioners, and the board may use the information contained in the ratios and listings in carrying out its duties and responsibilities under this section. The report and the information contained in it shall be kept confidential by the board of directors until the time it is made public by the commissioner or other lawful authority.  (b) The commissioner may seek the advice and recommendations of the board of directors concerning any matter affecting the duties and responsibilities of the commissioner regarding the financial condition of member insurers and companies seeking admission to transact insurance business in this state.  (c) The board of directors may, upon majority vote, make reports and recommendations to the commissioner upon any matter germane to the solvency, liquidation, rehabilitation or conservation of any member insurer or germane to the solvency of any company seeking to do an insurance business in this state. The reports and recommendations shall not be considered public documents.  (d) The board of directors may, upon majority vote, notify the commissioner of any information indicating a member insurer may be an impaired or insolvent insurer.  (e) The board of directors may, upon majority vote, make recommendations to the commissioner for the detection and prevention of insurer insolvencies.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2002, ch. 292,  79; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1. 
 27-34.3-13. Credits for assessments paid (tax offsets). (a) A member insurer may offset against its premium, franchise or income tax liability (or liabilities) to this state an assessment described in  27-34.3-9(h) to the extent of ten percent (10%) of the amount of the assessment for each of the five (5) calendar years following the year in which the assessment was paid. In the event a member insurer should cease doing business, all uncredited assessments may be credited against its premium, franchise, or income tax liability (or liabilities) for the year it ceases doing business.  (b) Any sums which are acquired by refund, pursuant to  27-34.3-9(f), from the association by member insurers, and which have been offset against premium, franchise or income taxes as provided in subsection (a) of this section, shall be paid by the insurers to this state in any manner that the tax authorities may require. The association shall notify the commissioner that refunds have been made.  History of Section.P.L. 1995, ch. 114,  1. 
 27-34.3-14. Miscellaneous provisions. (a) This chapter shall not be construed to reduce the liability for unpaid assessments of the insureds of an impaired or insolvent insurer operating under a plan with assessment liability.  (b) Records shall be kept of all meetings of the board of directors to discuss the activities of the association in carrying out its powers and duties under  27-34.3-8. The records of the association with respect to an impaired or insolvent insurer shall not be disclosed prior to the termination of a liquidation, rehabilitation or conservation proceeding involving the impaired or insolvent insurer, upon the termination of the impairment or insolvency of the insurer, or upon the order of a court of competent jurisdiction. Nothing in this subsection shall limit the duty of the association to render a report of its activities under  27-34.3-15.  (c) For the purpose of carrying out its obligations under this chapter, the association shall be deemed to be a creditor of the impaired or insolvent insurer to the extent of assets attributable to covered policies reduced by any amounts to which the association is entitled as subrogee pursuant to  27-34.3-8(k). Assets of the impaired or insolvent insurer attributable to covered policies shall be used to continue all covered policies and pay all contractual obligations of the impaired or insolvent insurer as required by this chapter. Assets attributable to covered policies, as used in this subsection, are that proportion of the assets which the reserves that should have been established for covered policies bear to the reserves that should have been established for all policies of insurance written by the impaired or insolvent insurer.  (d) As a creditor of the impaired or insolvent insurer as established in subsection (c) of this section and consistent with  27-14.3-38, the association and other similar associations shall be entitled to receive a disbursement of assets out of the marshalled assets, from time to time as the assets become available to reimburse it, as a credit against contractual obligations under this chapter. If the liquidator has not, within one hundred twenty (120) days of a final determination of insolvency of an insurer by the receivership court, made an application to the court for the approval of a proposal to disperse assets out of marshalled assets to guaranty associations having obligations because of the insolvency, then the association shall be entitled to make application to the receivership court for approval of its own proposal to disburse these assets.  (e)(1) Prior to the termination of any liquidation, rehabilitation or conservation proceeding, the court may take into consideration the contributions of the respective parties, including the association, the shareholders, and policy owners of the insolvent insurer, and any other party with a bona fide interest, in making an equitable distribution of the ownership rights of the insolvent insurer. In that determination, consideration shall be given to the welfare of the policy owners of the continuing or successor insurer.  (2) No distribution to stockholders, if any, of an impaired or insolvent insurer shall be made until and unless the total amount of valid claims of the association with interest on the claims for funds expended in carrying out its powers and duties under  27-34.3-8 with respect to the insurer have been fully recovered by the association.  (f)(1) If an order for liquidation or rehabilitation of an insurer domiciled in this state has been entered, the receiver appointed under the order shall have a right to recover on behalf of the insurer, from any affiliate that controlled it, the amount of distributions, other than stock dividends paid by the insurer on its capital stock, made at any time during the five (5) years preceding the petition for liquidation or rehabilitation subject to the limitations of subdivisions (2)  (4) of this subsection.  (2) No distribution shall be recoverable if the insurer shows that when paid the distribution was lawful and reasonable, and that the insurer did not know and could not reasonably have known that the distribution might adversely affect the ability of the insurer to fulfill its contractual obligations.  (3) Any person who was an affiliate that controlled the insurer at the time the distributions were paid shall be liable up to the amount of distributions received. Any person who was an affiliate who controlled the insurer at the time the distributions were declared, shall be liable up to the amount of distributions which would have been received if they had been paid immediately. If two (2) or more persons are liable with respect to the same distributions, they shall be jointly and severally liable.  (4) The maximum amount recoverable under this subsection shall be the amount needed in excess of all other available assets of the insolvent insurer to pay the contractual obligations of the insolvent insurer.  (5) If any person liable under subdivision (3) of this subsection is insolvent, all its affiliates that controlled it at the time the distribution was paid, shall be jointly and severally liable for any resulting deficiency in the amount recovered from the insolvent affiliate.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1; P.L. 2007, ch. 442,  2; P.L. 2009, ch. 158,  1; P.L. 2009, ch. 169,  1; P.L. 2009, ch. 303,  8; P.L. 2009, ch. 304,  8. 
 27-34.3-15. Examination of the association  Annual report. The association shall be subject to examination and regulation by the commissioner. The board of directors shall submit to the commissioner each year, not later than one hundred twenty (120) days after the associations fiscal year, a financial report in a form approved by the commissioner and a report of its activities during the preceding fiscal year. Upon the request of a member insurer, the association shall provide the member insurer with a copy of the report.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1. 
 27-34.3-16. Tax exemptions. The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real property.  History of Section.P.L. 1995, ch. 114,  1. 
 27-34.3-17. Immunity. There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer or its agents or employees, the association or its agents or employees, members of the board of directors, or the commissioner or the commissioners representatives, for any action or omission by them in the performance of their powers and duties under this chapter. The immunity shall extend to the participation in any organization of one or more other state associations of similar purposes and to any such organization and its agents or employees.  History of Section.P.L. 1995, ch. 114,  1. 
 27-34.3-18. Stay of proceedings  Reopening default judgments. All proceedings in which the insolvent insurer is a party in any court in this state shall be stayed one hundred eighty (180) days from the date an order of liquidation, rehabilitation or conservation is final to permit proper legal action by the association on any matters germane to its powers or duties. As to judgment under any decision, order, verdict or finding based on default the association may apply to have the judgment set aside by the same court that made the judgment and shall be permitted to defend against the suit on the merits.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2009, ch. 158,  1; P.L. 2009, ch. 169,  1. 
 27-34.3-19. Prohibited advertisement of insurance guaranty association act in insurance sales  Notice to policy owners. (a) No person, including an insurer, agent, producer, or affiliate of an insurer shall make, publish, disseminate, circulate or place before the public, or cause directly or indirectly, to be made, published, disseminated, circulated or placed before the public, in any newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or in the form of e-mail or an electronic website, or over any radio station or television station, or in any other way, any advertisement, announcement or statement, written or oral, which uses the existence of the insurance guaranty association of this state for the purpose of sales, solicitation or inducement to purchase any form of insurance covered by the Rhode Island life and health insurance guaranty association act; provided, that this section shall not apply to the association or any other entity which does not sell or solicit insurance. The use of the protection afforded by this chapter, other than as provided by this section, by any person in the sale, marketing or advertising of insurance constitutes unfair methods of competition and unfair or deceptive acts or practices under chapter 29 of this title and is subject to the sanctions imposed in that chapter.  (b) The association shall prepare a summary document describing the general purposes and current limitations of this chapter in compliance with subsection (c) of this section. This document shall be submitted to the commissioner for approval. At the expiration of the sixty (60) days after the date on which the commissioner approves the document, an insurer may not deliver a policy or contract to a policy or contract owner unless the summary document is delivered to the policy or contract owner at the time of delivery of the policy or contract. The document shall also be available upon request by a policy owner. The distribution, delivery or contents or interpretation of this document does not guarantee that either the policy or the contract or the owner of the policy or contract is covered in the event of the impairment or insolvency of a member insurer. The summary document shall be revised by the association as amendments to this chapter may require. Failure to receive this document does not give the policy owner, contract owner, certificate holder or insured any greater rights than those stated in this act.  (c) The summary document prepared under subsection (b) of this section shall contain a clear and conspicuous disclaimer on its face. The commissioner shall establish the form and content of the disclaimer. The disclaimer shall:  (1) State the name and address of the association and the insurance department;  (2) Prominently warn the policy or contract owner that the association may not cover the policy or, if coverage is available, it will be subject to substantial limitations and exclusions and conditioned on continued residence in this state;  (3) State the types of policies for which guaranty funds will provide coverage;  (4) State that the insurer and its agents are prohibited by law from using the existence of the association for the purpose of sales, solicitation or inducement to purchase any form of insurance;  (5) State that the policy or contract owner should not rely on coverage under the association when selecting an insurer;  (6) Explain rights available and procedures for filing a complaint to allege a violation of any provisions of this chapter; and  (7) Provide other information as directed by the commissioner including, but not limited to, sources for information about the financial condition of insurers provided that the information is not proprietary and is subject to disclosure under chapter 2 of title 38.  (d) A member insurer shall retain evidence of compliance with subsection (b) for so long as the policy or contract for which the notice is given remains in effect.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1. 
 27-34.3-2. Purpose. (a) The purpose of this chapter is to protect, subject to certain limitations, the persons specified in  27-34.3-3(a) against failure in the performance of contractual obligations, under life and health insurance policies and annuity contracts specified in  27-34.3-3(b), because of the impairment or insolvency of the member insurer that issued the policies or contracts.  (b) To provide this protection, an association of insurers is created to pay benefits and to continue coverages as limited in this chapter, and members of the association are subject to assessment to provide funds to carry out the purpose of this chapter.  (c) In accordance with this purpose, in determining the coverage limits to be applied in  27-34.3-3 in cases in which there were different statutory limits at the time the insurer was declared impaired and the time the insurer was declared insolvent, the statute with the higher limits shall be applied to the claim.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2012, ch. 296,  3; P.L. 2012, ch. 326,  3. 
 27-34.3-20. Prospective application. This chapter shall not apply to any insurer that is insolvent or unable to fulfill its contractual obligations prior to January 1, 1996, and any such insurer shall be subject to the provisions under chapter 34.1 of this title. Nothing in this chapter shall be construed to require an insurer to recompute its assessment bases for any year prior to January 1, 2005, and any assessment bases computed between January 1, 1966 and December 31, 2004 are hereby acknowledged and recognized as factual on the basis of premium date collected from or reported by member insurers with respect to those years.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1. 
 27-34.3-3. Coverage and limitations. (a) This chapter shall provide coverage for the policies and contracts specified in subsection (b) of this section:  (1) To persons who, regardless of where they reside (except for nonresident certificate holders under group policies or contracts), are the beneficiaries, assignees or payees of the persons covered under subsection (2); and  (2) To persons who are owners of or certificate holders under the policies or contracts (other than unallocated annuity contracts, and structured settlement annuities) and in each case who:  (i) Are residents; or  (ii) Are not residents, but only under all of the following conditions:  (A) The insurer that issued the policies or contracts is domiciled in this state;  (B) The states in which the persons reside have associations similar to the association created by this chapter; and  (C) The persons are not eligible for coverage by an association in any other state due to the fact that the insurer was not licensed in the state at the time specified in the states guaranty association law.  (3) For unallocated annuity contracts set forth in subsection (b) of this section, paragraphs (1) and (2) of this subsection shall not apply, and this chapter shall (except as provided in paragraphs (5) and (a)(6) of this subsection) provide coverage to:  (i) Persons who are owners of the unallocated annuity contracts if the contracts are issued to or in connection with a specific benefit plan whose plan sponsor has its principal place of business in this state; and  (ii) Persons who are owners of unallocated annuity contracts issued to or in connection with government lotteries if the owners are residents.  (4) For structured settlement annuities specified in subsection (b)(1), paragraphs (1) and (2) of this subsection shall not apply, and this chapter shall (except as provided in paragraphs (5) and (6) of this subsection) provide coverage to a person who is a payee under a structured settlement annuity (or beneficiary of a payee if the payee is deceased), if the payee:  (i) Is a resident, regardless of where the contract owner resides; or  (ii) Is not a resident, but only under both of the following conditions:  (A)(I) The contract owner of the structured settlement annuity is a resident; or  (II) The contract owner of the structured settlement annuity is not a resident but the insurer that issued the structured settlement annuity is domiciled in this state; and  The state in which the contract owner resides has an association similar to the association created by this chapter; and  (B) Neither the payee or beneficiary, nor the contract owner is eligible for coverage by the association of the state in which the payee or contract owner resides.  (5) This chapter shall not provide coverage to:  (i) A person who is a payee or beneficiary of a contract owner resident of this state, if the payee or beneficiary is afforded any coverage by the association of another state; or  (ii) A person covered under paragraph (3) of this subsection, if any coverage is provided by the association of another state to the person.  (6) This chapter is intended to provide coverage to a person who is a resident of this state and, in special circumstances, to a nonresident. In order to avoid duplicate coverage, if a person who would otherwise receive coverage under this chapter is provided coverage under the laws of any other state, the person shall not be provided coverage under this chapter. In determining the application of the provisions of this paragraph in situations where a person could be covered by the association of more than one state, whether as an owner, payee, beneficiary, or assignee, this chapter shall be construed in conjunction with other state laws to result in coverage by only one association.  (b)(1) This chapter shall provide coverage to the persons specified in subsection (a) of this section for direct, non-group life, health, or annuity policies or contracts and supplemental policies or contracts to any of these, for certificates under direct group policies and contracts, and for unallocated annuity contracts issued by member insurers, except as limited by this chapter. Annuity contracts and certificates under group annuity contracts include, but are not limited to, guaranteed investment contracts, deposit administration contracts, unallocated funding agreements, allocated funding agreements, structured settlement annuities, annuities issued to or in connection with government lotteries and any immediate or deferred annuity contracts.  (2) This chapter shall not provide coverage for:  (i) A portion of a policy or contract not guaranteed by the insurer, or under which the risk is borne by the policy or contract owner;  (ii) A policy or contract of reinsurance, unless assumption certificates have been issued pursuant to the reinsurance policy or contract;  (iii) A portion of a policy or contract to the extent that the rate of interest on which it is based, or the interest rate, crediting rate or similar factor determined by use of an index or other external reference stated in the policy or contract employed in calculating returns or changes in value:  (A) Averaged over the period of four (4) years prior to the date on which the member insurer becomes an impaired or insolvent insurer under this chapter, whichever is earlier, exceeds the rate of interest determined by subtracting two (2) percentage points from Moodys corporate bond yield average averaged for that same four-year (4) period or for such lesser period if the policy or contract was issued less than four (4) years before the member insurer becomes an impaired or insolvent insurer under this chapter, whichever is earlier; and  (B) On and after the date on which the member insurer becomes an impaired or insolvent insurer under this chapter, whichever is earlier, exceeds the rate of interest determined by subtracting three (3) percentage points from Moodys corporate bond yield average as most recently available;  (iv) A portion of a policy or contract issued to a plan or program of an employer, association or other person to provide life, health or annuity benefits to its employees, members or others to the extent that the plan or program is self-funded or uninsured, including but not limited to benefits payable by an employer, association or other person under:  (A) A multiple employer welfare arrangement as defined in 29 U.S.C.  1144;  (B) A minimum premium group insurance plan;  (C) A stop-loss group insurance plan; or  (D) An administrative services only contract;  (v) A portion of a policy or contract to the extent that it provides for:  (A) Dividends or experience rating credits;  (B) Voting rights; or  (C) Payment of any fees or allowances to any person, including the policy or contract owner, in connection with the service to or administration of the policy or contract.  (vi) A policy or contract issued in this state by a member insurer at a time when it was not licensed or did not have a certificate of authority to issue the policy or contract in this state;  (vii) An unallocated annuity contract issued to or in connection with a benefit plan protected under the federal pension benefit guaranty corporation, regardless of whether the federal pension benefit guaranty corporation has yet become liable to make any payments with respect to the benefit plan;  (viii) A portion of unallocated annuity contract that is not issued to or in connection with a specific employee, union or association of natural persons benefit plan or a government lottery;  (ix) A portion of a policy or contract to the extent that the assessments required by  27-34.3-9 with respect to the policy or contract are preempted by federal or state law; and  (x) An obligation that does not arise under the express written terms of the policy or contract issued by the insurer to the contract owner or policy owner, including, without limitation:  (A) Claims based on marketing materials;  (B) Claims based on side letters, riders or other documents that were issued by the insurer without meeting applicable policy form filing or approval requirements;  (C) Misrepresentations of or regarding policy benefits;  (D) Extracontractual claims; or  (E) A claim for penalties or consequential or incidental damages;  (xi) A contractual agreement that establishes the member insurers obligations to provide a book value accounting guaranty for defined contribution benefit plan participants by reference to a portfolio of assets that is owned by the benefit plan or its trustee, which in each case is not an affiliate of the member insurer;  (xii) A portion of a policy or contract to the extent it provides for interest or other changes in value to be determined by the use of an index or other external reference stated in the policy or contract, but which have not been credited to the policy or contract, or as to which the policy or contract owners rights are subject to forfeiture, as of the date the member insurer becomes an impaired or insolvent insurer under this chapter, whichever is earlier. If a policys or contracts interest or changes in value are credited less frequently than annually, then, for purposes of determining the values that have been credited and are not subject to forfeiture under this paragraph, the interest or change in value determined by using the procedures defined in the policy or contract will be credited as if the contractual date of crediting interest or changing values was the date of impairment or insolvency, whichever is earlier, and will not be subject to forfeiture;  (xiii) Any transaction or combination of transactions between a protected cell and the general account or another protected cell of a protected cell company organized under chapter 64 of this title; or  (xiv) A policy or contract providing any hospital, medical, prescription drug or other healthcare benefits pursuant to Part C or Part D of subchapter XVIII, chapter 7 of title 42 of the United States Code (commonly known as Medicare part C & D) or any regulations issued pursuant thereto.  (c) The benefits that the association may become obligated to cover shall in no event exceed the lesser of:  (1) The contractual obligations for which the insurer is liable or would have been liable if it were not an impaired or insolvent insurer; or  (2)(i) With respect to any one life, regardless of the number of policies or contracts:  (A) Three hundred thousand dollars ($300,000) in life insurance death benefits, but not more than one hundred thousand dollars ($100,000) in net cash surrender and net cash withdrawal values for life insurance;  (B) In health insurance benefits:  (I) One hundred thousand dollars ($100,000) for coverages not considered as disability insurance or basic hospital, medical and surgical insurance or major medical insurance or long-term care insurance, including any net cash surrender and net cash withdrawal values;  (II) Three hundred thousand dollars ($300,000) for disability insurance and three hundred thousand dollars ($300,000) for long-term care insurance;  (III) Five hundred thousand dollars ($500,000) for basic hospital, medical and surgical insurance; or  (C) Two hundred fifty thousand dollars ($250,000) in the present value of annuity benefits, including net cash surrender and net cash withdrawal values;  (ii) With respect to each individual participating in a governmental retirement plan established under  401, 403(b) or 457 of the U.S. Internal Revenue Code, 26 U.S.C.  401, 403(b) or 457, covered by an unallocated annuity contract or the beneficiaries of each such individual if deceased, in the aggregate, two hundred fifty thousand dollars ($250,000) in present value annuity benefits, including net cash surrender and net cash withdrawal values;  (iii) With respect to each payee of a structured settlement annuity or beneficiary or beneficiaries, of the payee if deceased, two hundred fifty thousand dollars ($250,000) in present value annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal values if any;  (iv) However in no event shall the association be obligated to cover more than: (A) an aggregate of three hundred thousand dollars ($300,000) in benefits with respect to any one life under this paragraph and paragraphs (i), (ii) and (iii) of this subdivision except with respect to benefits for basic hospital, medical and surgical insurance and major medical insurance under subparagraph 2(i)(B) of this subsection, in which case the aggregate liability of the association shall not exceed five hundred thousand dollars ($500,000) with respect to any one individual; or (B) with respect to one owner of multiple non-group policies of life insurance, whether the policy owner is an individual, firm, corporation or other person, and whether the persons insured are officers, managers, employees or other persons, more than five million dollars ($5,000,000) in benefits, regardless of the number of policies and contracts held by the owner;  (v) With respect to either: (A) one contract owner provided coverage under subsection (a)(3)(i); or (B) one plan sponsor whose plans own directly or in trust any one or more unallocated annuity contracts not included in paragraph (ii) of this subdivision, five million dollars ($5,000,000) in benefits, irrespective of the number of contracts with respect to the contract owner or plan sponsor. Provided, however, in the case where one or more unallocated annuity contracts that are covered contracts under this chapter and are owned by a trust or other entity for the benefit of two (2) or more plan sponsors, coverage shall be afforded by the association if the largest interest in the trust or entity owning the contract or contracts is held by a plan sponsor whose principal place of business is in this state and in no event shall the association be obligated to cover more than five million dollars ($5,000,000) in benefits with respect to all such unallocated contracts;  (vi) The limitations set forth in this subsection are limitations on the benefits for which the association is obligated before taking into account either its subrogation and assignment rights or the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer attributable to covered policies. The costs of the associations obligations under this chapter may be met by the use of assets attributable to covered policies or reimbursed to the association pursuant to its subrogation and assignment rights.  (d) In performing its obligations to provide coverage under  27-34.3-8, the association shall not be required to guarantee, assume, reinsure or perform, or cause to be guaranteed, assumed, reinsured or performed, contractual obligations of the insolvent or impaired insurer under a covered policy or contract that do not materially affect the economic values or economic benefits of the covered policy or contract.  History of Section.P.L. 1995, ch. 114,  1; P.L. 1999, ch. 22,  10; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1; P.L. 2009, ch. 158,  1; P.L. 2009, ch. 169,  1. 
 27-34.3-4. Construction. This chapter shall be construed to effect the purpose under  27-34.3-2. History of Section.P.L. 1995, ch. 141,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1. 
 27-34.3-5. Definitions. As used in this chapter: (1) Account means either of the two accounts created under  27-34.3-6.  (2) Association means the Rhode Island life and health insurance guaranty association created under  27-34.3-6.  (3) Authorized assessment or the term authorized when used in the context of assessments means a resolution by the board of directors has been passed whereby an assessment will be called immediately or in the future from member insurers for a specified amount. An assessment is authorized when the resolution is passed.  (4) Benefit plan means a specific employee, union or association of natural persons benefit plan.  (5) Called assessment or the term called when used in the context of assessments means that a notice has been issued by the association to member insurers requiring that an authorized assessment be paid within the time frame set forth within the notice. An authorized assessment becomes a called assessment when notice is mailed by the association to member insurers.  (6) Commissioner means the commissioner of insurance within the department of business regulation of this state.  (7) Contractual obligation means any obligation under a policy or contract or certificate under a group policy or contract, or portion of a group policy or contract for which coverage is provided under  27-34.3-3.  (8) Covered policy means any policy or contract or portion of a policy or contract for which coverage is provided under  27-34.3-3.  (9) Extra-contractual claims means claims not arising directly out of contract provisions, including, for example, claims relating to bad faith in the payment of claims, punitive or exemplary damages or attorneys fees and costs.  (10) Impaired insurer means a member insurer which is not an insolvent insurer, and  (i) Is placed under an order of rehabilitation or conservation by a court of competent jurisdiction.  (11) Insolvent insurer means a member insurer which after January 1, 1996, is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency.  (12) Member insurer means any insurer licensed or which holds a certificate of authority to transact in this state any kind of insurance for which coverage is provided under  27-34.3-3, and includes any insurer whose license or certificate of authority in this state may have been suspended, revoked, not renewed or voluntarily withdrawn, but does not include:  (i) A hospital or medical service organization, whether profit or nonprofit; or  (ii) A health maintenance organization; or  (iii) A fraternal benefit society; or  (iv) A mandatory state pooling plan; or  (v) A mutual assessment company or other person that operates on an assessment basis; or  (vi) An insurance exchange; or  (vii) An organization that has a certificate or license limited to the issuance of charitable gift annuities; or  (viii) An entity similar to any of the above.  (13) Moodys corporate bond yield average means the monthly average corporates as published by Moodys investors service, inc., or any successor to it.  (14) Owner of a policy or contract and policy owner and contract owner means the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and properly recorded as the owner on the books of the insurer. The terms owner, contract owner and policy owner do not include persons with a mere beneficial interest in a policy or contract.  (15) Person means any individual, corporation, limited liability company, partnership, association, governmental body or entity or voluntary organization.  (16) Plan sponsor means:  (i) The employer in case of a benefit plan established or maintained by a single employer;  (ii) The employee organization in the case of a benefit plan established or maintained by an employee organization; or  (iii) In the case of a benefit plan established or maintained by two (2) or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan.  (17) Premiums means amounts or considerations (by whatever name called) received on covered policies or contracts less returned premiums, considerations and deposits, and less dividends and experience credits. Premiums does not include any amounts or consideration received for any policies or contracts or for the portions of policies or contracts for which coverage is not provided under  27-34.3-3(b) except that assessable premium shall not be reduced on account of  27-34.3-3(b)(2)(iii) relating to interest limitations and  27-34.3-3(c)(2) relating to limitations with respect to one individual, one participant and one owner. Premiums shall not include:  (i) Premiums in excess of five million dollars ($5,000,000) on an unallocated annuity contract not issued under a governmental retirement benefit plan (or its trustee) established under  401, 403(b) or 457 of the United States Internal Revenue Code, 26 U.S.C.  401, 403(b) or 457.  (ii) With respect to multiple nongroup policies of life insurance owned by one owner, whether the policy owner is an individual, firm, corporation or other person, and whether the persons insured are officers, managers, employees or other persons, premiums in excess of five million dollars ($5,000,000) with respect to these policies or contracts, regardless of the number of policies or contracts held by the owner.  (18)(i) Principal place of business of a plan sponsor or a person other than a natural person means the single state in which the natural persons who establish policy for the direction, control and coordination of the operations of the entity as a whole primarily exercise that function, determined by the association in its reasonable judgment by considering the following factors:  (A) The state in which the primary executive and administrative headquarters of the entity is located;  (B) The state in which the principal office of the chief executive officer of the entity is located;  (C) The state in which the board of directors (or similar governing person or persons) of the entity conducts the majority of its meetings;  (D) The state in which the executive or management committee of the board of directors (or a similar governing person or persons) of the entity, conducts the majority of its meetings;  (E) The state from which the management of the overall operations of the entity is directed; and  (F) In the case of a benefit plan sponsored by affiliated companies comprising a consolidated corporation, the state in which the holding company or controlling affiliate has its principal place of business as determined using the above factors. However, in the case of a plan sponsor, if more than fifty percent (50%) of the participants in the benefit plan are employed in a single state, that state shall be deemed to be the principal place of business of the plan sponsor.  (ii) The principal place of business of a plan sponsor of a benefit plan described in subsection (16)(iii) of this section shall be deemed to be the principal place of business of the association, committee, joint board of trustees or other similar group of representatives of the parties who establish or maintain the benefit plan that, in lieu of a specific or clear designation of a principal place of business, shall be deemed to be the principal place of business of the employer or employee organization that has the largest investment in the benefit plan in question.  (19) Receivership court means the court in the insolvent or impaired insurers state having jurisdiction over the conservation, rehabilitation or liquidation of the insurer.  (20) Resident means a person to whom a contractual obligation is owed and who resides in this state on the date of entry of court order that determines a member insurer to be an impaired insurer or a court order that determines a member insured to be an insolvent insurer, whichever occurs first. A person may be a resident of only one state, which in the case of a person other than a natural person shall be its principal place of business. Citizens of the United States that are either: (i) residents of foreign countries; or (ii) residents of United States possessions, territories or protectorates that do not have an association similar to the association created by this chapter, shall be deemed residents of the state of domicile of the insurer that issued the polices or contracts.  (21) Structured settlement annuity means an annuity purchased in order to fund periodic payments for a claimant in payment for or with respect to personal injuries suffered by the claimant.  (22) State means a state, the District of Columbia, Puerto Rico, or a United States possession, territory or protectorate.  (23) Supplemental contract means a written agreement entered into for the distribution of proceeds under a life, health or annuity policy or contract.  (24) Unallocated annuity contract means any annuity contract or group annuity certificate which is not issued to and owned by an individual, except to the extent of any annuity benefits guaranteed to an individual by an insurer under the contract or certificate.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2002, ch. 292,  79; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1. 
 27-34.3-6. Creation of the association. (a) There is created a nonprofit legal entity to be known as the Rhode Island life and health insurance guaranty association. All member insurers shall be and remain members of the association as a condition of their authority to transact insurance in this state. The association shall perform its functions under the plan of operation established and approved under  27-34.3-10, or as previously established and approved under  27-34.1-11 [Repealed] and shall exercise its powers through a board of directors established under  27-34.3-7 or as previously established under  27-34.1-8 [Repealed]. For purposes of administration and assessment, the association shall maintain two (2) accounts:  (1) The life insurance and annuity account which includes the following subaccounts:  (i) Life insurance account;  (ii) Annuity account; which shall include annuity contracts owned by a governmental retirement plan (or its trustee) established under section 401, 403(b) or 457 of the United States Internal Revenue Code, 26 U.S.C.  401, 403(b) or 457, but shall otherwise exclude unallocated annuities; and  (iii) Unallocated annuity account which shall exclude contracts owned by a governmental retirement benefit plan (or its trustee) established under  401, 403(b) or 457 of the United States Internal Revenue Code, 26 U.S.C.  401, 403(b) or 457.  (2) The health insurance account.  (b) The association shall come under the immediate supervision of the commissioner and shall be subject to the applicable provisions of the insurance laws of this state. Meetings or records of the association may be open to the public upon majority vote of the board of directors. The commissioner or his or her designee shall have full and complete access to all documents received by, created by or otherwise obtained by the association and shall be invited to be present at all association meetings. The disclosure of confidential or privileged association information, documents, or records to the commissioner shall not change the confidential or privileged status of the information, documents or records.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1; P.L. 2008, ch. 475,  92; P.L. 2012, ch. 296,  3; P.L. 2012, ch. 326,  3. 
 27-34.3-7. Board of directors. (a) The board of directors of the association shall consist of:  (1) Not less than five (5) nor more than nine (9) member insurers serving terms as established in the plan of operation; and  (2) The commissioner or the commissioners designee. Only member insurers shall be eligible to vote. The members of the board shall be selected by member insurers subject to the approval of the commissioner. The board of directors, previously established under  27-34.1-8 [Repealed], shall continue to operate in accordance with the provision of this section. Vacancies on the board shall be filled for the remaining period of the term by a majority vote of the remaining board members, subject to the approval of the commissioner.  (b) In approving selections to the board, the commissioner shall consider, among other things, whether all member insurers are fairly represented.  (c) Members of the board may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors but members of the board shall not be compensated by the association for their services.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1; P.L. 2008, ch. 475,  92; P.L. 2012, ch. 296,  3; P.L. 2012, ch. 326,  3. 
 27-34.3-8. Powers and duties of the association. (a) If a member insurer is an impaired insurer, the association may, in its discretion, and subject to any conditions imposed by the association that do not impair the contractual obligations of the impaired insurer, and that are approved by the commissioner:  (1) Guarantee, assume or reinsure, or cause to be guaranteed, assumed, or reinsured, any or all of the policies or contracts of the impaired insurer;  (2) Provide the monies, pledges, loans, notes, guarantees or other means that are proper to effectuate subdivision (1) of this subsection and assure payment of the contractual obligations of the impaired insurer pending action under subdivision (1) of this subsection.  (b) If a member insurer is an insolvent insurer, the association shall, in its discretion, either:  (1)(i)(A) Guaranty, assume or reinsure, or cause to be guaranteed, assumed or reinsured, the policies or contracts of the insolvent insurer; or  (B) Assure payment of the contractual obligations of the insolvent insurer; and  (ii) Provide monies, pledges, loans, notes, guarantees, or other means that are reasonably necessary to discharge the associations duties; or  (2) Provide benefits and coverages in accordance with the following provisions:  (i) With respect to life and health insurance policies and annuities, assure payment of benefits for premiums identical to the premiums and benefits (except for terms of conversion and renewability) that would have been payable under the policies or contracts of the insolvent insurer, for claims incurred:  (A) With respect to group policies and contracts, not later than the earlier of the next renewal date under such policies or contracts or forty-five (45) days, but in no event less than thirty (30) days after the date on which the association becomes obligated with respect to the policies or contracts;  (B) With respect to nongroup policies, contracts and annuities not later than the earlier of the next renewal date (if any) under the policies or contracts or one year, but in no event less than thirty (30) days from the date on which the association becomes obligated with respect to the policies and contracts;  (ii) Make diligent efforts to provide all known insured or annuitants (for non-group policies and contracts) or group policy owners with respect to group policies or contracts thirty (30) days notice of the termination (pursuant to subparagraph (i) of this paragraph) of the benefits provided;  (iii) With respect to nongroup life and health insurance policies and annuities covered by the association, make available to each known insured or annuitant, or owner if other than the insured, or annuitant and with respect to an individual formerly insured or formerly an annuitant under a group policy who is not eligible for replacement group coverage, make available substitute coverage on an individual basis in accordance with the provisions of subdivision (iv) of this subsection, if the insureds or annuitants had a right under law or the terminated policy to convert coverage to individual coverage or to continue an individual policy or annuity in force until a specified age or for a specified time, during which the insurer had no right unilaterally to make changes in any provision of the policy or annuity or had a right only to make changes in premium by class;  (iv)(A) In providing the substitute coverage required under subdivision (iii) of this subsection, the association may offer either to reissue the terminated coverage or to issue an alternative policy.  (B) Alternative or reissued policies shall be offered without requiring evidence of insurability, and shall not provide for any waiting period or exclusion that would not have applied under the terminated policy.  (C) The association may reinsure any alternative or reissued policy.  (v)(A) Alternative policies adopted by the association shall be subject to the approval of the domiciliary insurance commissioner and the receivership court. The association may adopt alternative policies of various types for future issuance without regard to any particular impairment or insolvency.  (B) Alternative policies shall contain at least the minimum statutory provisions required in this state and provide benefits that shall not be unreasonable in relation to the premium charged. The association shall set the premium in accordance with a table of rates which it shall adopt. The premium shall reflect the amount of insurance to be provided and the age and class of risk of each insured, but shall not reflect any changes in the health of the insured after the original policy was last underwritten.  (C) Any alternative policy issued by the association shall provide coverage of a type similar to that of the policy issued by the impaired or insolvent insurer, as determined by the association.  (vi) If the association elects to reissue terminated coverage at a premium rate different from that charged under the terminated policy, the premium shall be set by the association in accordance with the amount of insurance provided and the age and class of risk, subject to approval of the domiciliary insurance commissioner and the receivership court.  (vii) The associations obligations with respect to coverage under any policy of the impaired or insolvent insurer or under any reissued or alternative policy shall cease on the date such coverage or policy is replaced by another similar policy by the policy owner, the insured, or the association.  (viii) When proceeding under paragraph (b)(2) of this section with respect to any policy or contract carrying guaranteed minimum interest rates, the association shall assure the payment or crediting of a rate of interest consistent with  27-34.3-3(b)(2)(iii).  (c) Nonpayment of premiums within thirty-one (31) days after the date required under the terms of any guaranteed, assumed, alternative or reissued policy or contract or substitute coverage shall terminate the associations obligations under the policy or coverage under this chapter with respect to the policy or coverage, except with respect to any claims incurred or any net cash surrender value which may be due in accordance with the provisions of this chapter.  (d) Premiums due for coverage after entry of an order of liquidation of an insolvent insurer shall belong to and be payable at the direction of the association. If the liquidator of an insolvent insurer requests, the association shall provide a report to the liquidator regarding such premium collected by the association. The association shall be liable for unearned premiums due to policy or contract owners arising after the entry of the order.  (e) The protection provided by this chapter shall not apply where any guaranty protection is provided to residents of this state by laws of the domiciliary state or jurisdiction of the impaired or insolvent insurer other than this state.  (f) In carrying out its duties under subsection (b), the association may:  (1) Subject to approval by a court of competent jurisdiction in this state, impose permanent policy or contract liens in connection with any guarantee, assumption or reinsurance agreement, if the association finds that the amounts which can be assessed under this chapter are less than the amounts needed to assure full and prompt performance of the associations duties under this chapter, or that the economic or financial conditions as they affect member insurers are sufficiently adverse to render the imposition of such permanent policy or contract liens, to be in the public interest;  (2) Subject to approval by a court of competent jurisdiction in this state, impose temporary moratoriums or liens on payments of cash values and policy loans, or any other right to withdraw funds held in conjunction with policies or contracts, in addition to any contractual provisions for deferral of cash or policy loan value. In addition, in the event of a temporary moratorium or moratorium charge imposed by the receivership court on payment of cash values or policy loans, or on any other right to withdraw funds held in conjunction with policies or contracts, out of the assets of the impaired or insolvent insurer, the association may defer the payment of such cash values, policy loans or other rights by the association for the period of the moratorium or moratorium charge imposed by the receivership court, except for claims covered by the association to be paid in accordance with a hardship procedure established by the liquidator or rehabilitator and approved by the receivership court.  (g) A deposit in this state, held pursuant to law or required by the commissioner for the benefit of creditors, including policy owners, not turned over to the domiciliary liquidator upon the entry of a final order of liquidation or order approving a rehabilitation plan of an insurer domiciled in this state or in a reciprocal state, pursuant to  27-14.3-56, shall be promptly paid to the association. The association shall be entitled to retain a portion of any amounts so paid to it equal to the percentage determined by dividing the aggregate amount of policy owners claims related to that insolvency for which the association has provided statutory benefits by the aggregate amount of all policy owners claims in this state related to that insolvency and shall remit to the domiciliary receiver the amount so paid to the association less the amount retained pursuant to this subsection. Any amount so paid to the association and retained by it shall be treated as a distribution of estate assets pursuant to applicable state insurance law dealing with early access disbursements.  (h) If the association fails to act within a reasonable period of time with respect to an insolvent insurer, as provided in subsection (b) of this section, the commissioner shall have the powers and duties of the association under this chapter with respect to the insolvent insurers.  (i) The association may render assistance and advice to the commissioner, upon the commissioners request, concerning rehabilitation, payment of claims, continuance of coverage, or the performance of other contractual obligations of any impaired or insolvent insurer.  (j) The association shall have standing to appear or intervene before any court or agency in this state with jurisdiction over an impaired or insolvent insurer concerning which the association is or may become obligated under this chapter or with jurisdiction over any person or property against whom the association may have rights through subrogation or otherwise. Standing shall extend to all matters germane to the powers and duties of the association, including, but not limited to, proposals for reinsuring, modifying or guaranteeing the policies or contracts of the impaired or insolvent insurer and the determination of the polices or contracts and contractual obligations. The association shall also have the right to appear or intervene before a court or agency in another state with jurisdiction over an impaired or insolvent insurer for which the association is or may become obligated or with jurisdiction over any person or property against whom the association may have rights through subrogation or otherwise.  (k)(1) A person receiving benefits under this chapter shall be deemed to have assigned the rights under, and any causes of action against any person for losses arising under, resulting from or otherwise relating to, the covered policy or contract to the association to the extent of the benefits received because of this chapter, whether the benefits are payments of or on account of contractual obligations, continuation of coverage or provision of substitute or alternative coverage. The association may require an assignment to it of these rights and causes of action by any payee, policy or contract owner, beneficiary, insured or annuitant as a condition precedent to the receipt of any right or benefits conferred by this chapter upon the person.  (2) The subrogation rights of the association under this subsection shall have the same priority against the assets of the impaired or insolvent insurer as that possessed by the person entitled to receive benefits under this chapter.  (3) In addition to subdivisions (1) and (2) of this subsection, the association shall have all common law rights of subrogation and any other equitable or legal remedy that would have been available to the impaired or insolvent insurer or owner, beneficiary or payee, of a policy or contract with respect to the policy or contracts including without limitation, in the case of a structured settlement annuity, any rights of the owner, beneficiary or payee of the annuity, to the extent of benefits received pursuant to this chapter, against a person originally or by succession responsible for the losses arising from the personal injury relating to the annuity or payment therefore, excepting any such person responsible solely by reason of serving as an assignee in respect of a qualified assignment under  130 of the United States Internal Revenue Code, 26 U.S.C.  130.  (4) If the preceding provisions of this subsection are invalid or ineffective with respect to any person or claim for any reason, the amount payable by the association with respect to the related covered obligations shall be reduced by the amount realized by any other person with respect to the person or claim that is attributable to the policies, or portion thereof, covered by the association.  (5) If the association has provided benefits with respect to a covered obligation and a person recovers amounts to which the association has rights as described in the preceding paragraphs of this subsection, the person shall pay to the association the portion of the recovery attributable to the policies, or portions thereof, covered by the association.  (l) In addition to the rights and powers provided in this chapter, the association may:  (1) Enter into any contracts as are necessary or proper to carry out the provisions and purposes of this chapter;  (2) Sue or be sued, including taking any legal actions necessary or proper to recover any unpaid assessments under  27-34.3-9 and to settle claims or potential claims against it;  (3) Borrow money to effect the purposes of this chapter; any notes or other evidence of indebtedness of the association not in default shall be legal investments for domestic insurers and may be carried as admitted assets;  (4) Employ or retain persons as are necessary or appropriate to handle the financial transactions of the association, and to perform any other functions as become necessary or proper under this chapter;  (5) Take such legal action that may be necessary or appropriate to avoid or recover payment of improper claims;  (6) Exercise, for the purposes of this chapter and to the extent approved by the commissioner, the powers of a domestic life or health insurer, but in no case may the association issue insurance policies or annuity contracts other than those issued to perform its obligations under this chapter;  (7) Organize itself as a corporation or another legal form permitted by the laws of this state;  (8) Request information from a person seeking coverage from the association in order to aid the association in determining its obligations under this chapter with respect to the person, and the person shall promptly comply with the request; and  (9) Take other necessary or appropriate action to discharge its duties and obligations under this chapter or to exercise its powers under this chapter.  (m) The association may join an organization of one or more other state associations of similar purposes, to further the purposes and administer the powers and duties of the association.  (n)(1)(a) At any time within one hundred eighty (180) days of the date of the order of liquidation, the association may elect to succeed to the rights and obligations of the ceding member insurer that relate to policies or annuities covered, in whole or in part, by the association, in each case under any one or more reinsurance contracts entered into by the insolvent insurer and its reinsurers and selected by the association. Any such assumption shall be effective as of the date of the order of liquidation. The election shall be effected by the association or the national organization of life and health insurance guaranty associations (NOLHGA) on its behalf sending written notice, return receipt requested to the affected reinsurers.  (b) To facilitate the earliest practicable decision about whether to assume any of the contracts of reinsurance, and in order to protect the financial position of the estate, the receiver and each reinsurer of the ceding member insurer shall make available upon request to the association or to NOLHGA on its behalf as soon as possible after commencement of formal delinquency proceedings: (i) Copies of in-force contracts of reinsurance and all related files and records relevant to the determination of whether such contracts should be assumed, and (ii) Notices of any defaults under the reinsurance contracts or any known event or condition which with the passage of time could become a default under the reinsurance contracts.  (c) The following subparagraphs (i) through (iv) shall apply to reinsurance contracts so assumed by the association.  (i) The association shall be responsible for all unpaid premiums due under the reinsurance contracts for periods both before and after the date of the order of liquidation, and shall be responsible for the performance of all other obligations to be performed after the date of the order of liquidation, in each case which relate to policies and annuities covered, in whole or in part, by the association. The association may charge policies and annuities covered in part by the association, through reasonable allocation methods, the costs for reinsurance in excess of the obligations of the association and shall provide notice and an accounting of these charges to the liquidator;  (ii) The association shall be entitled to any amounts payable by the reinsurer under the reinsurance contracts with respect to losses or events that occur in periods after the date of the order of liquidation and that relate to policies or annuities covered in whole or in part, by the association provided, that, upon receipt of any such amounts, the association shall be obliged to pay to the beneficiary under the policy or annuity on account of which the amounts were paid a portion of the amount equal to the lesser of:  (A) The amount received by the association; or  (B) The excess of the amount received by the association; over the amount equal to the benefits paid by the association on account of the policy or annuity less the retention of the insurer applicable to the loss or event;  (iii) Within thirty (30) days following the associations election (the election date), the association and each reinsurer under contracts assumed by the association shall calculate the net balance due to or from the association under each such reinsurance contract as of the election date with respect to policies or annuities covered, in whole or in part, by the association which calculation shall give, full credit to all items paid by either the insurer or its receiver or the reinsurer prior to the election date. The reinsurer shall pay the receiver any amounts due for losses or events prior to the date of the order of liquidation, subject to any set-off for premiums unpaid for periods prior to the date, and the association or reinsurer shall pay any remaining premiums in each case within five (5) days of the completion of the aforementioned calculation. Any disputes over the amounts due to either the association or the reinsurer shall be resolved by arbitration pursuant to the terms of the affected reinsurance contracts or, if the contract contains no arbitration clause, as otherwise provided by law. If the receiver has received any amounts due the association pursuant to paragraph (ii), the receiver, shall remit the same to the association as promptly as practicable.  (iv) If the association or receiver, on the associations behalf, within sixty (60) days of the election date, pays the unpaid premiums due for periods both before and after the election date, that relate to policies or annuities covered in whole or in part by the association the reinsurer shall not be entitled to terminate the reinsurance contracts for failure to pay premium insofar as the reinsurance contracts relate to policies or annuities covered in whole or in part by the association and shall not be entitled to set off any unpaid amounts due under other contracts, or unpaid amounts due from parties other than the association against amounts due to the association.  (2) During the period from the date of the order of liquidation until the election date (or, if the election date does not occur, until one hundred eighty (180) days after the date of the order of liquidation).  (a)(i) Neither the association nor the reinsurer shall have any rights or obligations under reinsurance contracts that the association has the right to assume under subdivision (n)(1), whether for periods prior to or after the date of the order of liquation; and  (ii) The reinsurer, the receiver and the association shall, to the extent practicable, provide each other data and records reasonably requested;  (b) Provided that once the association has elected to assume a reinsurance contract, the parties rights and obligations shall be governed by subdivision (n)(1).  (3) If the association does not elect to assume a reinsurance contract by the election date pursuant to subdivision (n)(1), the association shall have no rights or obligations, in each case for periods both before and after the date of the order of liquidation, with respect to the reinsurance contract.  (4) When policies or annuities, or covered obligations with respect thereto, are transferred to an assuming insurer, reinsurance on the policies or annuities may also be transferred by the association, in the case of contracts assumed under subdivision (n)(1), subject to the following:  (a) Unless the reinsurer and the assuming insurer agree otherwise, the reinsurance contract transferred shall not cover any new policies of insurance or annuities in addition to those transferred;  (b) The obligations described in paragraph (n)(1) of this section shall not apply with respect to matters arising after the effective date of the transfer;  (c) Notice shall be given in writing, return receipt requested, by the transferring party to the affected reinsurer not less than thirty (30) days prior to the effective date of the transfer.  (5) The provisions of subsection (n) shall supersede the provisions of any law or of any affected reinsurance contract that provides for or requires any payment of reinsurance proceeds, on account of losses or events that occur in periods after the date of the order of liquidation to the receiver, of the insolvent insurer or any other person. The receiver, shall remain entitled to any amounts payable by the reinsurer under the reinsurance contracts with respect to losses or events that occur in periods prior to the date of the order of liquidation subject to applicable setoff provisions.  (6) Except as otherwise provided in this section, nothing in this section (n):  Shall alter or modify the terms and conditions of any reinsurance contract. Nothing in this section shall abrogate or limit any rights of any reinsurer to claim that it is entitled to rescind a reinsurance contract.  Nothing in this section shall give a policy holder or beneficiary an independent cause of action against an indemnity reinsurer that is not otherwise set forth in the reinsurance contract. Nothing in this section shall limit or affect the associations rights as a creditor of the estate against the assets of the estate. Nothing in this section shall apply to reinsurance agreements covering property or casualty risks.  (o) The board of directors of the association shall have discretion and shall exercise reasonable business judgment to determine the means by which the association is to provide the benefits of this chapter in an economical and efficient manner.  (p) Where the association has arranged or offered to provide the benefits of this chapter to a covered person under a plan or arrangement that fulfills the associations obligations under this chapter, the person shall not be entitled to benefits from the association in addition to or other than those provided under the plan or arrangement.  (q) In carrying out its duties in connection with guaranteeing, assuming or reinsuring policies or contracts under subsection (a) or (b) of this section, the association may, subject to approval of the receivership court, issue substitute coverage for a policy or contract that provides an interest rate, crediting rate or similar factor determined by use of an index or other external reference stated in the policy or contract employed in calculating returns or changes in value by issuing an alternative policy or contract in accordance with the following provisions:  (r) Venue in a suit against the association arising under this chapter shall be in Providence County. The association shall not be required to give an appeal bond in an appeal that relates to a cause of action arising under this chapter.  (1) In lieu of the index or other external reference provided for in the original policy or contract, the alternative policy or contract provides for:  (i) A fixed interest rate; or  (ii) Payment of dividends with minimum guarantees; or  (iii) A different method of calculating interest or changes in value.  (2) There is no requirement for evidence of insurability, waiting period or other exclusion that would not have applied under the replaced policy or contract; and  (3) The alternative policy or contract is substantially similar to the replaced policy or contract in all other material terms.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1; P.L. 2009, ch. 158,  1; P.L. 2009, ch. 169,  1. 
 27-34.3-9. Assessments. (a) For the purpose of providing the funds necessary to carry out the powers and duties of the association, the board of directors shall assess the member insurers, separately for each account, at such time and for such amounts as the board finds necessary. Assessments shall be due not less than thirty (30) days after prior written notice to the member insurers and shall accrue interest at nine percent (9%) per annum on and after the due date.  (b) There shall be two (2) classes of assessments, as follows:  (1) Class A assessments shall be authorized and called for the purpose of meeting administrative and legal costs and other expenses. Class A assessments may be authorized and called whether or not related to a particular impaired or insolvent insurer.  (2) Class B assessments shall be authorized and called to the extent necessary to carry out the powers and duties of the association under  27-34.3-8 with regard to an impaired or an insolvent insurer.  (c)(1) The amount of any Class A assessment shall be determined by the board and may be authorized and called on a pro rata or non-pro rata basis. If pro rata, the board may provide that it be credited against future Class B assessments. The total of all non-pro rata assessment shall not exceed three hundred dollars ($300) per member insurer in any one calendar year. The amount of any Class B assessment shall be allocated for assessment purposes among the accounts pursuant to an allocation formula that may be based on the premiums or reserves of the impaired or insolvent insurer or any other standard deemed by the board in its sole discretion as being fair and reasonable under the circumstances.  (2) Class B assessments against member insurers for each account and subaccount shall be in the proportion that the premiums received on business in this state by each assessed member insurer or policies or contracts covered by each account for the three (3) most recent calendar years for which information is available preceding the year in which the insurer became insolvent, (or, in the case of an assessment with respect to an impaired insurer, the three (3) most recent calendar years for which information is available preceding the year in which the insurer became impaired) bears to premiums received on business in this state for such calendar years by all assessed member insurers.  (3) Assessments for funds to meet the requirements of the Association with respect to an impaired or insolvent insurer shall not be authorized or called until necessary to implement the purposes of this chapter. Classification of assessments under subsection (b) of this section and computation of assessments under this subsection shall be made with a reasonable degree of accuracy, recognizing that exact determinations may not always be possible. The association shall notify each member insurer of its anticipated pro rata share of an authorized assessment not yet called within one hundred eighty (180) days after the assessment is authorized.  (d) The association may abate or defer, in whole or in part, the assessment of a member insurer if, in the opinion of the board, payment of the assessment would endanger the ability of the member insurer to fulfill its contractual obligations. In the event an assessment against a member insurer is abated, or deferred in whole or in part, the amount by which the assessment is abated or deferred may be assessed against the other member insurers in a manner consistent with the basis for assessments set forth in this section. Once the conditions which have caused a deferral have been removed or rectified, the member insurer shall pay all assessments that were deferred pursuant to a repayment plan approved by the association.  (e)(1)(i) Subject to the provisions of subparagraph (ii) of this paragraph, the total of all assessments authorized by the association with respect to a member insurer for each subaccount of the life insurance and annuity account and for the health account shall not in any one calendar year exceed three percent (3%) of that member insurers average annual premiums received in this state on the policies and contracts covered by the subaccount or account during the three (3) calendar years preceding the year in which the insurer became an impaired or insolvent insurer.  (ii) If two (2) or more assessments are authorized in one calendar year with respect to insurers that become impaired or insolvent in different calendar years, the average annual premiums for purposes of the aggregate assessment percentage limitation referenced in subparagraph (i) of this paragraph shall be equal and limited to the higher of the three (3) year average annual premiums for the applicable subaccount or account as calculated pursuant to this section.  (iii) If the maximum assessment, together with the other assets of the association in any account, does not provide in any one year in either account an amount sufficient to carry out the responsibilities of the association, the necessary additional funds shall be assessed as soon after this as permitted by this chapter.  (2) The board may provide in the plan of operation a method of allocating funds among claims, whether relating to one or more impaired or insolvent insurers, when the maximum assessment will be insufficient to cover anticipated claims.  (3) If the maximum assessment for a subaccount of the life and annuity account in any one year does not provide an amount sufficient to carry out the responsibilities of the association, then pursuant to subdivision (c)(2) of this section, the board shall assess the other subaccounts of the life and annuity account for the necessary additional amount, subject to the maximum stated in subdivision (1) of this subsection.  (f) The board may, by an equitable method as established in the plan of operation, refund to member insurers, in proportion to the contribution of each insurer to that account, the amount by which the assets of the account exceed the amount the board finds is necessary to carry out during the coming year the obligations of the association with regard to that account, including assets accruing from assignment, subrogation, net realized gains and income from investments. A reasonable amount may be retained in any account to provide funds for the continuing expenses of the association and for future claims.  (g) It shall be proper for any member insurer, in determining its premium rates and policy owner dividends as to any kind of insurance within the scope of this chapter, to consider the amount reasonably necessary to meet its assessment obligations under this chapter.  (h) The association shall issue to each insurer paying an assessment under this chapter, other than Class A assessment, a certificate of contribution, in a form prescribed by the commissioner, for the amount of the assessment so paid. All outstanding certificates shall be of equal dignity and priority without reference to amounts or dates of issue. A certificate of contribution may be shown by the insurer in its financial statement as an asset in such form and for such amount, if any, and period of time as the commissioner may approve.  (i)(1) A member insurer that wishes to protest all or part of an assessment shall pay when due the full amount of the assessment as set forth in the notice provided by the association. The payment shall be available to meet association obligations during the pendency of the protest or any subsequent appeal. Payment shall be accompanied by a statement in writing that the payment is made under protest and setting forth a brief statement of the grounds for the protest.  (2) Within sixty (60) days following the payment of an assessment under protest by a member insurer, the association shall notify the member insurer in writing of its determination with respect to the protest unless the association notifies the member insurer that additional time is required to resolve the issues raised by the protest.  (3) Within thirty (30) days after a final decision has been made, the association shall notify the protesting member insurer in writing of that final decision. Within sixty (60) days of receipt of notice of the final decision, the protesting member insurer may appeal that final action to the commissioner.  (4) In the alternative to rendering a final decision with respect to a protest based on a question regarding the assessment base, the association may refer the protest to the commissioner for a final decision, with or without a recommendation from the association.  (5) If the protest or appeal on the assessment is upheld, the amount paid in error or excess shall be returned to the member company. Interest on a refund due a protesting member shall be paid at the rate actually earned by the association.  (j) The association may request information of member insurers in order to aid in the exercise of its power under this section and member insurers shall promptly comply with a request.  History of Section.P.L. 1995, ch. 114,  1; P.L. 2004, ch. 39,  1; P.L. 2004, ch. 44,  1; P.L. 2009, ch. 158,  1; P.L. 2009, ch. 169,  1. 
 27-34-1. Short title. This chapter shall be known and may be cited as the Rhode Island Property & Casualty Insurance Guaranty Association Act.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-10.5. Coordination among guaranty associations. (a) The association may join one or more organizations of other state associations of similar purposes, to further the purposes and administer the powers and duties of the association. The association may designate one or more of these organizations to act as a liaison for the association and, to the extent the association authorizes, to bind the association in agreements or settlements with receivers of insolvent insurance companies or their designated representatives.  (b) The association, in cooperation with other obligated or potentially obligated guaranty associations, or their designated representatives, shall make all reasonable efforts to coordinate and cooperate with receivers, or their designated representatives, in the most efficient and uniform manner, including the use of uniform data standards as promulgated or approved by the national association of insurance commissioners.  History of Section.P.L. 2010, ch. 91,  3; P.L. 2010, ch. 117,  3. 
 27-34-10. Duties and powers of the commissioner. (a) The commissioner shall:  (1) Notify the association of the existence of an insolvent insurer not later than three (3) days after he or she receives notice of the determination of the insolvency. The association shall be entitled to a copy of a complaint seeking an order of liquidation with a finding of insolvency against a member company at the same time that the complaint is filed with a court of competent jurisdiction; and  (2) Provide the association with a statement of the net direct written premiums of each member insurer upon request of the board of directors.  (b) The commissioner may:  (1) Suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this state of any member insurer that fails to pay an assessment when due or fails to comply with the plan of operation. As an alternative, the commissioner may levy a fine on a member insurer that fails to pay an assessment when due. The fine shall not exceed five percent (5%) of the unpaid assessment per month, except that a fine not be less than one hundred dollars ($100) per month;  (2) Revoke the designation of any servicing facility if he or she finds claims are being handled unsatisfactorily; and  (3) Examine, audit, or otherwise regulate the association.  (c) A final action or order of the commissioner under this chapter shall be subject to judicial review in a court of competent jurisdiction.  History of Section.P.L. 1988, ch. 407,  2; P.L. 1996, ch. 188,  14; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-11.5. Net worth exclusion. (a) For purposes of this section high net worth insured shall mean any insured, excluding state and local governments, whose net worth exceeds fifty million dollars ($50,000,000) on December 31 of the year prior to the year in which the insurer becomes an insolvent insurer; provided that an insureds net worth on that date shall be deemed to include the aggregate net worth of the insured and all of its subsidiaries and affiliates as calculated on a consolidated basis.  (b)(1) The association shall not be obligated to pay any first-party claims by a high net worth insured.  (2) The association shall have the right to recover from the high net worth insured all amounts paid by the association to or on behalf of such insured, whether for indemnity, defense or otherwise.  (c) The association shall not be obligated to pay any claim that would otherwise be a covered claim that is an obligation to or on behalf of a person who has a net worth greater than that allowed by the insurance guaranty association law of the state of residence of the claimant at the time specified by that states applicable law, and which association has denied coverage to that claimant on that basis.  (d) The association shall establish reasonable procedures subject to the approval of the commissioner for requesting financial information from insureds on a confidential basis for purposes of applying this section, provided that the financial information may be shared with any other association similar to the association and the liquidator for the insolvent insurer on the same confidential basis. Any request to an insured seeking financial information must advise the insured of the consequences of failing to provide the financial information. If an insured refuses to provide the requested financial information where it is requested and available, the association may, until such time as the information is provided, provisionally deem the insured to be a high net worth insured for the purpose of denying a claim under subsection (b) of this section.  (e) In any lawsuit contesting the applicability of this section where the insured has refused to provide financial information under the procedure established pursuant to subsection (d) of this section, the insured shall bear the burden of proof concerning its net worth at the relevant time. If the insured fails to prove that its net worth at the relevant time was less than the applicable amount, the court shall award the association its full costs, expenses and reasonable attorneys fees in contesting the claim.  History of Section.P.L. 2010, ch. 91,  3; P.L. 2010, ch. 117,  3. 
 27-34-11. Effect of paid claims. (a) Any person recovering under this chapter shall be deemed to have assigned any rights under the policy to the association to the extent of his or her recovery from the association. Every insured or claimant seeking the protection of this chapter shall cooperate with the association to the same extent as the person would have been required to cooperate with the insolvent insurer. The association shall have no cause of action against the insured of the insolvent insurer for sums it has paid out except any causes of action as the insolvent insurer would have had if the sums had been paid by the insolvent insurer and except as provided in subsection (b) of this section and  27-34-11.5. In the case of an insolvent insurer operating on a plan with assessment liability, payments of claims of the association shall not operate to reduce the liability of the insureds to the receiver, liquidator or statutory successor for unpaid assessments.  (b) The association shall have the right to recover from a person who is an affiliate of the insolvent insurer all amounts paid by the association on behalf of that person pursuant to the chapter, whether for indemnity, defense or otherwise.  (c) The receiver, liquidator, or statutory successor of an insolvent insurer shall be granted the utmost deference with regard to settlements of covered claims by the fund or a similar organization in another state.  (d) The association and any association similar to the association in another state shall be entitled to file a claim in the liquidation of an insolvent insurer for any amounts paid by them on covered claim obligations as determined under this chapter or similar laws in other states and shall receive dividends and other distributions at the priority set forth in  27-14.3-46.  (e) The association shall periodically file with the receiver or liquidator of the insolvent insurer statements of the covered claims paid by the association and estimates of anticipated claims on the association which shall preserve the rights of the association against the assets of the insolvent insurer.  History of Section.P.L. 1988, ch. 407,  2; P.L. 1999, ch. 498,  1; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-12.5. Prevention of insolvencies. To aid in the detection and prevention of insurer insolvencies: (1) The board of directors may, upon a majority vote, make recommendations to the commissioner on matters generally related to improving or enhancing regulation for solvency.  (2) At the conclusion of any domestic insurer insolvency in which the association was obligated to pay covered claims, the board of directors may, upon a majority vote, prepare a report on the history and causes of the insolvency, based on the information available to the association and submit the report to the commissioner.  (3) Reports and recommendations provided under this section shall not be considered public documents.  History of Section.P.L. 2010, ch. 91,  3; P.L. 2010, ch. 117,  3. 
 27-34-12. Exhaustion of other coverage. (a)(1) Any person having a claim against an insurer, shall be required first to exhaust all coverage provided by any other policy, including the right to a defense under the other policy, if the claim under the other policy arises from the same facts, injury or loss that gave rise to the covered claim against the association. The requirement to exhaust shall apply without regard to whether the other insurance policy is a policy written by a member insurer. However, no person shall be required to exhaust any right under the policy of an insolvent insurer or any right under a life insurance policy.  (2) Any amount payable on a covered claim under this chapter shall be reduced by the full applicable limits stated in the other insurance policy, or by the amount of the recovery under the other insurance policy as provided herein. The association shall receive a full credit for the stated limits, unless the claimant demonstrates that the claimant used reasonable efforts to exhaust all coverage and limits applicable under the other insurance policy. If the claimant demonstrates that the claimant used reasonable efforts to exhaust all coverage and limits applicable under the other insurance policy, or if there are no applicable stated limits under the policy, the association shall receive a full credit for the total recovery.  (i) The credit shall be deducted from the lesser of:  (A) The associations covered claim limit;  (B) The amount of the judgment or settlement of the claim; or  (C) The policy limits of the policy of the insolvent insurer.  (ii) In no case, however, shall the obligation of the association exceed the covered claim limit embodied in  27-34-8.  (3) Except to the extent that the claimant has a contractual right to claim defense under an insurance policy issued by another insurer, nothing in this section shall relieve the association of the duty to defend under the policy issued by the insolvent insurer. This duty shall, however, be limited by any other limitation on the duty to defend embodied in this chapter.  (4) A claim under a policy providing liability coverage to a person who may be jointly and severally liable as a joint tortfeasor with the person covered under the policy of the insolvent insurer that gives rise to the covered claim shall be considered to be a claim arising from the same facts, injury or loss that gave rise to the covered claim against the association.  (5) For purposes of this section, a claim under an insurance policy other than a life insurance policy shall include, but is not limited to:  (i) A claim against a health maintenance organization, a hospital plan corporation, a nonprofit hospital, medical or dental service corporation or disability insurance policy; and  (ii) Any amount payable by or on behalf of a self-insurer.  (6) The person insured by the insolvent insurers policy may not be pursued by a third-party claimant for any amount paid to the third-party by which the associations obligation is reduced by the application of this section.  (b) Any person having a claim which may be recovered from more than one insurance guaranty association or its equivalent shall seek recovery first from the association or its equivalent of the place of residence of the insured, except that if it is a first party claim for damage to property with a permanent location the person shall seek recovery first from the association of the location of the property. If it is a workers compensation claim, the person shall seek recovery first from the association of the residence of the claimant. Any recovery under this chapter shall be reduced by the amount of recovery from another insurance guaranty association or its equivalent.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-13. Repealed. History of Section.P.L. 1988, ch. 407,  2; Repealed by P.L. 2010, ch. 91,  2, effective June 19, 2010, and by P.L. 2010, ch. 117,  2, effective June 22, 2010. 
 27-34-14. Tax exemption. The association shall be exempt from the payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real or personal property.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-15. Recoupment of assessments. The rates and premiums charged for insurance policies to which this section applies shall include amounts sufficient to recoup a sum equal to the amounts paid to the association by the member insurer less any amounts returned to the member insurer by the association. Rates shall not be deemed excessive because they contain an amount reasonably calculated to recoup assessments paid by the member insurer.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-16. Immunity. There shall be no liability on the part of, and no cause of action of any nature shall arise against, any member insurer, the association, or its agents or employees, the board of directors, or any persons serving as an alternate or substitute representative of any director, or the commissioner or his or her representatives for any action taken or any failure to act by them in the performance of their powers and duties under this chapter.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-17. Stay of proceedings. All proceedings in which the insolvent insurer is a party or is obligated to defend a party in any court in this state shall, subject to waiver by the association in specific cases involving covered claims, be stayed for six (6) months and such additional time as may be determined by the court from the date the insolvency is determined or an ancillary proceeding is instituted in this state, whichever is later, to permit proper defense by the association of all pending causes of action. The liquidator, receiver, or statutory successor of an insolvent insurer covered by this chapter shall permit access by the board or its authorized representative to such of the insolvent insurers records that are necessary for the board in carrying out its functions under this chapter with regard to covered claims. In addition, the liquidator, receiver, or statutory successor shall provide the board or its representative with copies of the records upon the request by the board and at the expense of the board.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-18. Repealed. History of Section.P.L. 1988, ch. 407,  2; Repealed by P.L. 2010, ch. 91,  2, effective June 19, 2010, and by P.L. 2010, ch. 117,  2, effective June 22, 2010. 
 27-34-19. Prohibition against advertising of membership in association. No person shall make, publish, or circulate, or cause to be made, published, or circulated, any statement that uses the existence of the association for the purposes of sale, solicitation, or inducement to purchase any form of insurance within the scope of this chapter.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-2. Purpose. The purpose of this chapter is to provide a mechanism for the payment of covered claims under certain insurance policies to avoid excessive delay in payment and to the extent provided in this chapter, minimize financial loss to claimants or policyholders because of the insolvency of an insurer, and to provide an association to assess the cost of such protection among insurers.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-3. Scope. This chapter shall apply to all kinds of direct insurance, but shall not be applicable to the following:  (1) Life, annuity, health, or disability insurance;  (2) Mortgage guaranty, financial guaranty or other forms of insurance offering protection against investment risks. For purposes of this section financial guaranty insurance include any insurance under which loss is payable upon proof of occurrence of any of the following events to the damage of an insured claimant or obligee:  (i) Failure of any obligor or obligors on any debt instrument or other monetary obligation, including common or preferred stock, to pay when due the principal, interest, dividend or purchase price of such instrument or obligation, whether failure is the result of a financial default or insolvency and whether or not the obligation is incurred directly or as a guarantor by, or on behalf of, another obligor which has also defaulted;  (ii) Changes in the level of interest rates whether short-term or long-term, or in the difference between interest rates existing in various markets;  (iii) Changes in the rate of exchange of currency, or from the inconvertibility of one currency into another for any reason;  (iv) Changes in the value of specific assets or commodities, or price levels in general;  (3) Fidelity or surety bonds, or any other bonding obligations;  (4) Credit insurance, vendors single interest insurance, or collateral protection insurance or any similar insurance protecting the interests of a creditor arising out of a creditor-debtor transaction. For purposes of this section credit insurance means insurance on accounts receivable;  (5) Insurance of warranties or service contracts including insurance that provides for the repair, replacement or service of goods or property, indemnification for repair, replacement or service for the operational or structural failure of the goods or property due to a defect in materials, workmanship or normal wear and tear, or provides reimbursement for the liability incurred by the issuer of agreements or service contracts that provide such benefits;  (6) Title insurance;  (7) Ocean marine insurance, except that portion of the marine protection and indemnity insurance covering liability of the insured for personal injury, illness, or death to employees and insurance covering pleasure craft;  (8) Any transaction or combination of transactions between a person, including affiliates of the person, and an insurer, including affiliates of such insurer, which involves the transfer of investment or credit risk unaccompanied by transfer of insurance risk;  (9) Any insurance provided by or guaranteed by government; or  (10) Any transaction or combination of transactions between a protected cell and the general account or another protected cell of a protected cell company organized under the Protected Cell Companies Act, chapter 64 of this title, as those terms are defined in this chapter.  History of Section.P.L. 1988, ch. 407,  2; P.L. 1990, ch. 19,  1; P.L. 1991, ch. 165,  1; P.L. 1999, ch. 22,  8; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-4. Construction. This chapter shall be liberally construed to effect the purpose under  27-34-2 which will constitute an aid and guide to interpretation. History of Section.P.L. 1988, ch. 407,  2. 
 27-34-5. Definitions. As used in this chapter: (1) Account means any one of the three (3) accounts created by  27-34-6;  (2) Affiliate means a person, who directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with another on December 31 of the year immediately preceding the date the insurer becomes an insolvent insurer;  (3) Association means the Rhode Island insurance guaranty association created under  27-34-6.  (4) Association similar to the association means any guaranty association, security fund or other insolvency mechanism that affords protection similar to that of the association. The term shall also include any property and casualty insolvency mechanism that obtains assessments or other contributions from insurers on a pre-insolvency basis.  (5) Assumed claims transaction means the following:  (i) Policy obligations that have been assumed by the insolvent insurer, prior to the entry of a final order of liquidation, through a merger between the insolvent insurer and another entity obligated under the policies, and for which assumption consideration has been paid to the applicable guaranty associations, if the merged entity is a non-member insurer;  (ii) Policy obligations that have been assumed by the insolvent insurer, prior to the entry of a final order of liquidation, pursuant to a plan, approved by the domestic commissioner of the assuming insurer, which:  (A) Transfers the direct policy obligations and future policy renewals from one insurer to another insurer; and  (B) For which assumption consideration has been paid to the applicable guaranty associations, if the assumption is from a non-member insurer.  (C) For purposes of this section the term non-member insurer also includes a self-insurer, non-admitted insurer and risk retention group; or  (iii) An assumption reinsurance transaction in which all of the following has occurred:  (A) The insolvent insurer assumed, prior to the entry of a final order of liquidation, the claim or policy obligations of another insurer or entity obligated under the claims or policies;  (B) The assumption of the claim or policy obligations has been approved, if such approval is required, by the appropriate regulatory authorities; and  (C) As a result of the assumption, the claim or policy obligations became the direct obligations of the insolvent insurer through a novation of the claims or policies.  (6) Assumption consideration shall mean the consideration received by a guaranty association to extend coverage to the policies assumed by a member insurer from a non-member insurer in any assumed claims transaction including liabilities that may have arisen prior to the date of the transaction. The assumption consideration shall be in an amount equal to the amount that would have been paid by the assuming insurer during the three (3) calendar years prior to the effective date of the transaction to the applicable guaranty associations if the business had been written directly by the assuming insurer.  (i) In the event that the amount of the premiums for the three (3) year period cannot be determined, the assumption consideration will be determined by multiplying one hundred thirty percent (130%) against the sum of the unpaid losses, loss adjustment expenses, and incurred but not reported losses, as of the effective date of the assumed claims transaction, and then multiplying such sum times the applicable guaranty association assessment percentage for the calendar year of the transaction.  (ii) The funds paid to a guaranty association shall be allocated in the same manner as any assessments made during the three (3) year period. The guaranty association receiving the assumption consideration shall not be required to recalculate or adjust any assessments levied during the prior three (3) calendar years as a result of receiving the assumption consideration. Assumption consideration paid by an insurer may be recouped in the same manner as other assessments made by a guaranty association.  (7) Claimant means any person instituting a covered claim; provided that no person who is an affiliate of the insolvent insurer may be a claimant;  (8) Commissioner means the director of the department of business regulation or his or her designee;  (9) Control means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with, or corporate office held by, the person. Control shall be presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing, ten percent (10%) or more of the voting securities of any other person. This presumption may be rebutted by a showing that control does not exist in fact;  (10) Covered claim means:  (i) An unpaid claim, including one for unearned premiums, submitted by a claimant, which arises out of and is within the coverage and subject to the applicable limits of an insurance policy to which this chapter applies if the insurer becomes an insolvent insurer after the effective date of this chapter and the policy was either issued by the insurer or assumed by the insurer in an assumed claims transaction, and:  (A) The claimant or insured is a resident of this state at the time of the insured event; provided, that for entities other than an individual, the residence of a claimant, insured or policyholder is the state in which its principal place of business is located at the time of the insured event; or  (B) The claim is a first-party claim for damage to property with a permanent location in this state.  (ii) Except as provided elsewhere in this section, covered claim shall not include:  (A) Any amount awarded as punitive or exemplary damages;  (B) Any amount sought as a return of premium under any retrospective rating plan; or  (C) Any amount due any reinsurer, insurer, insurance pool, or underwriting association, health maintenance organization, hospital plan corporation, professional health service corporation or self-insurer as subrogation recoveries, reinsurance recoveries, contribution, indemnification or otherwise. No claim for any amount due any reinsurer, insurer, insurance pool, underwriting association, health maintenance organization, hospital plan corporation, professional health service corporation or self-insurer may be asserted against a person insured under a policy issued by an insolvent insurer other than to the extent the claim exceeds the association obligation limitations set forth in  27-34-8;  (D) Any claims excluded pursuant to  27-34-11.5 due to the high net worth of an insured;  (E) Any first party claims by an insured that is an affiliate of the insolvent insurer;  (F) Any fee or other amount relating to goods or services sought by or on behalf of any attorney or other provider of goods or services retained by the insolvent insurer or an insured prior to the date it was determined to be insolvent;  (G) Any fee or other amount sought by or on behalf of any attorney or other provider of goods or services retained by any insured or claimant in connection with the assertion or prosecution of any claim, covered or otherwise, against the association;  (H) Any claims for interest; or  (I) Any claim filed with the association or a liquidator for protection afforded under the insureds policy for incurred-but-not-reported losses.  (11) Insolvent insurer means an insurer licensed to transact insurance in this state either at the time the policy was issued; when the obligation with respect to the covered claim was assumed under an assumed claims transaction; or when the insured event occurred, and against whom a final order of liquidation has been entered after the effective date of this chapter with a finding of insolvency by a court of competent jurisdiction in the insurers state of domicile;  (12) Insured means any named insured, any additional insured, any vendor, lessor or any other party identified as an insured under the policy.  (13) Line of credit means an irrevocable stand-by commitment whereby the association or member insurer and a qualified financial institution or group of qualified financial institutions enter into a formal and binding contract in which the qualified financial institution or group of qualified financial institutions agree to lend a certain amount of money within a stated period of time.  (14)(a) Member insurer means any person who:  (i) Writes any kind of insurance to which this chapter applies, under  27-34-3, including the exchange of reciprocal or interinsurance contracts;  (ii) Is licensed to transact insurance in this state; and  (b) An insurer shall cease to be a member insurer effective on the day following the termination or expiration of its license to transact the kinds of insurance to which this chapter applies, however, the insurer shall remain liable as a member insurer for any and all obligations, including obligations for assessments levied prior to the termination or expiration of the insurers license and assessment levied after the termination or expiration, which relate to any insurer that became an insolvent insurer prior to the termination or expiration of the insurers license.  (iii) Is not otherwise excepted from membership by statute or regulation.  (15) Net direct written premiums means direct gross premiums written in this state on insurance policies to which this chapter applies, including policy and membership fees, less the following amounts: (i) Return premiums, (ii) Premiums on policies not taken and (iii) Dividends paid or credited to policyholders on that direct business. Net direct written premiums does not include premiums on contracts between insurers or reinsurers;  (16) Novation means that the assumed claim or policy obligations became the direct obligations of the insolvent insurer through consent of the policyholder and that thereafter the ceding insurer or entity initially obligated under the claims or policies is released by the policyholder from performing its claim or policy obligations. Consent may be express or implied based upon the circumstances, notice provided and conduct of the parties.  (17) Ocean marine insurance means any form of insurance, regardless of the name, label or marketing designation of the insurance policy, which insures against maritime perils or risks and other related perils or risks, which are usually insured against by traditional marine insurance, such as hull and machinery, marine builders risk, and marine protection and indemnity. Perils and risk insured against include without limitation loss, damage, expense or legal liability of the insured for loss, damage or expense arising out of or incident to ownership, operation, chartering, maintenance, use, repair or construction of any vessel, craft or instrumentality in use in ocean or inland waterways for commercial purposes, including liability of the insured for personal injury, injury, illness or death or for loss or damage to the property of the insured or another person.  (18) Person means any individual, aggregation of individuals, corporation, partnership, or other entity;  (19) Qualified financial institution shall have the same meaning as the term in  27-1.1-3.  (20) Receiver means liquidator, rehabilitator, conservator or ancillary receiver, as the context requires.  (21) Self-insurer means a person that covers its liability through a qualified individual or group self-insurance program or any other formal program created for the specific purpose of covering liabilities typically covered by insurance.  (22) Self-insured retention means:  (i) Any fund or other arrangement to pay claims other than by an insurance company; or  (ii) Any arrangement under which an insurance company has no obligation to pay claims on behalf of an insured if it is not reimbursed by the insured.  History of Section.P.L. 1988, ch. 407,  2; P.L. 1990, ch. 19,  1; P.L. 1991, ch. 165,  1; P.L. 2002, ch. 292,  61; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-6. Creation of the association. There is created a nonprofit unincorporated legal entity to be known as the Rhode Island Property & Casualty Insurance Guaranty Association, such entity formerly known as the Rhode Island insurers insolvency fund. All insurers defined as member insurers in  27-34-5(12) shall be and remain members of the association as a condition of their authority to transact insurance in this state. The association shall perform its functions under a plan of operation established and approved under  27-34-9 and shall exercise its powers through a board of directors established under  27-34-7. For the purposes of administration and assessment, there shall be three (3) separate accounts: (1) the workers compensation insurance account; (2) the automobile insurance account; and (3) the account for all other insurance to which this chapter applies.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-7. Board of directors. (a) The board of directors of the association shall consist of not less than five (5) nor more than eleven (11) persons serving terms as established in the plan of operation. The members of the board shall be selected by member insurers subject to the approval of the commissioner. Vacancies on the board shall be filled for the remaining period of the term by a majority vote of the remaining insurer members subject to the approval of the commissioner. Two (2) persons, may be public representatives, and may be appointed by the commissioner to the board of directors. Vacancies of positions held by public representatives shall be filled by the commissioner. A public representative may not be an officer, director or employee of an insurance company or any person engaged in the business of insurance. For the purposes of this section, term director shall mean an individual serving on behalf of an insurer member of the board of directors or a public representative on the board of directors.  (b) In approving selections to the board, the commissioner shall consider among other things whether all member insurers are fairly represented.  (c) Members of the board of directors may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors.  (d) Any board member who is an insurer in receivership shall be terminated as a board member, effective as of the date of the entry of the order of receivership. Any resulting vacancies on the board shall be filled for the remaining period of the term in accordance with the provisions of subsection (a).  (e) In the event that a director shall, because of illness, nonattendance at meetings or any other reason, be deemed unable to satisfactorily perform the designated functions as a director by missing three (3) consecutive board meetings, the board of directors may declare the office vacant and the member or director shall be replaced in accordance with the provisions of subsection (a).  (f) If the commissioner has reasonable cause to believe that a director failed to disclose a known conflict of interest with his or her duties on the board, failed to take appropriate action based on a known conflict or interest with his or her duties on the board, or has been indicted or charged with a felony, or misdemeanor involving moral turpitude, the commissioner may suspend that director pending the outcome of an investigation or hearing by the commissioner or the conclusion of any criminal proceedings. A company elected to the board may replace a suspended director prior to the completion of an investigation, hearing or criminal proceeding. In the event that the allegations are substantiated at the conclusion of an investigation, hearing or criminal proceeding, the office shall be declared vacant and the member or director shall be replaced in accordance with the provisions of subsection (a).  History of Section.P.L. 1988, ch. 407,  2; P.L. 2002, ch. 292,  61; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-8. Powers and duties of the association. (a) The association shall:  (1)(i) Be obligated to pay covered claims existing prior to the order of liquidation; arising within sixty (60) days after the order of liquidation or before the policy expiration date if less than sixty (60) days after the order of liquidation or before the insured replaces the policy or causes its cancellation if the insured does so within sixty (60) days of the order of liquidation. The obligations shall be satisfied by paying to the claimant an amount as follows:  (A) The full amount of a covered claim for benefits under a workers compensation insurance coverage;  (B) An amount not exceeding ten thousand dollars ($10,000), per policy for a covered claim for the return of unearned premium;  (C) An amount not exceeding five hundred thousand dollars ($500,000), per claimant for all other covered claims for insolvencies occurring on or after January 1, 2008 and an amount not exceeding three hundred thousand dollars ($300,000) per claimant for all other covered claims for insolvencies occurring prior to January 1, 2008.  (ii) In no event shall the association be obligated to pay a claimant an amount in excess of the obligation of the insolvent insurer under the policy or coverage from which the claim arises. Notwithstanding any other provision of this chapter, a covered claim shall not include a claim filed with the guaranty association after the final date set by the court for the filing of claims against the liquidator or receiver of an insolvent insurer. For the purpose of filing a claim under this subsection, notice of claims to the liquidator of the insolvent insurer shall be deemed notice to the association or its agent and a list of claims shall be periodically submitted to the association or association similar to the association in another state by the liquidator;  (iii) Any obligation of the association to defend an insured shall cease upon the associations payment or tender of an amount equal to the lesser of the associations covered claim obligation limit or the applicable policy limit.  (2) Be deemed the insurer to the extent of its obligation on the covered claims and to that extent, subject to the limitation provided in this chapter, shall have all rights, duties and obligations of the insolvent insurer as if the insurer had not become insolvent, including, but not limited to, the right to pursue and retain salvage and subrogation recoverable on covered claim obligations to the extent paid by the association. The association shall not be deemed the insolvent insurer for the purpose of conferring jurisdiction;  (3) Allocate claims paid and expenses incurred among the three (3) accounts separately, and assess member insurers separately for each account amounts necessary to pay the obligations of the association under subdivision (a)(1) of this subsection subsequent to an insolvency, the expenses of handling covered claims subsequent to an insolvency and other expenses authorized by this chapter. The assessments of each member insurer shall be in the proportion that the net direct written premiums of the member insurer for the calendar year preceding the assessment on the kinds of insurance in the account bears to the net direct written premiums of all member insurers for the calendar year preceding the assessment on the kinds of insurance in the account. Each member insurer shall be notified of the assessment not later than thirty (30) days before it is due.  A member insurer may not be assessed in any one year on any account an amount greater than two percent (2%) of that member insurers net direct written premiums for the calendar year preceding the assessment on the kinds of insurance in the account. If the maximum assessment, together with the other assets of the association in any account, does not provide in any one year in any account an amount sufficient to make all necessary payments from that account, each member insurer shall be assessed the additional amount that must be obtained to make all necessary payments of the underfunded account from the other two accounts, subject to the same limitation of two percent (2%) of that member insurers net direct written premiums for the calendar year preceding the assessment on the kinds of insurance in the account. The additional assessments shall be considered loans by and between the separate accounts. Amounts borrowed under this subsection shall be paid back to the separate accounts from which they were borrowed, out of assets, including, but not limited to, existing and future assessments in the account receiving the loan. An interest charge shall be levied on all amounts borrowed under this subsection based on the average prime rate of interest for each year the money remains unpaid. If the amounts borrowed remain unpaid on the seventh yearly anniversary as a result of the inability of the borrowing account to make repayment, then the amount borrowed and interest which is not repaid, starting with the principal and interest of the first year, shall be considered uncollectible. The funds available shall be prorated and the unpaid portion shall be paid as soon after this as funds become available. The association may exempt or defer, in whole or in part, the assessment of any member insurer if the assessment would cause the member insurers financial statement to reflect amounts of capital or surplus less than the minimum amounts required for a certificate of authority by any jurisdiction in which the member insurer is authorized to transact insurance. However, during the period of deferment, no dividends shall be paid to shareholders or policyholders. Deferred assessments shall be paid when the payment will not reduce capital or surplus below required minimums. Payments shall be refunded to those companies receiving larger assessments by virtue of the deferment, or, at the election of any company, credited against future assessments.  (4) Investigate claims brought against the association and adjust, compromise, settle, and pay covered claims to the extent of the associations obligation and deny all other claims. The association shall pay claims in any order that it may deem reasonable, including the payment of claims as they are received from the claimants or in groups or categories of claims. The association shall have the right to appoint and to direct legal counsel retained under liability insurance policies for the defense of covered claims;  (5) Notify claimants in this state as deemed necessary by the commissioner and upon the commissioners request, to the extent records are available to the association;  (6)(i) Have the right to review and contest as set forth in this subsection settlements, releases, compromises, waivers and judgments to which the insolvent insurer or its insureds were parties prior to the entry of the order of liquidation. In an action to enforce settlements, releases and judgments to which the insolvent insurer or its insureds were parties prior to the entry of the order of liquidation, the association shall have the right to assert the following defenses, in addition to the defenses available to the insurer:  (A) The association is not bound by a settlement, release, compromise or waiver executed by an insured or the insurer, or any judgment entered against an insured or the insurer by consent or through a failure to exhaust all appeals, if the settlement, release, compromise, waiver or judgment was:  (I) Executed or entered into within one hundred twenty (120) days prior to the entry of an order of liquidation, and the insured or the insurer did not use reasonable care in entering into the settlement, release, compromise, waiver or judgment, or did not pursue all reasonable appeals of an adverse judgment; or  (II) Executed by or taken against an insured or the insurer based on default, fraud, collusion or the insurers failure to defend.  (B) If a court of competent jurisdiction finds that the association is not bound by a settlement, release, compromise, waiver or judgment for the reasons described in subparagraph (i)(A), the settlement, release, compromise, waiver or judgment shall be set aside, and the association shall be permitted to defend any covered claim on the merits. The settlement, release, compromise, waiver or judgment may not be considered as evidence of liability or damages in connection with any claim brought against the association or any other party under this chapter.  (C) The association shall have the right to assert any statutory defenses or rights of offset against any settlement, release, compromise or waiver executed by an insured or the insurer, or any judgment taken against the insured or the insurer.  (ii) As to any covered claims arising from a judgment under any decision, verdict or finding based on the default of the insolvent insurer or its failure to defend, the association, either on its own behalf or on behalf of an insured may apply to have the judgment, order, decision, verdict or finding set aside by the same court or administrator that entered the judgment, order, decision, verdict or finding and shall be permitted to defend the claim on the merits.  (7) Handle claims through its employees or through one or more insurers or other persons designated as servicing facilities. Designation of a servicing facility is subject to the approval of the commissioner, but the designation may be declined by a member insurer;  (8) Reimburse each servicing facility for obligations of the association paid by the facility and for expenses incurred by the facility while handling claims on behalf of the association and shall pay the other expenses of the association authorized by this chapter;  (9)(i) The association shall obtain a line of credit for the benefit of each account, in an amount not to exceed the applicable maximum to ensure the immediate availability of funds for purposes of future claims and expenses attributable to an insurer insolvency in that account. The line of credit shall be obtained from qualified financial institutions. The line of credit shall provide for a thirty (30) day notice of termination or nonrenewal to the commissioner and the association and shall provide funding to the association within three (3) business days of receipt of written notice from the commissioner of an insolvent insurer in that account. Each member insurer upon receipt of notice from the association shall make immediate payment for its proportionate share of the amount borrowed based on the premium for the preceding calendar year. The maximum line of credit or preinsolvency assessment for each account shall be subject to prior review and approval by the commissioner at the time of origination.  (ii) If the association cannot obtain a line of credit, the association may obtain an irrevocable line of credit agreement from each member insurer in an amount not to exceed the member insurers maximum assessment pursuant to subdivision (3) of this subsection to ensure the immediate availability of funds for the purposes of future claims and expenses attributable to an insurer insolvency;  Any amount drawn under any line of credit shall be considered a payment toward the member insurers assessment provided for in subdivision (3) of this subsection;  The member insurer shall provide funding to the association under the line of credit within three (3) business days of receipt of a written request from the association for a draw-down under the line of credit;  The line of credit agreement shall be subject to prior review and approval by the commissioner at the time of origination and any subsequent renewal. It shall include any commercially reasonable provisions the association or the commissioner may deem advisable, including a provision that the line of credit is irrevocable or for a stated period of time and provides for thirty (30) day notice to the association and the commissioner that the line is being terminated or not renewed;  (iii) If a line of credit is not given as provided for in this section, the member insurer shall be responsible for the payment of an assessment of up to the members proportionate share of the applicable maximum as set forth in this subsection which shall be paid into a pre-insolvency assessment fund in each account.  (10) Submit, not later than ninety (90) days after the end of the associations fiscal year, a financial report for the preceding fiscal year in a form approved by the commissioner.  (b) The association may:  (1) Employ or retain persons as are necessary to handle claims and perform other duties of the association;  (2) Borrow funds necessary to effect the purposes of this chapter in accordance with the plan of operation;  (3) Sue or be sued;  (4) Negotiate and become a party to any contracts necessary to carry out the purpose of this chapter;  (5) Perform any other acts necessary or proper to effectuate the purpose of this chapter; and  (6) Refund to the member insurers in proportion to the contribution of each member insurer to that account that amount by which the assets of the account exceed the liabilities, if, at the end of any calendar year, the board of directors finds that the assets of the association in any account exceed the liabilities of that account as estimated by the board of directors for the coming year.  (c) Suits involving the association:  (1) Except for actions by the receiver, all actions relating to or arising out of this chapter against the association shall be brought in the courts in this state. The courts shall have exclusive jurisdiction over all actions relating to or arising out of this chapter against the association.  (2) The exclusive venue in any action by or against the association is in the Providence county superior court. The association may, at its option, waive this venue as to specific actions.  History of Section.P.L. 1988, ch. 407,  2; P.L. 1990, ch. 19,  1; P.L. 1991, ch. 2,  1; P.L. 1991, ch. 348,  12; P.L. 1992, ch. 137,  1; P.L. 1994, ch. 404,  16; P.L. 1996, ch. 189,  1; P.L. 2002, ch. 292,  61; P.L. 2004, ch. 549,  1; P.L. 2004, ch. 607,  1; P.L. 2005, ch. 161,  1; P.L. 2005, ch. 189,  1; P.L. 2006, ch. 111,  1; P.L. 2006, ch. 131,  1; P.L. 2007, ch. 88,  1; P.L. 2007, ch. 130,  1; P.L. 2007, ch. 341,  1; P.L. 2007, ch. 431,  1; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-34-9. Plan of operation. (a) The association shall submit to the commissioner a plan of operation and any amendments to the plan of operation necessary or suitable to assure the fair, reasonable, and equitable administration of the association. The plan of operation and amendments shall become effective upon approval in writing by the commissioner.  (b) If the association fails to submit a suitable plan of operation or suitable amendments to the plan, the commissioner shall, after notice and hearing, adopt and promulgate any reasonable rules necessary or advisable to effectuate the provisions of this chapter. The rules shall continue in force until modified by the commissioner or superseded by a plan or amendments to it submitted by the association and approved by the commissioner.  (c) All member insurers shall comply with the plan of operation.  (d) The plan of operation shall:  (1) Establish the procedures where all of the powers and duties of the fund under  27-34-8 will be performed;  (2) Establish the procedures for handling the assets of the association;  (3) Require that written procedures be established for the disposition of liquidating dividends or other monies received from the estate of the insolvent insurer;  (4) Require that written procedures be established to designate the amount and method of reimbursing members of the board of directors under  27-34-7;  (5) Establish procedures by which claims may be filed with the association and establish acceptable forms of proof of covered claims.  (6) Establish regular places and times for meetings of the board of directors;  (7) Require that written procedures be established for records to be kept of all financial transactions of the association, its agents and the board of directors;  (8) Provide that any member insurer aggrieved by any final action or decision of the association may appeal to the commissioner within thirty (30) days after the action or decision;  (9) Establish the procedures under which selections for the board of directors will be submitted to the commissioner;  (10) Contain additional provisions necessary or proper for the execution of the powers and duties of the association.  (e) The plan of operation may provide that any or all powers and duties of the association, except those under  27-34-8(a)(3) and 27-34-8(b)(2), are delegated to a corporation, association, similar to the association or other organization which performs or will perform functions similar to those of the association, or its equivalent, in two or more states. The corporation, association, similar to the association or organization shall be reimbursed as a servicing facility would be reimbursed and shall be paid for its performance of any other functions of the association. A delegation under this subsection shall take effect only with the approval of both the board of directors and the commissioner, and may be made only to a corporation, association, or organization which extends protection not substantially less favorable and effective than that provided by this chapter.  History of Section.P.L. 1988, ch. 407,  2; P.L. 2002, ch. 292,  61; P.L. 2010, ch. 91,  1; P.L. 2010, ch. 117,  1. 
 27-35-1.5. Subsidiaries of insurer. (a) Authorization. A domestic insurer, either by itself or in cooperation with one or more persons, may organize or acquire one or more subsidiaries. The subsidiaries may conduct any kind of business or businesses and their authority to do so shall not be limited by reason of the fact they are subsidiaries of a domestic insurer.  (b) Additional investment authority. In addition to investments in common stock, preferred stock, debt obligations and other securities permitted under all other sections of this chapter, a domestic insurer may also:  (1) Invest, in common stock, preferred stock, debt obligations, and other securities of one or more subsidiaries, amounts which do not exceed the lesser of ten percent (10%) of the insurers assets or fifty percent (50%) of the insurers surplus as regards policyholders, provided that after such investments, the insurers surplus as regards policyholders will be reasonable in relation to the insurers outstanding liabilities and adequate to meet its financial needs. In calculating the amount of such investments, investments in domestic or foreign insurance subsidiaries and health maintenance organizations shall be excluded, and there shall be included:  (i) Total net monies or other consideration expended and obligations assumed in the acquisition or formation of a subsidiary, including all organizational expenses and contributions to capital and surplus of the subsidiary whether or not represented by the purchase of capital stock or issuance of other securities; and  (ii) All amounts expended in acquiring additional common stock, preferred stock, debt obligations, and other securities; and all contributions to the capital or surplus of a subsidiary subsequent to its acquisition or formation;  (2) Invest any amount in common stock, preferred stock, debt obligations and other securities of one or more subsidiaries engaged or organized to engage exclusively in the ownership and management of assets authorized as investments for the insurer provided that each subsidiary agrees to limit its investments in any asset so that such investments will not cause the amount of the total investment of the insurer to exceed any of the investment limitations specified in subsection (b)(1) of this section or in chapter 11.1 of this title applicable to the insurer. For the purpose of this paragraph, the total investment of the insurer shall include:  (i) Any direct investment by the insurer in an asset; and  (ii) The insurers proportionate share of any investment in an asset by any subsidiary of the insurer, which shall be calculated by multiplying the amount of the subsidiarys investment by the percentage of the ownership of the subsidiary;  (3) With the approval of the commissioner, invest any greater amount in common stock, preferred stock, debt obligations, or other securities of one or more subsidiaries; provided that after the investment the insurers surplus as regards policyholders will be reasonable in relation to the insurers outstanding liabilities and adequate to its financial needs.  (c) Exemption from investment restrictions. Investments in common stock, preferred stock, debt obligations or other securities of subsidiaries made pursuant to subsection (b) of this section shall not be subject to any of the otherwise applicable restrictions or prohibitions contained in this chapter applicable to such investments of insurers.  (d) Qualification of investment; When determined. Whether any investment made pursuant to subsection (b) of this section meets the applicable requirements of that subsection is to be determined before the investment is made, by calculating the applicable investment limitations as though the investment had already been made, taking into account the then outstanding principal balance on all previous investments in debt obligations, and the value of all previous investments in equity securities as of the day they were made, net of any return of capital invested, not including dividends.  (e) Cessation of control. If an insurer ceases to control a subsidiary, it shall dispose of any investment therein made pursuant to this section within three (3) years from the time of the cessation of control or within such further time as the commissioner may prescribe, unless at any time after the investment shall have been made, the investment shall have met the requirements for investment under any other section of this chapter, and the insurer has so notified the commissioner.  History of Section.P.L. 2010, ch. 55,  2; P.L. 2010, ch. 70,  2. 
 27-35-1. Definitions. (a) Affiliate. An affiliate of, or person affiliated with, a specific person, is a person who directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the person specified. An affiliate does not include a protected cell of a protected cell company organized under the protected cell companies act, chapter 64 of this title.  (b) Commissioner means the definition prescribed by  42-14-5.  (c) Control. The term control (including the terms controlling, controlled by, and under common control with), means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or management services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control shall be presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing, ten percent (10%) or more of the voting securities of any other person. This presumption may be rebutted by a showing made in the manner provided by  27-35-3(k) that control does not exist in fact. The commissioner may determine, after furnishing all persons in interest notice and opportunity to be heard and making specific findings of fact to support the determination, that control exists in fact, notwithstanding the absence of a presumption to that effect.  (d) Group capital calculation instructions means the group capital calculation instructions, as adopted by the NAIC and as amended by the NAIC from time to time, in accordance with the procedures adopted by the NAIC.  (e) Group-wide supervisor means the regulatory official authorized to engage in conducting and coordinating group-wide supervision activities who is determined or acknowledged by the commissioner under  27-35-5.5(d) to have sufficient significant contacts with the internationally active insurance group.  (f) Insurance holding company system. An insurance holding company system consists of two (2) or more affiliated persons, one or more of which is an insurer.  (g) Insurer. The term insurer means any person or persons or corporation, partnership, or company authorized by the laws of this state to transact the business of insurance in this state, including entities organized or authorized to transact business in this state pursuant to chapters 19, 20, 20.1, 20.2, 20.3, and 41 of this title, except that it shall not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state.  (h) Internationally active insurance group means an insurance holding company system that:  (1) Includes an insurer registered under  27-35-3; and  (2) Meets the following criteria:  (i) Premiums written in at least three (3) countries;  (ii) The percentage of gross premiums written outside the United States is at least ten percent (10%) of the insurance holding company systems total gross written premiums; and  (iii) Based on a three-year (3) rolling average, the total assets of the insurance holding company system are at least fifty billion dollars ($50,000,000,000) or the total gross written premiums of the insurance holding company system are at least ten billion dollars ($10,000,000,000).  (i) Enterprise Risk. Enterprise Risk means any activity, circumstance, event or series of events involving one or more affiliates of an insurer that, if not remedied promptly, is likely to have a material adverse effect upon the financial condition or liquidity of the insurer or its insurance holding company system as a whole, including, but not limited to, anything that would cause the insurers risk-based capital to fall into company action level as set forth in chapters 4.6 and 4.7 of this title or would cause the insurer to be in a hazardous financial condition as set forth in chapter 14.2 of this title.  (j) NAIC means the National Association of Insurance Commissioners.  (k) NAIC liquidity stress test framework. The NAIC liquidity stress test framework is a separate NAIC publication that includes a history of the NAICs development of regulatory liquidity stress testing, the scope criteria applicable for a specific data year, and the liquidity stress test instructions and reporting templates for a specific data year, such scope criteria, instructions and reporting template being as adopted by the NAIC and as amended by the NAIC from time to time, in accordance with the procedures adopted by the NAIC.  (l) Person. A person is an individual, a corporation, a limited liability company, a partnership, an association, a joint stock company, a trust, an unincorporated organization, or any similar entity or any combination of the foregoing acting in concert, but shall not include any joint venture partnership exclusively engaged in owning, managing, leasing or developing real or tangible personal property.  (m) Scope criteria. The scope criteria, as detailed in the NAIC liquidity stress test framework, are the designated exposure bases along with minimum magnitudes thereof for the specified data year, used to establish a preliminary list of insurers considered scoped into the NAIC liquidity stress test framework for that data year.  (n) Securityholder. A securityholder of a specified person is one who owns any security of such person, including common stock, preferred stock, debt obligations, and any other security convertible into or evidencing the right to acquire any of the foregoing.  (o) Subsidiary. A subsidiary of a specified person is an affiliate controlled by such person directly, or indirectly, through one or more intermediaries.  (p) Voting security. The term voting security shall include any security convertible into or evidencing a right to acquire a voting security.  History of Section.P.L. 1971, ch. 273,  1; P.L. 1999, ch. 22,  11; P.L. 2000, ch. 178,  8; P.L. 2000, ch. 200,  18; P.L. 2000, ch. 229,  18; P.L. 2010, ch. 55,  1; P.L. 2010, ch. 70,  1; P.L. 2011, ch. 15,  2; P.L. 2011, ch. 26,  2; P.L. 2015, ch. 82,  13; P.L. 2015, ch. 105,  13; P.L. 2021, ch. 230,  3, effective July 8, 2021; P.L. 2021, ch. 231,  3, effective July 8, 2021. 
 27-35-10.5. Recovery. (a) If an order for liquidation or rehabilitation of a domestic insurer has been entered, the receiver appointed under the order shall have a right to recover on behalf of the insurer, (i) from any parent corporation or holding company or person or affiliate who otherwise controlled the insurer, the amount of distributions (other than distributions of shares of the same class of stock) paid by the insurer on its capital stock, or (ii) any payment in the form of a bonus, termination settlement or extraordinary lump sum salary adjustment made by the insurer or its subsidiary to a director, officer or employee, where the distribution or payment pursuant to (i) or (ii) is made at any time during the one year preceding the petition for liquidation, conservation or rehabilitation, as the case may be, subject to the limitations of subsections (b), (c), and (d) of this section.  (b) No distribution shall be recoverable if the parent or affiliate shows that when paid the distribution was lawful and reasonable, and that the insurer did not know and could not reasonably have known that the distribution might adversely affect the ability of the insurer to fulfill its contractual obligations.  (c) Any person who was a parent corporation or holding company or a person who otherwise controlled the insurer or affiliate at the time the distributions were paid shall be liable up to the amount of distributions or payments under subsection (a) of this section which the person received. Any person who otherwise controlled the insurer at the time the distributions were declared shall be liable up to the amount of distributions that would have been received if they had been paid immediately. If two (2) or more persons are liable with respect to the same distributions, they shall be jointly and severally liable.  (d) The maximum amount recoverable under this section shall be the amount needed in excess of all other available assets of the impaired or insolvent insurer to pay the contractual obligations of the impaired or insolvent insurer and to reimburse any guaranty funds.  (e) To the extent that any person liable under subsection (c) of this section is insolvent or otherwise fails to pay claims due from it, its parent corporation or holding company or person who otherwise controlled it at the time the distribution was paid, shall be jointly and severally liable for any resulting deficiency in the amount recovered from the parent corporation or holding company or person who otherwise controlled it.  History of Section.P.L. 2010, ch. 55,  2; P.L. 2010, ch. 70,  2. 
 27-35-10. Receivership. Whenever it appears to the commissioner that any person has committed a violation of this chapter which impairs the financial condition of a domestic insurer as to threaten insolvency or make the further transaction of business by it hazardous to its policyholders, creditors, shareholders, or the public, then the commissioner may proceed as provided in chapter 14.3 of this title to take possession of the property of the domestic insurer and to conduct its business.  History of Section.P.L. 1971, ch. 273,  1; P.L. 2011, ch. 15,  2; P.L. 2011, ch. 26,  2. 
 27-35-11. Revocation, suspension, or nonrenewal of insurers license. Whenever it appears to the commissioner that any person has committed a violation of this chapter which makes the continued operation of an insurer contrary to the interests of policyholders or the public, the commissioner may, after giving notice and an opportunity to be heard, determine to suspend, revoke, or refuse to renew the insurers license or authority to do business in this state for any period that he or she finds is required for the protection of policyholders or the public. That determination shall be accompanied by specific findings of fact and conclusions of law.  History of Section.P.L. 1971, ch. 273,  1. 
 27-35-12. Judicial review  Mandamus. (a) Any person aggrieved by any act, determination, rule, regulation, or order or any other action of the commissioner pursuant to this chapter may appeal the action to the superior court. The court shall conduct its review without a jury and by trial de novo, except that if all parties, including the commissioner, so stipulate, the review shall be confined to the record. Portions of the record may be introduced by stipulation into evidence in a trial de novo as to those parties so stipulating.  (b) The filing of an appeal pursuant to this section shall stay the application of any rule, regulation, order or other action of the commissioner to the appealing party unless the court, after giving the party notice and an opportunity to be heard, determines that a stay would be detrimental to the interest of policyholders, shareholders, creditors or the public.  (c) Any person aggrieved by any failure of the commissioner to act or make a determination required by this chapter may petition the superior court of Providence County for a writ in the nature of a mandamus or a peremptory mandamus directing the commissioner to act or make the determination.  History of Section.P.L. 1971, ch. 273,  1; P.L. 2010, ch. 55,  1; P.L. 2010, ch. 70,  1. 
 27-35-13. Conflict with other laws. All laws and parts of laws of this state inconsistent with this chapter are superseded with respect to matters covered by this chapter.  History of Section.P.L. 1971, ch. 273,  1. 
 27-35-14. Severability. If any provision of this chapter or its application to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application, and for this purpose the provisions of this chapter are severable.  History of Section.P.L. 1971, ch. 273,  1. 
 27-35-2.5. Acquisitions involving insurers not otherwise covered. (a) Definitions. The following definitions shall apply for the purposes of this section only:  (1) Acquisition means any agreement, arrangement or activity the consummation of which results in a person acquiring directly or indirectly the control of another person, and includes but is not limited to, the acquisition of voting securities, the acquisition of assets, bulk reinsurance and mergers.  (2) An involved insurer includes an insurer which either acquires or is acquired, is affiliated with an acquirer or acquired, or is the result of a merger.  (b) Scope.(1) Except as exempted in paragraph (2) of this subsection, this section applies to any acquisition in which there is a change in control of an insurer authorized to do business in this state.  (2) This section shall not apply to the following:  (a) A purchase of securities solely for investment purposes so long as the securities are not used by voting or otherwise to cause or attempt to cause the substantial lessening of competition in any insurance market in this state. If a purchase of securities results in a presumption of control under  27-35-1(c), it is not solely for investment purposes unless the commissioner of the insurers state of domicile accepts a disclaimer of control or affirmatively finds that control does not exist and the disclaimer action or affirmative finding is communicated by the domiciliary commissioner to the commissioner of this state;  (b) The acquisition of a person by another person when both persons are neither directly nor through affiliates primarily engaged in the business of insurance, if pre-acquisition notification is filed with the commissioner in accordance with subdivision (c)(1) of this section thirty (30) days prior to the proposed effective date of the acquisition. However, such pre-acquisition notification is not required for exclusion from this section if the acquisition would otherwise be excluded from this section by any other subparagraph of subdivision (b)(2) of this section;  (c) The acquisition of already affiliated persons;  (d) An acquisition if, as an immediate result of the acquisition,  (i) In no market would the combined market share of the involved insurers exceed five percent (5%) of the total market,  (ii) There would be no increase in any market share, or  (iii) In no market would  (I) The combined market share of the involved insurers exceed twelve percent (12%) of the total market, and  (II) The market share increase by more than two percent (2%) of the total market.  For the purpose of section (2)(d), a market means direct written insurance premium in this state for a line of business as contained in the annual statement required to be filed by insurers licensed to do business in this state;  (e) An acquisition for which a pre-acquisition notification would be required pursuant to this section due solely to the resulting effect on the ocean marine insurance line of business;  (f) An acquisition of an insurer whose domiciliary commissioner affirmatively finds that the insurer is in failing condition; there is a lack of feasible alternative to improving such condition; the public benefits of improving the insurers condition through the acquisition exceed the public benefits that would arise from not lessening competition; and the findings are communicated by the domiciliary commissioner to the commissioner of this state.  (c) Pre-acquisition notification; Waiting period. An acquisition covered by subsection (b) of this section may be subject to an order pursuant to subsection (e) of this section unless the acquiring person files a pre-acquisition notification and the waiting period has expired. The acquired person may file a pre-acquisition notification. The commissioner shall give confidential treatment to information submitted under this subsection in the same manner as provided in  27-35-6.  (1) The pre-acquisition notification shall be in such form and contain such information as prescribed by the NAIC relating to those markets which, under subdivision (b)(2)(d) of this section, cause the acquisition not to be exempted from the provisions of this section. The commissioner may require such additional material and information as deemed necessary to determine whether the proposed acquisition, if consummated, would violate the competitive standard of subsection (d) of this section. The required information may include an opinion of an economist as to the competitive impact of the acquisition in this state accompanied by a summary of the education and experience of such person indicating his or her ability to render an informed opinion.  (2) The waiting period required shall begin on the date of receipt of the commissioner of a pre-acquisition notification and shall end on the earlier of the thirtieth day after the date of receipt, or termination of the waiting period by the commissioner. Prior to the end of the waiting period, the commissioner on a one-time basis may require the submission of additional needed information relevant to the proposed acquisition, in which event the waiting period shall end on the earlier of the thirtieth day after receipt of the additional information by the commissioner or termination of the waiting period by the commissioner.  (d) Competitive standard.(1) The commissioner may enter an order under subdivision (e)(1) of this section with respect to an acquisition if there is substantial evidence that the effect of the acquisition may be substantially to lessen competition in any line of insurance in this state or tend to create a monopoly or if the insurer fails to file adequate information in compliance with subsection (c) of this section.  (2) In determining whether a proposed acquisition would violate the competitive standard of paragraph (1) of this subsection, the commissioner shall consider the following:  (a) Any acquisition covered under subsection (b) of this section involving two (2) or more insurers competing in the same market is prima facie evidence of violation of the competitive standards.  (i) If the market is highly concentrated and the involved insurers possess the following shares of the market:       Insurer A Insurer B     4% 4% or more   10% 2% or more   15% 1% or more    (ii) Or, if the market is not highly concentrated and the involved insurers possess the following shares of the market:       Insurer A Insurer B     5% 5% or more   10% 4% or more   15% 3% or more   19% 1% or more    A highly concentrated market is one in which the share of the four (4) largest insurers is seventy-five percent (75%) or more of the market. Percentages not shown in the tables are interpolated proportionately to the percentages that are shown. If more than two (2) insurers are involved, exceeding the total of the two columns in the table is prima facie evidence of violation of the competitive standard in paragraph (1) of this subsection. For the purpose of this item, the insurer with the largest share of the market shall be deemed to be Insurer A.  (b) There is a significant trend toward increased concentration when the aggregate market share of any grouping of the largest insurers in the market, from the two (2) largest to the eight (8) largest, has increased by seven percent (7%) or more of the market over a period of time extending from any base year five (5) to ten (10) years prior to the acquisition up to the time of the acquisition. Any acquisition or merger covered under subsection (b) of this section involving two (2) or more insurers competing in the same market is prima facie evidence of violation of the competitive standard in paragraph (1) of this subsection if:  (i) There is a significant trend toward increased concentration in the market;  (ii) One of the insurers involved is one of the insurers in a grouping of large insurers showing the requisite increase in the market share; and  (iii) Another involved insurers market is two percent (2%) or more.  (c) For the purposes of subdivision (d)(2) of this section:  (i) The term insurer includes any company or group of companies under common management, ownership or control;  (ii) The term market means the relevant product and geographical markets. In determining the relevant product and geographical markets, the commissioner shall give due consideration to, among other things, the definitions or guidelines, if any, promulgated by the NAIC and to information, if any, submitted by parties to the acquisition. In the absence of sufficient information to the contrary, the relevant product market is assumed to be the direct written insurance premium for a line of business, such line being that used in the annual statement required to be filed by insurers doing business in this state, and the relevant geographical market is assumed to be this state;  (iii) The burden of showing prima facie evidence of violation of the competitive standard rests upon the commissioner.  (d) Even though an acquisition is not prima facie violative of the competitive standard under paragraphs (2)(a) and (2)(b) of this subsection, the commissioner may establish the requisite anticompetitive effect based upon other substantial evidence. Even though an acquisition is prima facie violative of the competitive standard under sections (2)(a) and (2)(b) of this subsection, a party may establish the absence of the requisite anticompetitive effect based upon other substantial evidence. Relevant factors in making a determination under this subparagraph include, but are not limited to, the following: market shares, volatility of ranking of market leaders, number of competitors, concentration, trend of concentration in the industry, and ease of entry and exit into the market.  (3) An order may not be entered under subdivision (e)(1) of this section if:  (a) The acquisition will yield substantial economies of scale or economies in resource utilization that cannot be feasibly achieved in any other way, and the public benefits which would arise from such economies exceed the public benefits which would arise from not lessening competition; or  (b) The acquisition will substantially increase the availability of insurance, and the public benefits of the increase exceed the public benefits which would arise from not lessening competition.  (e) Orders and penalties.(1)(a) If an acquisition violates the standards of this section, the commissioner may enter an order:  (i) Requiring an involved insurer to cease and desist from doing business in this state with respect to the line or lines of insurance involved in the violation; or  (ii) Denying the application of an acquired or acquiring insurer for a license to do business in this state.  (b) Such an order shall not be entered unless:  (i) There is a hearing;  (ii) Notice of the hearing is issued prior to the end of the waiting period and not less than fifteen (15) days prior to the hearing; and  (iii) The hearing is concluded and the order is issued no later than sixty (60) days after the date of the filing of the pre-acquisition notification with the commissioner.  Every order shall be accompanied by a written decision of the commissioner setting forth findings of fact and conclusions of law.  (c) An order pursuant to this paragraph shall not apply if the acquisition is not consummated.  (2) Any person who violates a cease and desist order of the commissioner under paragraph (1) and while the order is in effect may, after notice and hearing and upon order of the commissioner, be subject to one or more of the penalties set forth in  42-14-16:  (3) Any insurer or other person who fails to make any filing required by this section, and who also fails to demonstrate a good faith effort to comply with any filing requirement, shall be subject to one or more penalties set forth in  42-14-16.  (f) Inapplicable provisions. Sections 27-35-8(b), 27-35-8(c), and 27-35-10 do not apply to acquisitions covered under subsection (b) of this section.  History of Section.P.L. 2010, ch. 55,  2; P.L. 2010, ch. 70,  2; P.L. 2011, ch. 15,  2; P.L. 2011, ch. 26,  2. 
 27-35-2. Acquisition of control of or merger with domestic insurer. (a) Filing requirements.(1) No person other than the issuer shall make a tender offer for or a request or invitation for tenders of, or enter into any agreement to exchange securities for, seek to acquire, or acquire, in the open market or otherwise, any voting security of a domestic insurer if, after the consummation thereof, such person would, directly or indirectly (or by conversion or by exercise of any right to acquire) be in control of the insurer, and no person shall enter into an agreement to merge with or otherwise to acquire control of a domestic insurer or any person controlling a domestic insurer unless, at the time the offer, request or invitation is made or the agreement is entered into, or prior to the acquisition of the securities if no offer or agreement is involved, such person has filed with the commissioner and has sent to the insurer, a statement containing the information required by this section and the offer, request, invitation, agreement or acquisition has been approved by the commissioner in the manner prescribed in this chapter;  (2) For purposes of this section, any controlling person of a domestic insurer seeking to divest its controlling interest in the domestic insurer, in any manner, shall file with the commissioner, with a copy to the insurer, confidential notice of its proposed divestiture at least thirty (30) days prior to the cessation of control. The commissioner shall determine those instances in which the party(ies) seeking to divest or to acquire a controlling interest in an insurer will be required to file for and obtain approval of the transaction. The information shall remain confidential until the conclusion of the transaction unless the commissioner, in his or her discretion, determines that confidential treatment will interfere with enforcement of this section. If the statement referred to in subdivision (a)(1) of this section is otherwise filed, this paragraph shall not apply.  (3) With respect to a transaction subject to this section, the acquiring person must also file a pre-acquisition notification with the commissioner, which shall contain the information set forth in  27-35-2.5(c)(1). A failure to file the notification may be subject to penalties specified in  27-35-2.5(e)(3).  (4) For the purposes of this section, a domestic insurer shall include any person controlling a domestic insurer unless the person, as determined by the commissioner, is either directly or through its affiliates primarily engaged in business other than the business of insurance. For the purposes of this section, person shall not include any securities broker holding, in the usual and customary brokers function, less than twenty percent (20%) of the voting securities of an insurance company or of any person which controls an insurance company.   (b) Content of statement.(1) The statement to be filed with the commissioner under this section shall be made under oath or affirmation and shall contain the following:  (i) The name and address of each person by whom or on whose behalf the merger or other acquisition of control referred to in subsection (a) of this section is to be effected, (hereinafter called the acquiring party), and:  (A) If the person is an individual, his or her principal occupation and all offices and positions held during the past five (5) years, and any conviction for crimes other than minor traffic violations during the past ten (10) years;  (B) If the person is not an individual, a report of the nature of its business operations during the past five (5) years or for the lesser period as the person and any predecessors shall have been in existence; an informative description of the business intended to be done by the person and the persons subsidiaries, and a list of all individuals who are or who have been selected to become directors or executive officers of the person, or who perform or will perform functions appropriate to such positions. The list shall include for each individual the information required by subparagraph (A) of this subdivision;  (ii) The source, nature and amount of the consideration used or to be used in effecting the merger or other acquisition of control, a description of any transaction where funds were or are to be obtained for any such purpose, (including any pledge of the insurers stock, or stock of any of its subsidiaries or controlling affiliates), and the identity of persons furnishing the consideration; provided, however, that where a source of the consideration is a loan made in the lenders ordinary course of business, the identity of the lender shall remain confidential, if the person filing the statement so requests;  (iii) Fully audited financial information as to the earnings and financial condition of each acquiring party for the preceding five (5) fiscal years of each acquiring party (or for such lesser period as the acquiring party and any predecessors shall have been in existence) and similar unaudited information as of a date not earlier than ninety (90) days prior to the filing of the statement;  (iv) Any plans or proposals which each acquiring party may have to liquidate the insurer, to sell its assets or merge or consolidate it with any person, or to make any other material change in its business or corporate structure or management;  (v) The number of shares of any security referred to in subsection (a) of this section which each acquiring party proposes to acquire, and the terms of the offer, request, invitation, agreement, or acquisition referred to in subsection (a) of this section, and a statement as to the method by which the fairness of the proposal was arrived at;  (vi) The amount of each class of any security referred to in subsection (a) of this section which is beneficially owned or concerning which there is a right to acquire beneficial ownership by each acquiring party;  (vii) A full description of any contracts, arrangements, or understanding with respect to any security referred to in subsection (a) of this section in which any acquiring party is involved, including, but not limited to transfer of any of the securities, joint ventures, loan or option arrangements, puts or calls, guarantees of loans, guarantees against loss or guarantees of profits, division of losses or profits, or the giving or withholding of proxies. The description shall identify the persons with whom the contracts, arrangements, or understandings have been entered into;  (viii) A description of the purchase of any security referred to in subsection (a) of this section during the twelve (12) calendar months preceding the filing of the statement by any acquiring party, including the dates of purchase, names of the purchasers, and consideration paid or agreed to be paid;  (ix) A description of any recommendations to purchase any security referred to in subsection (a) of this section made during the twelve (12) calendar months preceding the filing of the statement by any acquiring party, or by anyone based upon interviews or at the suggestion of the acquiring party;  (x) Copies of all tender offers for, requests or invitations for tenders of, exchange offers for, and agreements to acquire or exchange any securities referred to in subsection (a) of this section, and (if distributed) of additional soliciting material relating to them;  (xi) The terms of any agreement, contract, or understanding made with or proposed to be made with any broker-dealer as to solicitation of securities referred to in subsection (a) of this section for tender, and the amount of any fees, commissions, or other compensation to be paid to broker-dealers with regard thereto;  (xii) An agreement by the person required to file the statement referred to in subsection (a) of this section that it will provide the annual report, specified in  27-35-3(l), for so long as control exists;  (xiii) An acknowledgement by the person required to file the statement referred to in subsection (a) of this section that the person and all subsidiaries within its control in the insurance holding company system will provide information to the commissioner upon request as necessary to evaluate enterprise risk to the insurer; and  (xiv) Such additional information that the commissioner may by rule or regulation prescribe as necessary or appropriate for the protection of policyholders and securityholders of the insurer or in the public interest;  (2) If the person required to file the statement referred to in subsection (a) of this section is a partnership, limited partnership, syndicate, or other group, the commissioner may require that the information called for by paragraphs (1)(i)  (1)(xiv) of this subsection shall be given with respect to each partner of the partnership or limited partnership, each member of the syndicate or group, and each person who controls the partner or member. If any partner, member, or person is a corporation, or the person required to file the statement referred to in subsection (a) of this section is a corporation, the commissioner may require that the information called for by paragraphs (1)(i)  (1)(xiv) of this subsection shall be given with respect to the corporation, each officer and director of the corporation, and each person who is directly or indirectly the beneficial owner of more than ten percent (10%) of the outstanding voting securities of the corporation;  (3) If any material change occurs in the facts set forth in the statement filed with the commissioner and sent to the insurer pursuant to this section, an amendment setting forth the change, together with copies of all documents and other material relevant to the change, shall be filed with the commissioner and sent to the insurer within two (2) business days after the person learns of the change.   (c) Alternative filing materials. If any offer, request, invitation, agreement or acquisition referred to in subsection (a) of this section is proposed to be made by means of a registration statement under the Securities Act of 1933 or in circumstances requiring the disclosure of similar information under the Securities Exchange Act of 1934 or under a state law requiring similar registration or disclosure, the person required to file the statement referred to in subsection (a) of this section may utilize the documents in furnishing the information called for by that statement.  (d) Approval by commissioner; hearings.(1) The commissioner shall approve any merger or other acquisition of control referred to in subsection (a) of this section unless, after a public hearing held on the merger or acquisition, at the discretion of the commissioner or upon the request of the acquiring party, the insurer or any other interested party, he or she finds that any of the following conditions exist:  (i) After the change of control the domestic insurer referred to in subsection (a) of this section would not be able to satisfy the requirements for the issuance of a license to write the line or lines of insurance for which it is presently licensed;  (ii) The effect of the merger or other acquisition of control would be substantially to lessen competition in insurance in this state or tend to create a monopoly. In applying the competitive standard in this subparagraph:  (A) The informational requirements of  27-35-2.5(c)(1) and the standards of  27-35-2.5(d)(2) shall apply;  (B) The merger or other acquisition shall not be disapproved if the commissioner finds that any of the situations meeting the criteria provided by  27-35-2.5(d)(3) exist; and  (C) The commissioner may condition the approval of the merger or other acquisition on the removal of the basis of disapproval within a specified period of time;  (iii) The financial condition of any acquiring party is such as might jeopardize the financial stability of the insurer, or prejudice the interest of its policyholders;  (iv) The plans or proposals which the acquiring party has to liquidate the insurer, sell its assets or consolidate or merge it with any person, or to make any other material change in its business or corporate structure or management, are unfair and unreasonable to policyholders of the insurer and not in the public interest;  (v) The competence, experience, and integrity of those persons who would control the operation of the insurer are such that it would not be in the interest of policyholders of the insurer and of the public to permit the merger or other acquisition of control; or  (vi) The acquisition is likely to be hazardous or prejudicial to the insurance-buying public.  (2) The public hearing referred to in subdivision (1) of this subsection, if required, shall be held within thirty (30) days after the statement required by subsection (a) of this section is filed, and at least twenty (20) days notice of the public hearing shall be given by the commissioner to the person filing the statement. Not less than seven (7) days notice of the public hearing shall be given by the person filing the statement to the insurer and to such other persons as may be designated by the commissioner. The commissioner shall make a determination within the sixty (60) day period preceding the effective date of the proposed transaction. At the hearing, the person filing the statement, the insurer, any person to whom notice of hearing was sent, and any other person whose interest may be affected shall have the right to present evidence, examine and cross examine witnesses, and offer oral and written arguments and in connection therewith shall be entitled to conduct discovery proceedings in the same manner as is presently allowed in the superior court of this state. All discovery proceedings shall be concluded not later than three (3) days prior to the commencement of the public hearing.  (3) If the proposed acquisition of control will require the approval of more than one commissioner, the public hearing referred to in subdivision (2) of this subsection may be held on a consolidated basis upon request of the person filing the statement referred to in subsection (a) of this section. Such person shall file the statement referred to in subsection (a) of this section with the national association of insurance commissioners (NAIC) within five (5) days of making the request for a public hearing. A commissioner may opt out of a consolidated hearing, and shall provide notice to the applicant of the opt-out within ten (10) days of the receipt of the statement referred to in subsection (a) of this section. A hearing conducted on a consolidated basis shall be public and shall be held within the United States before the commissioners of the states in which the insurers are domiciled. Such commissioners shall hear and receive evidence. A commissioner may attend such hearing, in person or by telecommunication.  (4) In connection with a change of control of a domestic insurer, any determination by the commissioner that the person acquiring control of the insurer shall be required to maintain or restore the capital of the insurer to the level required by the laws and regulations of this state shall be made not later than sixty (60) days after the date of notification of the change in control submitted pursuant to subsection (a) of this section.  (5) The commissioner may retain at the acquiring persons expense any attorneys, actuaries, accountants and other experts not otherwise a part of the commissioners staff as may be reasonably necessary to assist the commissioner in reviewing the proposed acquisition of control.   (e) Exemptions. The provisions of this section shall not apply to any offer, request, invitation, agreement or acquisition which the commissioner by order shall exempt from this section as not having been made or entered into for the purpose and not having the effect of changing or influencing the control of a domestic insurer, or as otherwise not comprehended within the purposes of this section.  (f) Violations. The following shall be violations of this section:  (1) The failure to file any statement, amendment, or other material required to be filed pursuant to subsection (a) or (b) of this section; or  (2) The effectuation or any attempt to effectuate an acquisition of control of, divestiture of, or merger with, a domestic insurer unless the commissioner has given his or her approval.  (g) Jurisdiction; consent to service of process. The courts of this state are hereby vested with jurisdiction over every person not resident, domiciled, or authorized to do business in this state who files a statement with the commissioner under this section, and over all actions involving such person arising out of violations of this section, and each such person shall be deemed to have performed acts equivalent to and constituting an appointment by the person of the commissioner to be his true and lawful attorney upon whom may be served all lawful process in any action, suit, or proceeding arising out of violations of this section. Copies of all lawful process shall be served on the commissioner and transmitted by registered or certified mail by the commissioner to the person at his or her last known address.  History of Section.P.L. 1971, ch. 273,  1; P.L. 1992, ch. 445,  10; P.L. 1993, ch. 180,  31; P.L. 2002, ch. 240,  1; P.L. 2010, ch. 55,  1; P.L. 2010, ch. 70,  1; P.L. 2011, ch. 15,  2; P.L. 2011, ch. 26,  2. 
 27-35-3. Registration of insurers. (a) Registration. Every insurer authorized to do business in this state and that is a member of an insurance holding company system shall register with the commissioner, except a foreign insurer subject to registration requirements and standards adopted by statute or regulation in the jurisdiction of its domicile that are substantially similar to those contained in:  (1) This section;  (2) Section 27-35-4(a)(1), (b) and (d) and  (3) Either  27-35-4(a)(2) or a provision such as the following: Each registered insurer shall keep current the information required to be disclosed in its registration statement by reporting all material changes or additions within fifteen (15) days after the end of the month in which it learns of each change or addition.  Any insurer subject to registration under this section shall register fifteen (15) days after it becomes subject to registration, and annually thereafter by May 1 of each year for the previous calendar year, unless the commissioner for good cause shown extends the time for registration, and then within the extended time. The commissioner may require any insurer authorized to do business in the state that is a member of an insurance holding company system and that is not subject to registration under this section to furnish a copy of the registration statement, the summary specified in subsection (c) of this section, or other information filed by the insurance company with the insurance regulatory authority of its domiciliary jurisdiction.  (b) Information and form required. Every insurer subject to registration shall file a registration statement with the commissioner on a form and in a format prescribed by the NAIC that shall contain the following current information:  (1) The capital structure, general financial condition, ownership, and management of the insurer and any person controlling the insurer;  (2) The identity and relationship of every member of the insurance holding company system;  (3) The following agreements in force and transactions currently outstanding or that have occurred during the last calendar year between the insurer and its affiliates:  (i) Loans, other investments or purchases, sales or exchanges of securities of the affiliates by the insurer or of the insurer by its affiliates;  (ii) Purchases, sales, or exchanges of assets;  (iii) Transactions not in the ordinary course of business;  (iv) Guarantees or undertakings for the benefit of an affiliate that result in an actual contingent exposure of the insurers assets to liability, other than insurance contracts entered into in the ordinary course of the insurers business;  (v) All management service contracts, service contracts, and all cost sharing arrangements;  (vi) Reinsurance agreements;  (vii) Dividends and other distributions to shareholders; and  (viii) Consolidated tax allocation agreements;  (4) Any pledge of the insurers stock, including stock of any subsidiary or controlling affiliate, for a loan made to any member of the insurance holding company system;  (5) If requested by the commissioner, the insurer shall include financial statements of or within an insurance holding company system, including all affiliates. Financial statements may include, but are not limited to, annual audited financial statements filed with the U.S. Securities and Exchange Commission (SEC) pursuant to the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended. An insurer required to file financial statements pursuant to this paragraph may satisfy the request by providing the commissioner with the most recently filed parent corporation financial statements that have been filed with the SEC;  (6) Other matters concerning transactions between registered insurers and any affiliates as may be included from time to time in any registration forms adopted or approved by the commissioner;  (7) Statements that the insurers board of directors oversees corporate governance and internal controls and that the insurers officers or senior management have approved, implemented, and continue to maintain and monitor corporate governance and internal control procedures; and  (8) Any other information required by the commissioner by rule or regulation.  (c) Summary of changes to registration statement. All registration statements shall contain a summary outlining all items in the current registration statement representing changes from the prior registration statement.  (d) Materiality. No information need be disclosed on the registration statement filed pursuant to subsection (b) of this section if that information is not material for the purposes of this section. Unless the commissioner by rule, regulation, or order provides otherwise, sales, purchases, exchanges, loans, or extensions of credit, investments, or guarantees involving one-half of one percent (.5%) or less of an insurers admitted assets as of the 31st day of December next preceding shall not be deemed material for purposes of this section. The definition of materiality provided in this subsection shall not apply for purposes of the group capital calculation or the liquidity stress test framework.  (e) Reporting of dividends to shareholders. Subject to  27-35-4(b), each registered insurer shall report to the commissioner all dividends and other distributions to shareholders within fifteen (15) business days following the declaration thereof.  (f) Information of insurers. Any person within an insurance holding company system subject to registration shall be required to provide complete and accurate information to an insurer, where the information is reasonably necessary to enable the insurer to comply with the provisions of this act.  (g) Termination of registration. The commissioner shall terminate the registration of any insurer that demonstrates that it no longer is a member of an insurance holding company system.  (h) Consolidated filing. The commissioner may require or allow two (2) or more affiliated insurers subject to registration to file a consolidated registration statement.  (i) Alternative registration. The commissioner may allow an insurer that is authorized to do business in this state and which is part of an insurance holding company system to register on behalf of any affiliated insurer which is required to register under subsection (a) and to file all information and material required to be filed under this section.  (j) Exemptions. The provisions of this section shall not apply to any insurer, information, or transaction if and to the extent that the commissioner by rule, regulation, or order shall exempt from the provisions of this section.  (k) Disclaimer. Any person may file with commissioner a disclaimer of affiliation with any authorized insurer or a disclaimer may be filed by the insurer or any member of an insurance holding company system. The disclaimer shall fully disclose all material relationships and bases for affiliation between the person and the insurer as well as the basis for disclaiming the affiliation.  A disclaimer of affiliation shall be deemed to have been granted unless the commissioner, within thirty (30) days following receipt of a complete disclaimer, notifies the filing party that the disclaimer is disallowed. In the event of disallowance, the disclaiming party may request an administrative hearing, which shall be granted. The disclaiming party shall be relieved of its duty to register under this section if approval of the disclaimer has been granted by the commissioner, or if the disclaimer is deemed to have been approved.  (l) Enterprise riskfilings.  (1) The ultimate controlling person of every insurer subject to registration shall also file an annual enterprise risk report. The report shall, to the best of the ultimate controlling persons knowledge and belief, identify the material risks within the insurance holding company system that could pose enterprise risk to the insurer. The report shall be filed with the lead state commissioner of the insurance holding company system as determined by the procedures within the Financial Analysis Handbook adopted by the National Association of Insurance Commissioners (NAIC).  (2) Group capital calculation. Except as provided below, the ultimate controlling person of every insurer subject to registration shall concurrently file with the registration an annual group capital calculation, as directed by the lead state commissioner. The report shall be completed in accordance with the NAIC group capital calculation instructions, which may permit the lead state commissioner to allow a controlling person, that is not the ultimate controlling person, to file the group capital calculation. The report shall be filed with the lead state commissioner of the insurance holding company system, as determined by the commissioner, in accordance with the procedures within the Financial Analysis Handbook adopted by the NAIC. Insurance holding company systems described below are exempt from filing the group capital calculation:  (i) An insurance holding company system that has only one insurer within its holding company structure, that only writes business in its domestic state, and assumes no business from any other insurer;  (ii) An insurance holding company system that is required to perform a group capital calculation, specified by the United States Federal Reserve Board. The lead state commissioner shall request the calculation from the Federal Reserve Board, under the terms of information sharing agreements in effect. If the Federal Reserve Board cannot share the calculation with the lead state commissioner, the insurance holding company system is not exempt from the group capital calculation filing;  (iii) An insurance holding company system whose non-United States group-wide supervisor is located within a reciprocal jurisdiction, as described in  27-1.1-1(g) that recognizes the United States state regulatory approach to group supervision and group capital;  (iv) An insurance holding company system:  (A) That provides information to the lead state that meets the requirements for accreditation under the NAIC financial standards and accreditation program, either directly or indirectly through the group-wide supervisor, who has determined the information is satisfactory to allow the lead state to comply with the NAIC group supervision approach, as detailed in the NAIC Financial Analysis Handbook; and  (B) Whose non-United States group-wide supervisor that is not in a reciprocal jurisdiction recognizes and accepts, as specified by the commissioner in regulation, the group capital calculation as the world-wide group capital assessment for United States insurance groups who operate in that jurisdiction;  (v) Notwithstanding the provisions of subsections (l)(2)(iii) and (iv) of this section, a lead state commissioner shall require the group capital calculation for United States operations of any non-United States based insurance holding company system where, after any necessary consultation with other supervisors or officials, it is deemed appropriate by the lead state commissioner for prudential oversight and solvency monitoring purposes or for ensuring the competitiveness of the insurance marketplace.  (vi) Notwithstanding the exemptions from filing the group capital calculation stated in subsections (l)(2)(iii) and (iv) of this section, the lead state commissioner has the discretion to exempt the ultimate controlling person from filing the annual group capital calculation or to accept a limited group capital filing or report, in accordance with criteria as specified by the commissioner in regulation.  (vii) If the lead state commissioner determines that an insurance holding company system no longer meets one or more of the requirements for an exemption from filing the group capital calculation under this section, the insurance holding company system shall file the group capital calculation at the next annual filing date unless given an extension by the lead state commissioner based on reasonable grounds shown.  (3) Liquidity stress test. The ultimate controlling person of every insurer subject to registration and also scoped into the NAIC liquidity stress test framework shall file the results of a specific years liquidity stress test. The filing shall be made to the lead state insurance commissioner of the insurance holding company system as determined by the procedures within the Financial Analysis Handbook adopted by the National Association of Insurance Commissioners:  (i) The NAIC liquidity stress test framework includes scope criteria applicable to a specific data year. These scope criteria are reviewed at least annually by the financial stability task force or its successor. Any change to the NAIC liquidity stress test framework or to the data year for which the scope criteria are to be measured, shall be effective on January 1 of the year following the calendar year when such changes are adopted. Insurers meeting at least one threshold of the scope criteria are considered scoped into the NAIC liquidity stress test framework for the specified data year, unless the lead state insurance commissioner, in consultation with the NAIC financial stability task force or its successor, determines the insurer should not be scoped into the framework for that data year. Similarly, insurers that do not trigger at least one threshold of the scope criteria are considered scoped out of the NAIC liquidity stress test framework for the specified data year, unless the lead state insurance commissioner, in consultation with the NAIC financial stability task force or its successor, determines the insurer should be scoped into the framework for that data year.  (A) Regulators wish to avoid having insurers scoped in and out of the NAIC liquidity stress test framework on a frequent basis. The lead state insurance commissioner, in consultation with the financial stability task force or its successor, will assess this concern as part of the determination for an insurer.  (ii) The performance of, and filing of the results from, a specific years liquidity stress test shall comply with the NAIC liquidity stress test frameworks instructions and reporting templates for that year and any lead state insurance commissioner determinations, in conjunction with the financial stability task force or its successor, provided within the framework.  (m) Violations. The failure to file a registration statement or any summary of the registration statement or enterprise risk filing required by this section within the time specified for the filing shall be a violation of this section.  History of Section.P.L. 1971, ch. 273,  1; P.L. 1993, ch. 180,  31; P.L. 1996, ch. 188,  15; P.L. 1999, ch. 141,  2; P.L. 2002, ch. 292,  80; P.L. 2010, ch. 55,  1; P.L. 2010, ch. 70,  1; P.L. 2011, ch. 15,  2; P.L. 2011, ch. 26,  2; P.L. 2013, ch. 18,  2; P.L. 2013, ch. 21,  2; P.L. 2021, ch. 230,  3, effective July 8, 2021; P.L. 2021, ch. 231,  3, effective July 8, 2021. 
 27-35-4. Standards and management of an insurer within a holding company system. (a) Transactions within an insurance holding company system.  (1) Transactions within an insurance holding company system to which an insurer subject to registration is a party shall be subject to the following standards:  (i) The terms shall be fair and reasonable;  (ii) Agreements for cost sharing and management services shall include such provisions as required by rule and regulation issued by the commissioner;  (iii) Charges or fees for services performed shall be reasonable;  (iv) Expenses incurred and payment received shall be allocated to the insurer in conformity with customary insurance accounting practices consistently applied;  (v) The books, accounts, and records of each party to all such transactions shall be so maintained as to clearly and accurately disclose the nature and details of the transactions including such accounting information as is necessary to support the reasonableness of the charges or fees to the respective parties; and  (vi) The insurers surplus as regards policyholders following any dividends or distributions to shareholder affiliates shall be reasonable in relation to the insurers outstanding liabilities and adequate to its financial needs;  (vii) The charges or fees for services performed shall be reasonable; and  (2) The following transactions involving a domestic insurer and any person in its insurance holding company system, including amendments or modifications of affiliate agreements previously filed pursuant to this section, which are subject to any materiality standards contained in subparagraphs (A) through (G) of this subsection, may not be entered into unless the insurer has notified the commissioner in writing of its intention to enter into the transaction at least thirty (30) days prior, or such shorter period as the commissioner may permit, and the commissioner has not disapproved it within that period. The notice for amendments or modifications shall include the reasons for the change and the financial impact on the domestic insurer. Informal notice shall be reported, within thirty (30) days after a termination of a previously filed agreement, to the commissioner for determination of the type of filing required, if any.  (A) Sales, purchases, exchanges, loans, extensions of credit, or investments, provided the transactions are equal to or exceed:  (i) With respect to nonlife insurers, the lesser of three percent (3%) of the insurers admitted assets or twenty-five percent (25%) of surplus as regards policyholders as of the 31st day of December next preceding; or  (ii) With respect to life insurers, three percent (3%) of the insurers admitted assets; as of the 31st day of December next preceding;  (B) Loans or extensions of credit to any person who is not an affiliate, where the insurer makes the loans or extensions of credit with the agreement or understanding that the proceeds of the transactions, in whole or in substantial part, are to be used to make loans or extensions of credit to, to purchase assets of, or to make investments in, any affiliate of the insurer making the loans of extensions of credit, provided the transactions are equal to or exceed:  (i) With respect to nonlife insurers, the lesser of three percent (3%) of the insurers admitted assets or twenty-five percent (25%) of surplus as regards policyholders as of the 31st day of December next preceding;  (ii) With respect to life insurers, three percent (3%) of the insurers admitted assets; as of the 31st day of December next preceding;  (C) Reinsurance agreements or modifications thereto, including:  (I) All reinsurance pooling agreements;  (II) Agreements in which the reinsurance premium or a change in the insurers liabilities, or the projected reinsurance premiums or a change in the insurers liabilities in any of the next three (3) years, equals or exceeds five percent (5%) of the insurers surplus as regards policyholders as of the 31st day of December next preceding, including those agreements which may require as consideration the transfer of assets from an insurer to a nonaffiliate, if an agreement or understanding exists between the insurer and nonaffiliate that any portion of those assets will be transferred to one or more affiliates of the insurer;  (D) All management agreements, service contracts, tax allocation agreements, guarantees and all cost sharing arrangements;  (E) Guarantees when made by a domestic insurer; provided, however, that a guarantee which is quantifiable as to amount is not subject to the notice requirements of this subsection unless it exceeds the lesser of one-half of one percent (.5%) of the insurers admitted assets or ten percent (10%) of surplus as regards policyholders as of the 31st day of December next preceding. Further, all guarantees which are not quantifiable as to amount are subject to the notice requirements of this subsection;  (F) Direct or indirect acquisitions or investments in a person that controls the insurer or in an affiliate of the insurer in an amount which, together with its present holdings in such investments, exceeds two and one-half percent (2.5%) of the insurers surplus to policyholders. Direct or indirect acquisitions or investments in subsidiaries acquired pursuant to  27-35-1.5 (or authorized under any other section of this chapter), or in non-subsidiary insurance affiliates that are subject to the provisions of this act, are exempt from this requirements; and  (G) Any material transactions, specified by regulation, which the commissioner determines may adversely affect the interests of the insurers policyholders;  Nothing contained in this paragraph shall be deemed to authorize or permit any transactions which, in the case of an insurer not a member of the same insurance holding company system, would be otherwise contrary to law.  (3) A domestic insurer may not enter into transactions which are part of a plan or series of like transactions with persons within the insurance holding company system if the purpose of those separate transactions is to avoid the statutory threshold amount and thus avoid the review that would occur otherwise. If the commissioner determines that the separate transactions were entered into over any twelve (12) month period for that purpose, he or she may exercise his or her authority under  27-35-9.  (4) The commissioner, in reviewing transactions pursuant to subdivision (a)(2) of this section shall consider whether the transactions comply with the standards set forth in subdivision (a)(1) of this section and whether they may adversely affect the interests of policyholders.  (5) The commissioner shall be notified within thirty (30) days of any investment of the domestic insurer in any one corporation if the total investment in the corporation by the insurance holding company system exceeds ten percent (10%) of the corporations voting securities.  (b) Adequacy of surplus. For the purposes of this chapter, in determining whether an insurers surplus as regards policyholders is reasonable in relation to the insurers outstanding liabilities and adequate to its financial needs, the following factors, among others, shall be considered:  (1) The size of the insurer as measured by its assets, capital and surplus, reserves, premium writings, insurance in force, and other appropriate criteria;  (2) The extent to which the insurers business is diversified among the several lines of insurance;  (3) The number and size of risks insured in each line of business;  (4) The extent of the geographical dispersion of the insurers insured risks;  (5) The nature and extent of the insurers reinsurance program;  (6) The quality, diversification, and liquidity of the insurers investment portfolio;  (7) The recent past and projected future trend in the size of the insurers investment portfolio;  (8) The surplus as regards policyholders maintained by other comparable insurers;  (9) The adequacy of the insurers reserves; and  (10) The quality and liquidity of investment in affiliates. The commissioner may treat this investment as a disallowed asset for the purposes of determining the adequacy of surplus as regards policyholders whenever in his or her judgment the investment warrants.  (c) Dividends and other distributions.(1) No domestic insurer shall pay any extraordinary dividend or make any other extraordinary distribution to its shareholders until thirty (30) days after the commissioner has received notice of the declaration thereof and has not within that period disapproved the payment, or until the commissioner has approved the payment within the thirty (30) day period;  (2) For purposes of this section, an extraordinary dividend or distribution includes any dividend or distribution of cash or other property, whose fair market value together with that of other dividends or distributions made within the preceding twelve (12) months exceeds the lesser of:  (i) ten percent (10%) of the insurers surplus as regards policyholders as of the 31st day of December next preceding; or  (ii) the net gain from operations of the insurer, if the insurer is a life insurer, or the net income, if the insurer is not a life insurer, not including realized capital gains, for the twelve (12) month period ending the 31st day of December next preceding, but shall not include pro rata distributions of any class of the insurers own securities.  In determining whether a dividend or distribution is extraordinary, an insurer other than a life insurer may carry forward net income from the previous two (2) calendar years that has not already been paid out as dividends. This carry forward shall be computed by taking the net income from the second and third preceding calendar years, not including realized capital gains, less dividends paid in the second and immediate preceding calendar years;  (3) Notwithstanding any other provision of law, an insurer may declare an extraordinary dividend or distribution which is conditional upon the commissioners approval, and the declaration shall confer no rights upon shareholders until: (i) the commissioner has approved the payment of the dividend or distribution or (ii) the commissioner has not disapproved the payment within the thirty (30) day period referred to in subdivision (1) of this subsection.  (d) Management of domestic insurers subject to registration. All domestic insurers shall become in compliance and maintain compliance with the provisions of this title addressing good corporate governance standards  27-1-2.1, unless otherwise exempted in  27-1-2.1.  History of Section.P.L. 1971, ch. 273,  1; P.L. 1991, ch. 257,  4; P.L. 1991, ch. 348,  10; P.L. 1992, ch. 325,  1; P.L. 1999, ch. 141,  2; P.L. 2010, ch. 55,  1; P.L. 2010, ch. 70,  1; P.L. 2011, ch. 15,  2; P.L. 2011, ch. 26,  2. 
 27-35-5.5. Group supervision. (a) Power of the commissioner. With respect to any insurer registered under  27-35-3, and in accordance with subsection (c) below, the commissioner shall also have the power to participate in a supervisory college for any domestic insurer that is part of an insurance holding company system with international operations in order to determine compliance by the insurer with this chapter. The powers of the commissioner with respect to supervisory colleges include, but are not limited to, the following:  (1) Initiating the establishment of a supervisory college;  (2) Clarifying the membership and participation of other supervisors in the supervisory college;  (3) Clarifying the functions of the supervisory college and the role of other regulators, including the establishment of a group wide supervisor;  (4) Coordinating the ongoing activities of the supervisory college, including planning meetings, supervisory activities, and processes for information sharing; and  (5) Establishing a crisis management plan.  (b) Expenses. Each registered insurer subject to this section shall be liable for and shall pay the reasonable expenses of the commissioners participation in a supervisory college in accordance with subsection (c) below, including reasonable travel expenses. For purposes of this section, a supervisory college may be convened as either a temporary or permanent forum for communication and cooperation between the regulators charged with the supervision of the insurer or its affiliates, and the commissioner may establish a regular assessment to the insurer for the payment of these expenses.  (c) Supervisory college. In order to assess the business strategy, financial position, legal and regulatory position, risk exposure, risk management, and governance processes, and as part of the examination of individual insurers in accordance with  27-35-5, the commissioner may participate in a supervisory college with other regulators charged with supervision of the insurer or its affiliates, including other state, federal, and international regulatory agencies. The commissioner may enter into agreements in accordance with  27-35-6(c) providing the basis for cooperation between the commissioner and the other regulatory agencies, and the activities of the supervisory college. Nothing in this section shall delegate to the supervisory college the authority of the commissioner to regulate or supervise the insurer or its affiliates within its jurisdiction.  (d) The commissioner is authorized to act as the group wide supervisor for any internationally active insurance group in accordance with the provisions of this section. However, the commissioner may otherwise acknowledge another regulatory official as the group wide supervisor where the internationally active insurance group:  (1) Does not have substantial insurance operations in the United States;  (2) Has substantial insurance operations in the United States, but not in this state; or  (3) Has substantial insurance operations in the United States and this state, but the commissioner has determined pursuant to the factors set forth in subsections (e) and (i) of this section that the other regulatory official is the appropriate group wide supervisor.  An insurance holding company system that does not otherwise qualify as an internationally active insurance group may request that the commissioner make a determination or acknowledgment as to a group wide supervisor pursuant to this section.  (e) In cooperation with other state, federal, and international regulatory agencies, the commissioner will identify a single group wide supervisor for an internationally active insurance group. The commissioner may determine that the commissioner is the appropriate group wide supervisor for an internationally active insurance group that conducts substantial insurance operations concentrated in this state. However, the commissioner may acknowledge that a regulatory official from another jurisdiction is the appropriate group wide supervisor for the internationally active insurance group. The commissioner shall consider the following factors when making a determination or acknowledgment under this subsection:  (1) The place of domicile of the insurers within the internationally active insurance group that hold the largest share of the groups written premiums, assets, or liabilities;  (2) The place of domicile of the top-tiered insurer(s) in the insurance holding company system of the internationally active insurance group;  (3) The location of the executive offices or largest operational offices of the internationally active insurance group;  (4) Whether another regulatory official is acting, or is seeking to act, as the group wide supervisor under a regulatory system that the commissioner determines to be:  (i) Substantially similar to the system of regulation provided under the laws of this state; or  (ii) Otherwise sufficient in terms of providing for group wide supervision, enterprise risk analysis, and cooperation with other regulatory officials; and  (5) Whether another regulatory official acting or seeking to act as the group wide supervisor provides the commissioner with reasonably reciprocal recognition and cooperation.  However, a commissioner identified under this section as the group wide supervisor may determine that it is appropriate to acknowledge another supervisor to serve as the group wide supervisor. The acknowledgment of the group wide supervisor shall be made after consideration of the factors listed in this subsection and shall be made in cooperation with, and subject to, the acknowledgment of other regulatory officials involved with supervision of members of the internationally active insurance group, and in consultation with the internationally active insurance group.  (f) Notwithstanding any other provision of law, when another regulatory official is acting as the group wide supervisor of an internationally active insurance group, the commissioner shall acknowledge that regulatory official as the group wide supervisor. However, in the event of a material change in the internationally active insurance group that results in:  (1) The internationally active insurance groups insurers domiciled in this state holding the largest share of the groups premiums, assets, or liabilities; or  (2) This state being the place of domicile of the top-tiered insurer(s) in the insurance holding company system of the internationally active insurance group, the commissioner shall make a determination or acknowledgment as to the appropriate group wide supervisor for such an internationally active insurance group pursuant to subsection (e) of this section.  (g) Pursuant to  27-35-5, the commissioner is authorized to collect from any insurer registered pursuant to  27-35-3 all information necessary to determine whether the commissioner may act as the group wide supervisor of an internationally active insurance group or if the commissioner may acknowledge another regulatory official to act as the group wide supervisor. Prior to issuing a determination that an internationally active insurance group is subject to group wide supervision by the commissioner, the commissioner shall notify the insurer registered pursuant to  27-35-3 and the ultimate controlling person within the internationally active insurance group. The internationally active insurance group shall have not less than thirty (30) days to provide the commissioner with additional information pertinent to the pending determination. The commissioner shall publish on its internet website the identity of internationally active insurance groups that the commissioner has determined are subject to group wide supervision by the commissioner.  (h) If the commissioner is the group wide supervisor for an internationally active insurance group, the commissioner is authorized to engage in any of the following group wide supervision activities:  (1) Assess the enterprise risks within the internationally active insurance group to ensure that:  (i) The material financial condition and liquidity risks to the members of the internationally active insurance group who or that are engaged in the business of insurance are identified by management; and  (ii) Reasonable and effective mitigation measures are in place;  (2) Request, from any member of an internationally active insurance group subject to the commissioners supervision, information necessary and appropriate to assess enterprise risk, including, but not limited to, information about the members of the internationally active insurance group regarding:  (i) Governance, risk assessment, and management;  (ii) Capital adequacy; and  (iii) Material intercompany transactions;  (3) Coordinate and, through the authority of the regulatory officials of the jurisdictions where members of the internationally active insurance group are domiciled, compel development and implementation of reasonable measures designed to ensure that the internationally active insurance group is able to timely recognize and mitigate enterprise risks to members of such internationally active insurance group who or that are engaged in the business of insurance;  (4) Communicate with other state, federal, and international regulatory agencies for members within the internationally active insurance group and share relevant information subject to the confidentiality provisions of  27-35-6, through supervisory colleges as set forth in subsection (c) of this section or otherwise;  (5) Enter into agreements with, or obtain documentation from, any insurer registered under  27-35-3, any member of the internationally active insurance group, and any other state, federal, and international regulatory agencies for members of the internationally active insurance group, providing the basis for, or otherwise clarifying, the commissioners role as group wide supervisor, including provisions for resolving disputes with other regulatory officials. Such agreements or documentation shall not serve as evidence in any proceeding that any insurer or person within an insurance holding company system not domiciled or incorporated in this state is doing business in this state or is otherwise subject to jurisdiction in this state; and  (6) Other group wide supervision activities, consistent with the authorities and purposes enumerated above, as considered necessary by the commissioner.  (i) If the commissioner acknowledges that another regulatory official from a jurisdiction that is not accredited by the NAIC is the group wide supervisor, the commissioner is authorized to reasonably cooperate, through supervisory colleges or otherwise, with group wide supervision undertaken by the group wide supervisor, provided that:  (1) The commissioners cooperation is in compliance with the laws of this state; and  (2) The regulatory official acknowledged as the group wide supervisor also recognizes and cooperates with the commissioners activities as a group wide supervisor for other internationally active insurance groups where applicable. Where such recognition and cooperation is not reasonably reciprocal, the commissioner is authorized to refuse recognition and cooperation.  (j) The commissioner is authorized to enter into agreements with, or obtain documentation from, any insurer registered under  27-35-3, any affiliate of the insurer, and other state, federal, and international regulatory agencies for members of the internationally active insurance group, that provide the basis, for or otherwise clarify, a regulatory officials role as group wide supervisor.  (k) The commissioner may promulgate regulations necessary for the administration of this section.  (l) A registered insurer subject to this section shall be liable for and shall pay the reasonable expenses of the commissioners participation in the administration of this section, including the engagement of attorneys, actuaries and any other professionals and all reasonable travel expenses.  History of Section.P.L. 2011, ch. 15,  1; P.L. 2011, ch. 26,  1; P.L. 2015, ch. 82,  13; P.L. 2015, ch. 105,  13. 
 27-35-5. Examination. (a) Power of commissioner. Subject to the limitation contained in this section and in addition to the powers which 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 such 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 days delay, or may suspend or revoke the insurers license.   (c) Use of consultants. The commissioner may retain at the registered insurers expense such attorneys, actuaries, accountants, and other experts not otherwise a part of the commissioners 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.  History of Section.P.L. 1971, ch. 273,  1; P.L. 2010, ch. 55,  1; P.L. 2010, ch. 70,  1; P.L. 2011, ch. 15,  2; P.L. 2011, ch. 26,  2. 
 27-35-6. Confidential treatment. (a) Documents, materials, or other information in the possession or control of the department of business regulation that are obtained by or disclosed to the commissioner or any other person in the course of an examination or investigation made pursuant to  27-35-5, and all information reported pursuant to  27-35-2(b)(1)(xii), 27-35-2(b)(1)(xiii), 27-35-3, 27-35-4, and 27-35-5.5 are recognized by this state as being proprietary and to contain trade secrets, and shall be confidential by law and privileged, shall not be subject to the access of public records act, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. However, the commissioner is authorized to use the documents, materials, or other information in the furtherance of any regulatory or legal action brought as part of the commissioners official duties. The commissioner shall not otherwise make the documents, materials, or other information public, without the prior written consent of the insurer to which it pertains unless the commissioner, after giving the insurer and its affiliates who would be affected thereby notice and opportunity to be heard, determines that the interests of policyholders, shareholders, or the public will be served by the publication thereof, in which event the commissioner may publish all or any part of it in a manner that he or she may deem appropriate.  (1) For purposes of the information reported and provided to the department of insurance, pursuant to  27-35-3()(2), the commissioner shall maintain the confidentiality of the group capital calculation and group capital ratio produced within the calculation and any group capital information received from an insurance holding company supervised by the Federal Reserve Board or any United States group-wide supervisor.  (2) For purposes of the information reported and provided to the department pursuant to  27-35-3()(3), the commissioner shall maintain the confidentiality of the liquidity stress test results and supporting disclosures and any liquidity stress test information received from an insurance holding company supervised by the Federal Reserve Board and non-United States group-wide supervisors.  (b) Neither the commissioner nor any person who received documents, materials, or other information while acting under the authority of the commissioner or with whom such documents, materials, or other information are shared pursuant to this chapter shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subsection (a) of this section.  (c) In order to assist in the performance of the commissioners duties, the commissioner:  (1) May share documents, materials, or other information, including the confidential and privileged documents, materials, or information subject to subsection (a), including proprietary and trade secret documents and materials with other state, federal, and international regulatory agencies, with the NAIC, with any third-party consultants designated by the commissioner, and with state, federal, and international law enforcement authorities, including members of any supervisory college described in  27-35-5.5, provided that the recipient agrees in writing to maintain the confidentiality and privileged status of the document, material, or other information and has verified in writing the legal authority to maintain confidentiality.  (2) Notwithstanding subparagraph (c)(1) above, the commissioner may only share confidential and privileged documents, material, or information reported pursuant to  27-35-3() with commissioners of states having statutes or regulations substantially similar to subsection (a) of this section and who have agreed in writing not to disclose such information.  (3) May receive documents, materials, or information, including otherwise confidential and privileged documents, materials, or information, including proprietary trade-secret information from the NAIC and its affiliates and subsidiaries and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material, or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information.  (4) Shall enter into written agreements with the NAIC and any third-party consultant designated by the commissioner governing sharing and use of information provided pursuant to this chapter consistent with this subsection that shall:  (i) Specify procedures and protocols regarding the confidentiality and security of information shared with the NAIC and any third-party consultant designated by the commissioner pursuant to this chapter, including procedures and protocols for sharing by the NAIC with other state, federal or international regulators. The agreement shall provide that the recipient agrees in writing to maintain the confidentiality and privileged status of the documents, materials, or other information and has verified in writing the legal authority to maintain such confidentiality;  (ii) Specify that ownership of information shared with the NAIC or any third-party consultant pursuant to this chapter remains with the commissioner and the NAICs or a third-party consultants, as designated by the commissioner, use of the information is subject to the direction of the commissioner;  (iii) Excluding documents, material, or information reported pursuant to  27-35-3()(3), prohibit the NAIC or third-party consultant designated by the commissioner from storing the information shared pursuant to this chapter in a permanent database after the underlying analysis is completed;  (iv) Require prompt notice to be given to an insurer whose confidential information in the possession of the NAIC or a third-party consultant designated by the commissioner pursuant to this chapter is subject to a request or subpoena to the NAIC or a third-party consultant designated by the commissioner for disclosure or production;  (v) Require the NAIC or a third-party consultant designated by the commissioner to consent to intervention by an insurer in any judicial or administrative action in which the NAIC or a third-party consultant designated by the commissioner and its affiliates and subsidiaries may be required to disclose confidential information about the insurer shared with the NAIC or a third-party consultant designated by the commissioner pursuant to this chapter; and  (vi) For documents, material, or information reporting pursuant to  27-35-3()(3), in the case of an agreement involving a third-party consultant, provide for notification of the identity of the consultant to the applicable insurers.  (d) The sharing of information by the commissioner pursuant to this chapter shall not constitute a delegation of regulatory authority or rulemaking, and the commissioner is solely responsible for the administration, execution, and enforcement of the provisions of this chapter.  (e) No waiver of any applicable privilege or claim of confidentiality in the documents, materials, or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subsection (c).  (f) Documents, materials, or other information in the possession or control of the NAIC or a third-party consultant pursuant to this chapter shall be confidential by law and privileged, shall not be subject to  38-2-3, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action.  (g) The group capital calculation and resulting group capital ratio required under  27-35-3(l)(2) and the liquidity stress test, along with its results and supporting disclosures required under  27-35-3()(3), are regulatory tools for assessing group risks and capital adequacy and group liquidity risks, respectively, and are not intended as a means to rank insurers or insurance holding company systems generally. Therefore, except as otherwise may be required under the provisions of this chapter, the making, publishing, disseminating, circulating, or placing before the public, or causing directly or indirectly to be made, published, disseminated, circulated, or placed before the public in a newspaper, magazine, or other publication, or in the form of a notice, circular, pamphlet, letter, or poster, or over any radio or television station or any electronic means of communication available to the public, or in any other way as an advertisement, announcement, or statement containing a representation or statement with regard to the group capital calculation, group capital ratio, the liquidity stress test results, or supporting disclosures for the liquidity stress test of any insurer or any insurer group, or of any component derived in the calculation by any insurer, broker, or other person engaged in any manner in the insurance business would be misleading and is therefore prohibited; provided, however, that if any materially false statement with respect to the group capital calculation, resulting group capital ratio, an inappropriate comparison of any amount to an insurers or insurance groups group capital calculation or resulting group capital ratio, liquidity stress test result, supporting disclosures for the liquidity stress test, or an inappropriate comparison of any amount to an insurers or insurance groups liquidity stress test result or supporting disclosures is published in any written publication and the insurer is able to demonstrate to the commissioner, with substantial proof the falsity of such statement or the inappropriateness, as the case may be, then the insurer may publish announcements in a written publication if the sole purpose of the announcement is to rebut the materially false statement.  History of Section.P.L. 1971, ch. 273,  1; P.L. 2010, ch. 55,  1; P.L. 2010, ch. 70,  1; P.L. 2011, ch. 15,  2; P.L. 2011, ch. 26,  2; P.L. 2021, ch. 230,  3, effective July 8, 2021; P.L. 2021, ch. 231,  3, effective July 8, 2021. 
 27-35-7. Rules and regulations. The commissioner may, upon notice and opportunity for all interested persons to be heard, issue rules, regulations and orders that are necessary to carry out the provisions of this chapter.  History of Section.P.L. 1971, ch. 273,  1. 
 27-35-8. Injunctions  Prohibitions against voting securities  Sequestration of voting securities. (a) Injunctions. Whenever it appears to the commissioner that any insurer or any director, officer, employee, or agent thereof has committed or is about to commit a violation of this chapter or of any rule, regulation, or order issued by the commissioner under this chapter, the commissioner may apply to the superior court of Providence County for an order enjoining the insurer or director, officer, employee, or agent thereof from violating or continuing to violate this chapter or any rule, regulation or order, and for such other equitable relief as the nature of the case and the interests of the insurers policyholders, creditors, and shareholders or the public may require.  (b) Voting of securities; when prohibited. No security which is the subject of any agreement or arrangement regarding acquisition, or which is acquired or to be acquired, in contravention of the provisions of this chapter or of any rule, regulation, or order issued by the commissioner under this chapter may be voted at any shareholders meeting, or may be counted for quorum purposes, and any action of shareholders requiring the affirmative vote of a percentage of shares may be taken as though the securities were not issued and outstanding; but no action taken at the meeting shall be invalidated by the voting of the securities, unless the action would materially affect control of the insurer or unless the courts of this state have so ordered. If an insurer or the commissioner has reason to believe that any security of the insurer has been or is about to be acquired in contravention of the provisions of this chapter or of any rule, regulation, or order issued by the commissioner under this chapter the insurer or the commissioner may apply to the superior court for Providence County to enjoin any offer, request, invitation, agreement, or acquisition made in contravention of  27-35-4 or any rule, regulation, or order issued by the commissioner under that section to enjoin the voting of any security so acquired, to void any vote of the security already cast at any meeting of shareholders, and for such other equitable relief as the nature of the case and the interests of the insurers policyholders, creditors, and shareholders or the public may require.  (c) Sequestration of voting securities. In any case where a person has acquired or is proposing to acquire any voting securities in violation of this chapter or any rule, regulation, or order issued by the commissioner under this chapter, the superior court for Providence County may, on such notice that the court deems appropriate, upon the application of the insurer or the commissioner seize or sequester any voting securities of the insurer owned directly or indirectly by the person, and issue such orders as may be appropriate to effectuate the provisions of this chapter. Notwithstanding any other provisions of law, for the purposes of this chapter, the situs of the ownership of the securities of domestic insurers shall be deemed to be in this state.  History of Section.P.L. 1971, ch. 273,  1; P.L. 2010, ch. 55,  1; P.L. 2010, ch. 70,  1. 
 27-35-9. Sanctions. (a) Any insurer failing, without just cause, to file any registration statement as required in this chapter shall be required, after notice and hearing, to pay a penalty of five hundred dollars ($500) for each days delay, to be recovered by the commissioner, and the penalty so recovered shall be paid into the general revenue fund of this state. The maximum penalty under this section is that determined pursuant to  42-14-16. The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.  (b) Every director or officer of an insurance holding company system who knowingly violates, participates in, or assents to, or who knowingly shall permit any of the officers or agents of the insurer to engage in transactions or make investments which have not been properly reported or submitted as required by this chapter or which violate this chapter shall pay, in their individual capacity, a civil forfeiture determined pursuant to  42-14-16, after notice and hearing. In determining the amount of the civil forfeiture, the commissioner shall take into account the appropriateness of the forfeiture with respect to the gravity of the violation, the history of previous violations, and such other matters as justice may require.  (c) Whenever it appears to the commissioner that any insurer subject to this act or any director, officer, employee, or agent of the insurer has engaged in any transaction or entered into a contract which is subject to  27-35-4 of this chapter and which would not have been approved had approval been requested, the commissioner may order the insurer to immediately cease and desist any further activity under the transaction or contract. After notice and hearing the commissioner may also order the insurer to void any contracts and restore the status quo if that action is in the best interest of the policyholders, creditors, or the public.  (d) Whenever it appears to the commissioner that any insurer or any director, officer, employee or agent thereof has committed a willful violation of this chapter, that insurer or any director, officer, employee or agent thereof shall be in violation of chapter 54 of title 27.  (e) Whenever it appears to the commissioner that any person has committed a violation of  27-35-2 of this chapter and which prevents the full understanding of the enterprise risk to the insurer by affiliates or by the insurance holding company system, the violation may serve as an independent basis for disapproving dividends or distributions and for placing the insurer under an order of supervision in accordance with chapter 14.1 of this title.  History of Section.P.L. 1971, ch. 273,  1; P.L. 1991, ch. 257,  5; P.L. 1991, ch. 348,  10; P.L. 2010, ch. 55,  1; P.L. 2010, ch. 70,  1; P.L. 2011, ch. 15,  2; P.L. 2011, ch. 26,  2. 
 27-36-1. Representation. All hearings conducted in accordance with the provisions of this title and chapter 62 of title 42 shall be attended by the attorney general or his or her designee and he or she shall represent, protect, and advocate the rights of the consumers at the hearings; provided, that if the hearings are related to a rate increase request by a health insurer, then the hearings shall be open to the public and shall be held by the department of business regulation. The department shall promulgate rules and regulations to ensure that the general public is given adequate notice. The term health insurer as used in this chapter includes all persons, firms, corporations, or other organizations offering and assuring health services on a prepaid or primarily expense incurred basis, including, but not limited to, policies of accident or sickness insurance, as defined by chapter 18 of this title, nonprofit hospital or medical service plans, whether organized under chapter 10 or 20 of this title or under any public law or by special act of the general assembly, health maintenance organizations, and any other entity which insures or reimburses for diagnostic, therapeutic, or preventive services to a defined population on the basis of a periodic premium. It shall also include all organizations providing health benefits coverage for employees on a self-insurance basis without the intervention of other entities.  History of Section.P.L. 1977, ch. 219,  1; P.L. 1987, ch. 569,  1; P.L. 1990, ch. 335,  1; P.L. 1996, ch. 355,  1. 
 27-36-2. Annual assessments of insurance companies. (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 generals 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 such 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 generals 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.  History of Section.P.L. 1977, ch. 219,  1; P.L. 1987, ch. 569,  1; P.L 1995, ch. 370, art. 40,  87; P.L. 2000, ch. 55, art. 11,  1; P.L. 2001, ch. 127,  1; P.L. 2008, ch. 9, art. 15,  1. 
 27-37-1. Notice of cancellation. No policy of group insurance issued in this state shall be cancelled by the insurer unless written notice of cancellation is mailed to the group contract holder by certified or registered mail at least thirty (30) days prior to the cancellation date in order for the cancellation to be effective.  History of Section.P.L. 1979, ch. 215,  1; P.L. 2002, ch. 292,  81. 
 27-38.1-1. Definitions. For the purposes of this chapter, the following words and terms have the following meanings:  (1) Health insurers as used in this chapter includes all persons, firms, corporations, or other organizations offering and assuring health services on a prepaid or primarily expense incurred basis, including, but not limited to, policies of accident or sickness insurance, as defined by chapter 18 of this title, except for supplemental policies which only provide coverage for specified diseases, or other supplemental policies, nonprofit hospital or medical service plans, whether organized under chapter 19 or 20 of this title or under any public law or by special act of the general assembly, health maintenance organizations, and any other entity, which insures or reimburses for diagnostic, therapeutic, or preventive services to a determined population on the basis of a periodic premium;  (2) Pediatric preventive care means those services recommended by the committee on practice and ambulatory medicine of the American academy of pediatrics when delivered, supervised, prescribed, or recommended by a physician and rendered to a child from birth through age nineteen (19); and  (3) School policy means a policy of accident and sickness insurance, as defined in  27-18-1, providing coverage for a minor child only and issued by or through the school attended by the child.  History of Section.P.L. 1988, ch. 488,  1. 
 27-38.1-2. Coverage required for pediatric preventive care. (a) Every health insurance plan providing coverage for a dependent or minor child, other than school policies, shall include benefits for pediatric preventive care. All benefits shall be reimbursed in accordance with the reimbursement policies and procedure of each health insurer.  (b) Every health insurer shall provide benefits for pediatric preventive care or make that care available to its enrolled participants. Benefits do not need to be provided pursuant to this section for pediatric preventive care services that are paid for or offered free of charge by the state of Rhode Island. Benefits do not need to be provided for the cost of biologicals used for vaccinations.  History of Section.P.L. 1988, ch. 488,  1. 
 27-38.1-3. Benefits to be included in basic coverage. The benefits mandated by this chapter shall be included in all benefit plans offered by every health insurer and health maintenance organization. Benefit plans offered by health insurers and health maintenance organizations may impose copayment charges for the benefits mandated by this chapter; in no instance shall the copayment amounts be greater than copayment charges imposed for other physician office visits, nor shall the copayment charges pose a barrier to obtaining pediatric preventive care. Benefits for pediatric services shall be reimbursed in accordance with each health insurers respective principles and mechanisms of reimbursement. The provisions of this benefit will supersede any deductible requirements.  History of Section.P.L. 1988, ch. 488,  1. 
 27-38.2-1. Coverage for treatment of mental health and substance use disorders. (a) A group health plan and an individual or group health insurance plan shall provide coverage for the treatment of mental health and substance use disorders under the same terms and conditions as that coverage is provided for other illnesses and diseases.  (b) Coverage for the treatment of mental health and substance use disorders shall not impose any annual or lifetime dollar limitation.  (c) Financial requirements and quantitative treatment limitations on coverage for the treatment of mental health and substance use disorders shall be no more restrictive than the predominant financial requirements applied to substantially all coverage for medical conditions in each treatment classification.  (d) Coverage shall not impose non-quantitative treatment limitations for the treatment of mental health and substance use disorders unless the processes, strategies, evidentiary standards, or other factors used in applying the non-quantitative treatment limitation, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation with respect to medical/surgical benefits in the classification.  (e) The following classifications shall be used to apply the coverage requirements of this chapter: (1) Inpatient, in-network; (2) Inpatient, out-of-network; (3) Outpatient, in-network; (4) Outpatient, out-of-network; (5) Emergency care; and (6) Prescription drugs.  (f) Medication-assisted treatment or medication-assisted maintenance services of substance use disorders, opioid overdoses, and chronic addiction, including methadone, buprenorphine, naltrexone, or other clinically appropriate medications, is included within the appropriate classification based on the site of the service.  (g) Payors shall rely upon the criteria of the American Society of Addiction Medicine when developing coverage for levels of care for substance use disorder treatment.  (h) Patients with substance use disorders shall have access to evidence-based, non-opioid treatment for pain, therefore coverage shall apply to medically necessary chiropractic care and osteopathic manipulative treatment performed by an individual licensed under  5-37-2.  (i) Parity of cost-sharing requirements. Regardless of the professional license of the provider of care, if that care is consistent with the providers scope of practice and the health plans credentialing and contracting provisions, cost-sharing for behavioral health counseling visits and medication maintenance visits shall be consistent with the cost-sharing applied to primary care office visits.  History of Section.P.L. 1994, ch. 225,  1; P.L. 1994, ch. 336,  1; P.L. 2001, ch. 174,  2; P.L. 2001, ch. 409,  2; P.L. 2002, ch. 292,  83; P.L. 2014, ch. 108,  1; P.L. 2014, ch. 130,  1; P.L. 2015, ch. 209,  1; P.L. 2015, ch. 236,  1; P.L. 2016, ch. 172,  2; P.L. 2016, ch. 189,  2; P.L. 2017, ch. 165,  5; P.L. 2017, ch. 314,  5; P.L. 2018, ch. 169,  1; P.L. 2018, ch. 253,  1. 
 27-38.2-2. Definitions. For the purposes of this chapter, the following words and terms have the following meanings:  (1) Financial requirements means deductibles, copayments, coinsurance, or out-of-pocket maximums.  (2) Group health plan means an employee welfare benefit plan as defined in 29 U.S.C.  1002(1) to the extent that the plan provides health benefits to employees or their dependents directly or through insurance, reimbursement, or otherwise. For purposes of this chapter, a group health plan shall not include a plan that provides health benefits directly to employees or their dependents, except in the case of a plan provided by the state or an instrumentality of the state.  (3) Health insurance plan means health insurance coverage offered, delivered, issued for delivery, or renewed by a health insurer.  (4) Health insurers means all persons, firms, corporations, or other organizations offering and assuring health services on a prepaid or primarily expense-incurred basis, including but not limited to, policies of accident or sickness insurance, as defined by chapter 18 of this title; nonprofit hospital or medical service plans, whether organized under chapter 19 or 20 of this title or under any public law or by special act of the general assembly; health maintenance organizations, or any other entity that insures or reimburses for diagnostic, therapeutic, or preventive services to a determined population on the basis of a periodic premium. Provided, this chapter does not apply to insurance coverage providing benefits for:  (i) Hospital confinement indemnity;  (ii) Disability income;  (iii) Accident only;  (iv) Long-term care;  (v) Medicare supplement;  (vi) Limited benefit health;  (vii) Specific disease indemnity;  (viii) Sickness or bodily injury or death by accident or both; and  (ix) Other limited benefit policies.  (5) Mental health or substance use disorder means any mental disorder and substance use disorder that is listed in the most recent revised publication or the most updated volume of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association or the International Classification of Disease Manual (ICO) published by the World Health Organization; provided, that tobacco and caffeine are excluded from the definition of substance for the purposes of this chapter.  (6) Non-quantitative treatment limitations means: (i) Medical management standards; (ii) Formulary design and protocols; (iii) Network tier design; (iv) Standards for provider admission to participate in a network; (v) Reimbursement rates and methods for determining usual, customary, and reasonable charges; and (vi) Other criteria that limit scope or duration of coverage for services in the treatment of mental health and substance use disorders, including restrictions based on geographic location, facility type, and provider specialty.  (7) Quantitative treatment limitations means numerical limits on coverage for the treatment of mental health and substance use disorders based on the frequency of treatment, number of visits, days of coverage, days in a waiting period, or other similar limits on the scope or duration of treatment.  History of Section.P.L. 1994, ch. 225,  1; P.L. 1994, ch. 336,  1; P.L. 2001, ch. 174,  2; P.L. 2001, ch. 409,  2; P.L. 2014, ch. 108,  1; P.L. 2014, ch. 130,  1. 
 27-38.2-3. Medical necessity and appropriateness of treatment. (a) Upon request of the reimbursing health insurers, all providers of treatment of mental illness shall furnish medical records or other necessary data which substantiates that initial or continued treatment is at all times medically necessary and appropriate. When the provider cannot establish the medical necessity and/or appropriateness of the treatment modality being provided, neither the health insurer nor the patient shall be obligated to reimburse for that period or type of care that was not established. The exception to the preceding can only be made if the patient has been informed of the provisions of this subsection and has agreed in writing to continue to receive treatment at his or her own expense.  (b) The health insurers, when making the determination of medically necessary and appropriate treatment, must do so in a manner consistent with that used to make the determination for the treatment of other diseases or injuries covered under the health insurance policy or agreement.  (c) Any subscriber who is aggrieved by a denial of benefits provided under this chapter may appeal a denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23.  History of Section.P.L. 1994, ch. 225,  1; P.L. 1994, ch. 336,  1; P.L. 1999, ch. 148,  1; P.L. 2001, ch. 174,  2; P.L. 2001, ch. 409,  2; P.L. 2008, ch. 475,  93. 
 27-38.2-4. Network coverage. The healthcare benefits outlined in this chapter apply only to services delivered within the health insurers provider network; provided, that all health insurers shall be required to provide coverage for those benefits mandated by this chapter outside of the health insurers provider network where it can be established that the required services are not available from a provider in the health insurers network.  History of Section.P.L. 1994, ch. 225,  1; P.L. 1994, ch. 336,  1; P.L. 2001, ch. 174,  2; P.L. 2001, ch. 409,  2; P.L. 2014, ch. 108,  1; P.L. 2014, ch. 130,  1. 
 27-38.2-5. Repealed. History of Section.P.L. 2001, ch. 174,  3; P.L. 2001, ch. 409,  3; Repealed by P.L. 2014, ch. 108,  2, effective June 16, 2014; P.L. 2014, ch. 130,  2, effective June 16, 2014. 
 27-38.2-6. Infant and early childhood mental wellness task force. (a) The general assembly hereby finds that:  (1) Infant and early childhood mental health is defined by Zero to Three as the developing capacity of the child from birth to five (5) years of age to: form close and secure adult and peer relationships, experience, manage and express a full range of emotions, and explore the environment and learn  all in the context of family, community and culture.  (2) Significant mental health challenges can and do occur in babies and young children. Epidemiological studies show a sixteen percent (16%) to eighteen percent (18%) prevalence rate of mental health disorders in children between age one and age six (6). Evidence shows that many mental health challenges occurring in the first years of life persist and increase the risk of problems related to early learning and development in all areas, and to serious long-term health and mental health challenges and poor educational and economic outcomes.  (3) Young children respond to and process emotional experiences and traumatic events in ways that are very different from adults and older children. Consequently, identifying and addressing mental health challenges in early childhood requires special skills and knowledge. Promoting responsive and nurturing parent/caregiver-child relationships is particularly important for babies and young children.  (4) It is essential to treat young childrens mental health challenges in the context of their relationships within families, homes, and communities. The emotional well-being of young children is directly tied to the functioning of their parents/caregivers and the families in which they live. Thus, successful mental health treatment for young children involves working to build and strengthen consistent, supportive relationships within their families and community. Identifying and treating mental health challenges of parents and caregivers, especially maternal depression which is a common condition and can negatively impact child development, is also needed. When relationships are reliably responsive and supportive and stress is reduced, young children can thrive.  (5) Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-5) is the only recommended diagnosis system for children under age six (6). DC: 0-5 is a system of classification of mental health and developmental disorders for infants and toddlers.  (6) Evidence-based and evidence-informed parent-child dyadic therapies exist that focus on the powerful influence of the parent/caregiver-child relationship to positively impact a childs trajectory. Evidence-based interventions aimed at mental health challenges are more effective when implemented during early childhood rather than school age. It is a misconception that young children will grow out of their difficulties or simply forget early traumatic experiences.  (7) In Rhode Island, approximately fifty percent (50%) of infants and young children have Medicaid health coverage which covers screening, evaluation, diagnosis, and treatment for childrens mental health needs starting at birth. Data from 2018 indicate that less than eight percent (8%) of the Medicaid population under age six (6) received any mental health services.  (8) According to the National Center for Children in Poverty, at least twenty-one (21) states have adopted research-informed infant/early childhood mental health state policies and scaled initiatives. Medicaid policy in at least thirteen (13) states and the District of Columbia recommends or requires the use of the developmentally-appropriate DC: 0-5 system for the diagnosis of children under age six (6), and at least twelve (12) states require providers to use an evidence-based dyadic treatment model for children under age six (6).  (b) The executive office of health and human services shall establish a task force to develop a plan to improve promotion of social and emotional well-being of young children as well as screening, assessment, diagnosis, and treatment of mental health challenges for children from birth through age five (5) with Medicaid coverage.  (c) The planning task force shall include representation from the RI Association for Infant Mental Health and representatives from pediatric health care, mental health care, child psychiatry, child welfare, early intervention, family home visiting, early care and education, advocacy organizations, Medicaid managed care organizations, Medicaid accountable entities, families with young children, and other stakeholders as needed.  (d) The plan established in accordance with this section shall include strategies to:  (1) Promote use of developmentally appropriate screening, assessment, diagnosis, and evidence-based and evidence-informed parent-child dyadic therapies for children from birth through age five (5).  (2) Identify mental health promotion and prevention-related parenting support programs, particularly evidence-based or evidence-informed parent-child programs supporting social and emotional well-being.  (3) Allow for effective screening, evaluation, and treatment over multiple visits with a qualified practitioner in a variety of settings, including in childrens homes, at childcare and early learning programs, in schools, and in clinical and other professional settings.  (4) Establish a registry of trained infant/early childhood mental health professionals that can be a resource across health care, education, and human service settings.  (5) Strengthen infant and early childhood mental health skills, knowledge, and practices of all providers who work with young children (birth through age five (5)) in health care, mental health care, early childhood, and child welfare service sectors.  (6) Address and respond to the intergenerational effects of racism, economic insecurity, and toxic stress that influence the health and mental health of parents/caregivers, babies, and young children.  (e) The task force shall submit a plan to the governor and general assembly on or before June 30, 2023.  History of Section.P.L. 2022, ch. 303,  1, effective June 29, 2022; P.L. 2022, ch. 304,  1, effective June 29, 2022. 
 27-38-1  27-38-9. Repealed.
 27-39-1. Definitions. As used in this chapter: (1) Elective surgical procedure means any non-emergency surgical procedure that may be scheduled at the convenience of the patient or the surgeon without jeopardizing the patients life or causing serious impairment to the patients bodily functions;  (2) Eligible physician means a physician licensed to practice medicine and surgery who holds the rank of diplomate of an American board (M.D.) or certified specialist (D.O.) in the surgical or medical specialty for which surgery is proposed; and  (3) Second surgical opinion means an opinion of an eligible physician based on that physicians examination of a person for the purpose of evaluating the medical advisability of that person undergoing an elective surgical procedure. The examinations must be performed after another physician licensed to practice medicine and surgery has proposed to perform the surgical procedure on the person but prior to the performance of the surgical procedure.  History of Section.P.L. 1983, ch. 143,  1. 
 27-39-2. Insurance benefits for second opinion. (a) Any insurer issuing an individual insurance policy which provides coverage of surgical operations performed on a person while confined in a hospital as an inpatient shall make available under the policy benefits for a second surgical opinion for elective surgical procedures performed in a hospital either on an inpatient or outpatient basis or in a licensed surgical facility.  (b) Benefits for a second surgical opinion shall include payment for the second surgical opinion services of an eligible physician and for essential laboratory and X-ray services incidental to those services, either as a benefit under the individual policy or, at the insurers option, as an additional benefit offered to the prospective policyholder at issue of a policy. Benefit payments may be limited to second surgical opinion services of eligible physicians who have agreed to participate in an insurers second surgical opinion program. The benefits shall be equal to amounts payable under the policy for covered in hospital consultations. As a condition of eligibility for a second surgical opinion benefit, the subscriber shall notify the insurer in advance to verify eligibility and compliance with the provisions in this section.  History of Section.P.L. 1983, ch. 143,  1. 
 27-39-3. Insurance benefits for third opinion. If a second surgical opinion does not confirm that a proposed elective surgical procedure is medically advisable, benefits must be provided under the policy for a third surgical opinion in the same manner as for the second opinion. As a condition of eligibility for a second surgical opinion benefit, the subscriber shall notify the insured in advance to verify eligibility and compliance with the provisions in this section.  History of Section.P.L. 1983, ch. 143,  1. 
 27-39-4. Exclusions. (a) The second surgical opinion benefit provisions of a policy may exclude: (1) benefits while the patient is confined in a hospital as an inpatient, (2) any surgical procedures not covered by the policy, and (3) surgical procedures in the following categories: cosmetic surgery, pregnancy related surgery, dental surgery, podiatric surgery, and sterilization.  (b) If an eligible physician who furnishes a second or third surgical opinion also performs the surgical procedure, the policy need not provide payment for the second and third opinion services of that physician.  History of Section.P.L. 1983, ch. 143,  1. 
 27-39-5. Severability. If any provision of this chapter or its application to any person or circumstances is held invalid, that invalidity shall not affect other provisions or applications of the chapter which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared to be severable.  History of Section.P.L. 1983, ch. 143,  1. 
 27-4.1-1. Prepaid legal services plans unaffected. Nothing in this chapter shall apply to or affect a nonprofit prepaid legal services plan that operates in this state by a nonprofit prepaid legal services corporation subject to chapter 20.3 of this title.  History of Section.P.L. 1986, ch. 431,  1. 
 27-4.1-10. Rules and regulations. The commissioner may make reasonable rules and regulations necessary to effect the purposes of this chapter.  History of Section.P.L. 1986, ch. 431,  1. 
 27-4.1-2. Legal services insurance as a form of accident and health insurance  Effect of other laws. Legal services insurance provides for the mental and emotional welfare of human beings by defraying the costs of legal services; it shall be deemed to be accident and health insurance and shall be classified this way for the purposes of chapters 34.1 and 34.3 of this title. Legal services insurance may only be written pursuant to the provision of this chapter. Except to the extent expressly provided in this chapter, nothing in any other chapter of this title regulating the form, content, or provisions of accident and health insurance policies or the filing and approval of these policies including premium rates shall apply to legal services insurance policies written under and subject to the provisions of this chapter.  History of Section.P.L. 1986, ch. 431,  1; P.L. 1999, ch. 147,  3. 
 27-4.1-3. Authority to transact business. Any insurance company incorporated by or under the laws of this state or any foreign or alien insurance company duly licensed to do business in this state may transact the business of legal services insurance, if that company is authorized to do property and casualty and/or accident and health insurance business in this state.  History of Section.P.L. 1986, ch. 431,  1. 
 27-4.1-4. Legal services insurance defined. Legal services insurance is insurance which involves the assumption of a contractual obligation to reimburse the beneficiary against or pay on behalf of the beneficiary all or a portion of his or her fees, costs, or expenses related to or arising out of services performed by or under the supervision of an attorney who is not an employee of or under the control of the insurer directly or indirectly and who is licensed to practice in the state of Rhode Island or any other state where the attorney provides these services. Legal services insurance may also include provisions for basic legal services rendered to the beneficiary, by telephone or mail, by one or more attorneys licensed to practice in the state of Rhode Island or any other state where the attorney provides these basic legal services none of whom are employees of or under the control of the insurer directly or indirectly. Legal services insurance does not include the provision of or reimbursement for legal services incidental to other insurance coverage. Beneficiaries of legal services shall not be required to select an attorney other than one of the beneficiarys own choosing except for basic legal advice rendered by telephone or mail as described in this section. Attorneys providing basic legal advice rendered by telephone or mail under legal insurance policies shall refer all beneficiaries to an attorney of the beneficiarys choice for other than basic legal services and shall be prohibited from taking any of these referrals.  History of Section.P.L. 1986, ch. 431,  1. 
 27-4.1-5. Individual and group legal services insurance. Any insurance company authorized to write legal services insurance in this state shall have the power to issue individual or group legal services insurance policies or may, by providing for the mental and emotional welfare of individuals and members of his or her family by defraying the costs of legal services, include legal services insurance in and as a part of a group accident and health insurance policy. Group legal services insurance is that form of voluntary legal services insurance covering not less than ten (10) employees or members, with or without their eligible dependents, written under a master policy issued to any governmental corporation, unit, agency, or department, or to any employer or association of employers, including the trustee or trustees of a fund established by an employer or association of employers, or to a labor union or other similar employee organization, including the trustees of a fund established by a labor union or employee organization. The terms employee and employees have the meaning given to each term in the policy.  History of Section.P.L. 1986, ch. 431,  1. 
 27-4.1-6. Filing of forms and classification of risks and premiums. No policy of legal services insurance shall be issued or delivered to any person in this state, nor shall any application, certificate of group insurance, rider, or endorsement be used in connection with the policy, until a copy of the form and of the classification of risks and premium rates pertaining to the risks have been filed with the insurance commissioner, nor until the expiration of sixty (60) days after this unless the commissioner gives written approval sooner.  History of Section.P.L. 1986, ch. 431,  1. 
 27-4.1-7. Disapproval of forms. (a) The commissioner may, within sixty (60) days after the filing of any form, disapprove the form:  (1) If the benefits provided in the form are unreasonable in relation to the premium charged;  (2) If it contains a provision or provisions which are unjust, unfair, inequitable, misleading, deceptive, or encourage misrepresentation of the policy, or if it fails to include a provision deemed by the commissioner to be necessary for the protection of the interest of the public; or  (3) If it does not comply with the requirements of the law.  (b) If the commissioner notifies the insurer that has filed any form that it does not comply with the provisions of this chapter, it shall be unlawful for the insurer to issue that form or use it in connection with any policy. In that notice the commissioner shall specify the reasons for his or her disapproval and state that a hearing will be granted within twenty (20) days after a request in writing by the insurer.  (c) The commissioner may for good cause exempt any group insurance policy or class of group insurance policies from the requirements of subsection (a).  History of Section.P.L. 1986, ch. 431,  1. 
 27-4.1-8. Hearing and use of disapproved forms. The commissioner may at any time, after a hearing of which not less than twenty (20) days written notice has been given to the insurer, withdraw approval of any form on any of the grounds stated in this chapter. It shall be unlawful for the insurer to issue that form or use it in connection with any policy after the effective date of the withdrawal of approval. The notice of any hearing called under this section shall specify the matter to be considered at the hearing and any decision affirming disapproval or directing withdrawal of approval under this chapter shall be in writing and shall specify the reasons for the decision.  History of Section.P.L. 1986, ch. 431,  1. 
 27-4.1-9. Judicial review of actions of commissioner. The action of the commissioner in disapproving any policy form or withdrawing approval of any policy form shall be subject to review by the superior court for Providence and Bristol counties.  History of Section.P.L. 1986, ch. 431,  1. 
 27-4.10-1. Definitions. As used in this chapter, the term: (1) Agent means a person who is the agent of record of a policy or who has a business relationship with the policyholder or insured.  (2) Commissioner means the director of the department of business regulation and any assistant to the director.  (3) Insured means an individual who is covered by a policy.  (4) Insurer means the insurance company that issued or currently insures the policy.  (5) Policy means an individual life insurance policy owned by an individual who is a resident of this state, regardless of whether the policy has been issued, delivered, or renewed in this state.  History of Section.P.L. 2018, ch. 126,  1; P.L. 2018, ch. 196,  1. 
 27-4.10-2. Notice. (a) The commissioner shall develop, and post on its website, a written notice to inform a policyholder of alternatives to the lapse or surrender of a policy, and of the policyholders rights, as an owner of the policy, that are related to the disposition of a policy. The notice must be developed at no cost to insurers, agents, or other licensees and must be written in lay terms.  (b) The written notice must contain all of the following:  (1) A statement explaining that life insurance is a critical part of a broader financial plan;  (2) A statement explaining that there are alternatives to the lapse or surrender of a policy;  (3) A general description of the following alternatives to the lapse or surrender of a policy:  (i) Accelerated death benefits available under the policy or as a rider to the policy;  (ii) The assignment of the policy as a gift;  (iii) The sale and assignment of the policy pursuant to a life settlement contract, including that a life settlement is a regulated transaction in this state pursuant to chapter 72 of title 27;  (iv) The replacement of the policy;  (v) The maintenance of the policy pursuant to the terms of the policy or a rider to the policy, or through a life settlement contract;  (vi) The maintenance of the policy through loans issued by an insurer or a third party, using the policy or the cash surrender value of the policy as collateral for the loan;  (vii) Conversion of the policy from a term policy to a permanent policy;  (viii) Conversion of the policy in order to obtain long-term-care health insurance coverage or a long-term-care benefit plan; and  (4) A statement explaining that life insurance, life settlements, or other alternatives to the lapse or surrender of the policy described in the notice may not be available to a particular policyholder depending on a number of circumstances, including the age and health status of the insured or the terms of a life insurance policy, and that the policyholder should contact his or her financial advisor, insurance agent, broker, or attorney to obtain further advice and assistance.  (c) An insurer, an agent, or an insurer and its agent must advise a policyholder with the annual benefit statement or otherwise that policyholders considering making changes in the status of the policy should consult a licensed insurance agent or financial advisor and that important information related to policy options, including information about an accelerated death benefit, nursing home benefit, critical illness benefit, and additional benefits may be found on the department of business regulation (DBR) website.  History of Section.P.L. 2018, ch. 126,  1; P.L. 2018, ch. 196,  1. 
 27-4.2-1. Preamble. (a) The Rhode Island department of business regulation, the insurance division, recognizes that licensed insurers routinely enter into reinsurance agreements that yield legitimate relief to the ceding insurer from strain to surplus.  (b) It is improper for a licensed insurer, in the capacity of ceding insurer, to enter into reinsurance agreements for the principal purpose of producing significant surplus aid for the ceding insurer, typically on a temporary basis, while not transferring all of the significant risks inherent in the business being reinsured. In substance or effect, the expected potential liability to the ceding insurer remains basically unchanged by the reinsurance transaction, notwithstanding certain risk elements in the reinsurance agreement, such as catastrophic mortality or extraordinary survival. The terms of agreements referred to in this section and described in  27-4.2-3 would violate:  (1) Applicable sections of the general laws relating to financial statements of insurers, resulting in distorted financial statements which do not properly reflect the financial condition of the ceding insurer;  (2) Applicable sections of the general laws relating to reinsurance reserve credits, resulting in a ceding insurer improperly reducing liabilities or establishing assets for reinsurance ceded; and  (3) Applicable sections of the general laws relating to creating a situation that may be hazardous to policyholders and the people of this state.  History of Section.P.L. 1995, ch. 111,  2. 
 27-4.2-2. Applicability. This chapter shall apply to all domestic life and accident and health insurers and to all other licensed life and accident and health insurers that are not subject to a substantially similar regulation in their domiciliary state. This chapter shall also similarly apply to licensed property and casualty insurers with respect to their accident and health business. This chapter shall not apply to assumption reinsurance, yearly renewable term reinsurance or certain non-proportional reinsurance such as stop loss or catastrophe reinsurance.  History of Section.P.L. 1995, ch. 111,  2. 
 27-4.2-3. Accounting requirements. (a) No insurer subject to this chapter shall, for reinsurance ceded, reduce any liability or establish any asset in any financial statement filed with the department if, by the terms of the reinsurance agreement, in substance or effect, any of the following conditions exist:  (1) Renewal expense allowances provided or to be provided to the ceding insurer by the reinsurer in any accounting period are not sufficient to cover anticipated allocable renewal expenses of the ceding insurer on the portion of the business reinsured, unless a liability is established for the present value of the shortfall (using assumptions equal to the applicable statutory reserve basis on the business reinsured). Those expenses include commissions, premium taxes and direct expenses including, but not limited to, billing, valuation, claims and maintenance expected by the company at the time the business is reinsured;  (2) The ceding insurer can be deprived of surplus or assets at the reinsurers option or automatically upon the occurrence of some event, such as the insolvency of the ceding insurer, except that termination of the reinsurance agreement by the reinsurer for nonpayment of reinsurance premiums or other amounts due, such as modified coinsurance reserve adjustments, interest and adjustments on funds withheld, and tax reimbursements, shall not be considered to be a deprivation of surplus or assets;  (3) The ceding insurer is required to reimburse the reinsurer for negative experience under the reinsurance agreement, except that neither offsetting experience refunds against current and prior years losses under the agreement nor payment by the ceding insurer of an amount equal to the current and prior years losses under the agreement upon voluntary termination of in-force reinsurance by the ceding insurer shall be considered a reimbursement to the reinsurer for negative experience. Voluntary termination does not include situations where termination occurs because of unreasonable provisions that allow the reinsurer to reduce its risk under the agreement. An example of this provision is the right of the reinsurer to increase reinsurance premiums or risk and expense charges to excessive levels forcing the ceding company to prematurely terminate the reinsurance treaty;  (4) The ceding insurer must, at specific points in time scheduled in the agreement, terminate or automatically recapture all or part of the reinsurance ceded;  (5) The reinsurance agreement involves the possible payment by the ceding insurer to the reinsurer of amounts other than from income realized from the reinsured policies. For example, it is improper for a ceding company to pay reinsurance premiums, or other fees or charges to a reinsurer that are greater than the direct premiums collected by the ceding company;  (6) The treaty does not transfer all of the significant risk inherent in the business being reinsured. The risk categories considered shall be morbidity, mortality, lapse, credit quality, reinvestment, and disintermediation. These categories are further defined in the regulation promulgated pursuant to this chapter;  (7)(i) The credit quality, reinvestment, or disintermediation risk is significant for business reinsured and the ceding company does not (other than for the classes of business excepted in subdivision (a)(7)(ii) of this section) either transfer the underlying assets to the reinsurer or legally segregate these assets in a trust or escrow account or establish a mechanism satisfactory to the commissioner which legally segregates, by contract or contract provision, the underlying assets;  (ii) Notwithstanding the requirements of subdivision (a)(7)(i) of this section, the assets supporting the reserves for the following classes of business and any classes of business which do not have a significant credit quality, reinvestment or disintermediation risk may be held by the ceding company without segregation of these assets:  (A) Health insurance  long term care insurance/long term disability insurance;  (B) Traditional non-par permanent;  (C) Traditional par permanent;  (D) Adjustable premium permanent;  (E) Indeterminate premium permanent;  (F) Universal life fixed premium (no dump-in premiums allowed);  (iii) The associated formula for determining the reserve interest rate adjustment must use a formula that reflects the ceding companys investment earnings and incorporates all realized and unrealized gains and losses reflected in the statutory statement. An acceptable formula shall be set forth in regulations promulgated pursuant to this chapter;  (8) Settlements are made less frequently than quarterly or payments due from the reinsurer are not made in cash within ninety (90) days of the settlement date;  (9) The ceding insurer is required to make representations or warranties not reasonably related to the business being reinsured;  (10) The ceding insurer is required to make representations or warranties about future performance of the business being reinsured; and  (11) The reinsurance agreement is entered into for the principal purpose of producing significant surplus aid for the ceding insurer, typically on a temporary basis, while not transferring all of the significant risks inherent in the business reinsured and, in substance or effect, the expected potential liability to the ceding insurer remains basically unchanged.  (b) Notwithstanding subsection (a), an insurer subject to this chapter may, with the prior approval of the commissioner, take a reserve credit or establish any asset the commissioner may deem consistent with chapter 1.1 of this title and regulations promulgated under that chapter, including actuarial interpretations or standards adopted by the insurance division of the department of business regulation.  (c)(1) Agreements entered into after the effective date of this chapter which involve the reinsurance of business issued prior to the effective date of the agreements, along with any subsequent amendments to it, shall be filed by the ceding company with the commissioner within thirty (30) days from its date of execution. Each filing shall include data detailing the financial impact of the transaction. The ceding insurers actuary who signs the financial statement actuarial opinion with respect to valuation of reserves shall consider this chapter and any applicable actuarial standards of practice when determining the proper credit in financial statements filed with the insurance division of the department of business regulation. The actuary should maintain adequate documentation and be prepared upon request to describe the actuarial work performed for inclusion in the financial statements and to demonstrate that the work conforms to this regulation.  (2) Any increase in surplus net of federal income tax resulting from arrangements described in subsection (c)(1) shall be identified separately on the insurers statutory financial statement as a surplus item (aggregate write-ins for gains and losses in surplus in the capital and surplus account, of the annual statement) and recognition of the surplus increase as income shall be reflected on a net of tax basis in the annual statement as earnings emerge from the business reinsured.  History of Section.P.L. 1995, ch. 111,  2. 
 27-4.2-4. Written agreements. (a) No reinsurance agreement or amendment to any agreement may be used to reduce any liability or to establish any asset in any financial statement filed with the insurance division of the department of business regulation, unless the agreement, amendment, or a binding letter of intent has been duly executed by both parties no later than the as of date of the financial statement.  (b) In the case of a letter of intent, a reinsurance agreement or an amendment to a reinsurance agreement must be executed within a reasonable period of time, not exceeding ninety (90) days from the execution date of the letter of intent, in order for credit to be granted for the reinsurance ceded.  (c) The reinsurance agreement shall contain provisions which provide that:  (1) The agreement shall constitute the entire agreement between the parties with respect to the business being reinsured and that there are no understandings between the parties other than as expressed in the agreement; and  (2) Any change or modification to the agreement shall be null and void unless made by amendment to the agreement and signed by both parties.  History of Section.P.L. 1995, ch. 111,  2. 
 27-4.2-5. Repealed.
 27-4.2-6. Rules and regulations. The insurance commissioner shall have the authority to promulgate rules and regulations necessary to carry out the purposes of this chapter.  History of Section.P.L. 1995, ch. 111,  2. 
 27-4.2-7. Existing agreements. Insurers subject to this act shall reduce to zero by December 31, 1997, any reserve credits or assets established with respect to reinsurance agreements entered into prior to the effective date of this act which, under the provisions of this act would not be entitled to recognition of the reserve credits or assets; provided, however, that the reinsurance agreements shall have been in compliance with laws or regulations in existence immediately preceding the effective date of this act.  History of Section.P.L. 2011, ch. 18,  4; P.L. 2011, ch. 25,  4. 
 27-4.3-1.1. Definitions. Operative date of the valuation manual means January 1 of the first calendar year that the valuation manual as defined in chapter 4.5 of this title is effective.  History of Section.P.L. 2013, ch. 17,  3; P.L. 2013, ch. 20,  3. 
 27-4.3-1. Short title. This chapter shall be known as the Standard Nonforfeiture Law for Life Insurance Act.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.3-10. Severability. If any provision of this chapter, or the application of the 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 to which it is held invalid, shall not be affected by that invalidity.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.3-11. Rules and regulations. The director of the department of business regulation may adopt reasonable rules and regulations for the implementation and administration of this chapter.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.3-2. Nonforfeiture benefits. (a) Policies issued on and after January 1, 1994, except as stated in  27-4.3-9, shall not be delivered or issued for delivery in this state unless they shall contain in substance the following provisions, or corresponding provisions which in the opinion of the commissioner of insurance are at least as favorable to the defaulting or surrendering policyholder as are the minimum requirements specified in this chapter and are essentially in compliance with  27-4.3-8:  (1) That in the event of default in any premium payment, the insurance company will grant, upon proper request not later than sixty (60) days after the due date of the premium in default, a paid up nonforfeiture benefit on a plan stipulated in the policy, effective as of the due date, of the amount as specified in this chapter. In lieu of the stipulated paid up nonforfeiture benefit, the insurance company may substitute, upon proper request not later than sixty (60) days after the due date of the premium in default, an actuarially equivalent alternative paid up nonforfeiture benefit which provides a greater amount or longer period of death benefits or, if applicable, a greater amount or earlier payment of endowment benefits;  (2) That upon surrender of the policy within sixty (60) days after the due date of any premium payment in default after premiums have been paid for at least three (3) full years in the case of ordinary insurance or five (5) full years in the case of industrial insurance, the insurance company will pay, in lieu of any paid up nonforfeiture benefit, a cash surrender value of an amount as specified in this chapter;  (3) That a specified paid up nonforfeiture benefit shall become effective as specified in the policy unless the person entitled to make an election elects another available option not later than sixty (60) days after the due date of the premium in default;  (4) That if the policy shall have become paid up by completion of all premium payments or if it is continued under any paid-up nonforfeiture benefit which became effective on or after the third policy anniversary in the case of ordinary insurance or the fifth policy anniversary in the case of industrial insurance, the insurance company will pay, upon surrender of the policy within thirty (30) days after any policy anniversary, a cash surrender value of an amount as specified in this chapter;  (5) In the case of policies which cause, on a basis guaranteed in the policy, unscheduled changes in benefits or premiums or which provide an option for changes in benefits or premiums other than a change to a new policy, a statement of the mortality table, interest rate, and method used in calculating cash surrender values and the paid up nonforfeiture benefits available under the policy. In the case of all other policies, a statement of the mortality table and interest rate used in calculating the cash surrender values and the paid up nonforfeiture benefits available under the policy, together with a table showing the cash surrender value, if any, and paid up nonforfeiture benefit, if any, available under the policy on each policy anniversary either during the first twenty (20) policy years or during the term of the policy, whichever is shorter; the values and benefits to be calculated upon the assumption that there are no dividends or paid up additions credited to the policy and that there is no indebtedness to the insurance company on the policy; and  (6) A statement that the cash surrender values and the paid up nonforfeiture benefits available under the policy are not less than the minimum values and benefits required by or pursuant to the insurance law of the state in which the policy is delivered; an explanation of the manner in which the cash surrender values and the paid up nonforfeiture benefits are altered by the existence of any paid up additions credited to the policy or any indebtedness to the insurance company on the policy; if a detailed statement of the method of computation of the values and benefits shown in the policy is not stated in the policy, a statement that the method of computation has been filed with the insurance supervisory official of the state in which the policy is delivered; and a statement of the method to be used in calculating the cash surrender value and a paid up nonforfeiture benefit available under the policy on any policy anniversary beyond the last anniversary for which the values and benefits are consecutively shown in the policy.  (b) Any of the provisions of subsection (a) not applicable by reason of the plan of insurance may, to the extent inapplicable, be omitted from the policy.  (c) The insurance company shall reserve the right to defer the payment of any cash surrender value for a period of six (6) months after demand for the payment with surrender of the policy.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.3-3. Computation of cash surrender value. (a) Any cash surrender value available under the policy in the event of default in a premium payment due on any policy anniversary, whether or not required by  27-4.3-2, shall be an amount not less than the excess, if any, of the present value, on the anniversary, of the future guaranteed benefits which could have been provided for by the policy, including any existing paid up additions, if there had been no default, over the sum of:  (1) The then present value of the adjusted premiums as defined in  27-4.3-5, corresponding to premiums which would have fallen due on and after the anniversary; and  (2) The amount of any indebtedness to the insurance company on the policy.  (b) For any policy issued on or after January 1, 1994, which provides supplemental life insurance or annuity benefits at the option of the insured and for an identifiable additional premium by rider or supplemental policy provision, the cash surrender value referred to in subsection (a) shall be an amount not less than the sum of the cash surrender value as defined in subsection (a) for a similar policy issued at the same age without the rider or supplemental policy provision and the cash surrender value as defined in subsection (a) for a policy which provides only the benefits provided by the rider or supplemental policy provision.  (c) For any family policy issued on or after January 1, 1994, which defines a primary insured and provides term insurance on the life of the spouse of the primary insured expiring before the spouses attaining age seventy-one (71), the cash surrender value referred to in subsection (a) of this section shall be an amount not less than the sum of the cash surrender value as defined in subsection (a) for a similar policy issued at the same age without the term insurance on the life of the spouse and the cash surrender value as defined in subsection (a) for a policy which provides only the benefits provided by the term insurance on the life of the spouse.  (d) Any cash surrender value available within thirty (30) days after any policy anniversary under any policy paid up by completion of all premium payments or any policy continued under any paid up nonforfeiture benefit, whether or not required by  27-4.3-2, shall be an amount not less than the present value, on the anniversary, of the future guaranteed benefits provided for by the policy, including any existing paid-up additions, decreased by any indebtedness to the insurance company on the policy.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.3-4. Computation of paid-up nonforfeiture benefits. Any paid-up nonforfeiture benefit available under the policy in the event of default in a premium payment due on any policy anniversary shall be such that its present value as of the anniversary shall be at least equal to the cash surrender value then provided for by the policy or, if none is provided for, that cash surrender value which would have been required by this chapter in the absence of the condition that the premium shall have been paid for at least a specified period.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.3-5. Calculations of adjusted premiums by the nonforfeiture net level premium method. (a) This section shall apply to all policies issued on or after January 1, 1994. Except as provided in subsection (g) of this section, the adjusted premiums for any policy shall be calculated on an annual basis and shall be such a uniform percentage of the respective premiums specified in the policy for each policy year, excluding amounts payable as extra premiums to cover impairments or special hazards, and also excluding any uniform annual contract charge or policy fee specified in the policy in a statement of the method to be used in calculating the cash surrender values and paid-up nonforfeiture benefits, that the present value, at the date of issue of the policy, of all adjusted premiums shall be equal to the sum of: (1) the then-present value of the future-guaranteed benefits provided for by the policy; (2) one percent (1%) of either the amount of insurance, if the insurance be uniform in amount, or the average amount of insurance at the beginning of each of the first ten (10) policy years; and (3) one hundred twenty-five percent (125%) of the nonforfeiture, net-level premium as defined in subsection (b); provided, however, that in applying the percentage specified in subdivision (a)(3), no nonforfeiture net-level premium shall be deemed to exceed four percent (4%) of either the amount of insurance, if the insurance be uniform in amount, or the average amount of insurance at the beginning of each of the first ten (10) policy years. The date of issue of a policy for the purpose of this section shall be the date as of which the rated age of the insured is determined.  (b) The nonforfeiture, net-level premium shall be equal to the present value, at the date of issue of the policy, of the guaranteed benefits provided for by the policy divided by the present value, at the date of issue of the policy, of an annuity of one per annum payable on the date of issue of the policy and on each anniversary of the policy on which a premium falls due.  (c) In the case of policies that cause, on a basis guaranteed in the policy, unscheduled changes in benefits or premiums, or that provide an option for changes in benefits or premiums, other than a change to a new policy, the adjusted premiums and present values shall initially be calculated on the assumption that future benefits and premiums do not change from those stipulated at the date of issue of the policy. At the time of any change in the benefits or premiums, the future-adjusted premiums, nonforfeiture, net-level premiums, and present values shall be recalculated on the assumption that future benefits and premiums do not change from those stipulated by the policy immediately after the change.  (d) Except as otherwise provided in subsection (g), the recalculated future-adjusted premiums for any policy shall be a uniform percentage of the future premiums specified in the policy for each policy year, excluding amounts payable as extra premiums to cover impairments and special hazards, and also excluding any uniform annual contract charge or policy fee specified in the policy in a statement of the method to be used in calculating the cash surrender values and paid up nonforfeiture benefits, so that the present value, at the time of change to the newly defined benefits or premiums, of all future-adjusted premiums shall be equal to the excess of: (1) the sum of: (i) the then-present value of the then-future-guaranteed benefits provided for by the policy and (ii) the additional expense allowance, if any, over (2) the then-cash-surrender value, if any, or present value of any paid up, nonforfeiture benefit under this policy.  (e) The additional expense allowance, at the time of the change to the newly defined benefits or premiums, shall be the sum of: (1) one percent (1%) of the excess, if positive, of the average amount of insurance at the beginning of each of the first ten (10) policy years subsequent to the change over the average amount of insurance prior to the change at the beginning of each of the first ten (10) policy years subsequent to the time of the most recent previous change, or, if there has been no previous change, the date of issue of the policy; and (2) one hundred twenty-five percent (125%) of the increase, if positive, in the nonforfeiture net-level premium.  (f) The recalculated, nonforfeiture net-level premium shall be equal to the result obtained by dividing subdivision (f)(1) by subdivision (f)(2) where:  (1) Equals the sum of:  (i) The nonforfeiture net-level premium applicable prior to the change multiplied by the present value of an annuity of one per annum payable on each anniversary of the policy on or subsequent to the date of the change on which a premium would have fallen due had the change not occurred, and  (ii) The present value of the increase in future-guaranteed benefits provided for by the policy; and  (2) Equals the present value of an annuity of one per annum payable on each anniversary of the policy on, or subsequent to, the date of change on which a premium falls due.  (g) Notwithstanding any other provisions of this section to the contrary, in the case of a policy issued on a substandard basis that provides reduced graded amounts of insurance so that, in each policy year, the policy has the same tabular mortality cost as a similar policy issued on the standard basis that provides for a higher uniform amount of insurance, adjusted premiums and present values for the substandard policy may be calculated as if it were issued to provide higher uniform amounts of insurance on the standard basis.  (h) All adjusted premiums and present values referred to in this chapter shall for all policies of ordinary insurance be calculated on the basis of the Commissioners 1980 Standard Ordinary Mortality Table or, at the election of the company for any one or more specified plans of life insurance, the Commissioners 1980 Standard Ordinary Mortality Table with ten-year (10) select mortality factors; adjusted premiums and present values shall for all policies of industrial insurance be calculated on the basis of the Commissioners 1961 Standard Industrial Mortality Table; for all policies issued in a particular calendar year be calculated on the basis of a rate of interest not exceeding the nonforfeiture interest rate as defined in this section, for policies issued in that calendar year. Provided, however that:  (1) At the option of the insurance company, calculations for all policies issued in a particular calendar year may be made on the basis of a rate of interest not exceeding the nonforfeiture interest rate, as defined in this section, for policies issued in the immediately preceding calendar year;  (2) Under any paid-up nonforfeiture benefit, including any paid-up dividend additions, any cash surrender value available, whether or not required by  27-4.3-2, shall be calculated on the basis of the mortality table and rate of interest used in determining the amount of any paid-up nonforfeiture benefit and paid-up dividend additions, if any;  (3) An insurance company may calculate the amount of any guaranteed paid-up nonforfeiture benefit including any paid-up additions under the policy on the basis of an interest rate no lower than that specified in the policy for calculating cash surrender values;  (4) In calculating the present value of any paid-up term insurance with accompanying pure endowment, if any, offered as a nonforfeiture benefit, the rates of mortality assumed may be not more than those shown in the Commissioners 1980 Extended-Term Insurance Table for policies of ordinary insurance and not more than the Commissioners 1961 Industrial Extended-Term Insurance Table for policies of industrial insurance;  (5) For insurance issued on a substandard basis, the calculation of any adjusted premiums and present values may be based on appropriate modifications of the tables mentioned in this subsection;  (6)(i) For policies issued prior to the operative date of the valuation manual, any Commissioners Standard Ordinary Mortality Tables, adopted after 1980 by the National Association of Insurance Commissioners, that are approved by regulation promulgated by the commissioner of insurance for use in determining the minimum nonforfeiture standard, may be substituted for the Commissioners 1980 Standard Ordinary Mortality Table with or without ten-year (10) select mortality factors or for the Commissioners 1980 Extended-Term Insurance Table.  (ii) For policies issued on or after the operative date of the valuation manual the valuation manual shall provide the Commissioners Standard Mortality Table for use in determining the minimum nonforfeiture standard that may be substituted for the Commissioners 1980 Standard Ordinary Mortality Table with or without ten-year (10) Select Mortality Factors or for the Commissioners 1980 Extended-Term Insurance Table. If the commissioner approves by regulation any Commissioners Standard Ordinary Mortality Table adopted by the NAIC for use in determining the minimum nonforfeiture standard for policies issued on or after the operative date of the valuation manual, then that minimum nonforfeiture standard supersedes the minimum nonforfeiture standard provided by the valuation manual.  (7)(i) For policies issued prior to the operative date of the valuation manual, any Commissioners Standard Industrial Mortality Tables, adopted after 1980 by the National Association of Insurance Commissioners, that are approved by regulation promulgated by the commissioner of insurance for use in determining the minimum nonforfeiture standard, may be substituted for the Commissioners 1961 Standard Industrial Mortality Table or the Commissioners 1961 Industrial Extended-Term Insurance Table.  (ii) For policies issued on or after the operative date of the valuation manual, the valuation manual shall provide the Commissioners Standard Mortality Table for use in determining the minimum nonforfeiture standard that may be substituted for the Commissioners 1961 Standard Industrial Mortality Table or the Commissioners 1961 Industrial Extended-Term Insurance Table. If the commissioner approves by regulation any Commissioners Standard Industrial Mortality Table adopted by the NAIC for use in determining the minimum nonforfeiture standard for policies issued on or after the operative date of the valuation manual then that minimum nonforfeiture standard supersedes the minimum nonforfeiture standard provided by the valuation manual.  (i) The nonforfeiture interest rate is defined below:  (A) For policies issued prior to the operative date of the valuation manual, the nonforfeiture interest rate per annum for any policy issued in a particular calendar year shall be equal to one hundred and twenty-five percent (125%) of the calendar year statutory valuation interest rate for the policy as defined in chapter 4.5 of this title, rounded to the nearer one-quarter of one percent (.25%); provided, however, that the nonforfeiture interest rate shall not be less than four percent (4%).  (B) For policies issued on and after the operative date of the valuation manual, the nonforfeiture interest rate per annum for any policy issued in a particular calendar year shall be provided by the valuation manual.  (j) Notwithstanding any other provision in this title to the contrary, any re-filing of nonforfeiture values or their methods of computation for any previously approved policy form that involves only a change in the interest rate or mortality table used to compute nonforfeiture values shall not require re-filing of any other provisions of that policy form.  History of Section.P.L. 1993, ch. 180,  1; P.L. 2002, ch. 292,  14; P.L. 2013, ch. 17,  1; P.L. 2013, ch. 20,  1; P.L. 2014, ch. 91,  1; P.L. 2014, ch. 94,  1. 
 27-4.3-6. Nonforfeiture benefits for indeterminate premium plans. In the case of any plan of life insurance which provides for future premium determination, the amounts of which are to be determined by the insurance company based on then estimates of future experience, or in the case of any plan of life insurance which is of such a nature that minimum values cannot be determined by the methods described in  27-4.3-2  27-4.3-5, then:  (1) The commissioner of insurance must be satisfied that the benefits provided under the plan are substantially as favorable to policyholders and insured as the minimum benefits required by  27-4.3-2  27-4.3-5;  (2) The commissioner of insurance must be satisfied that the benefits and the pattern of premiums of that plan are not such as to mislead prospective policyholders or insured; and  (3) The cash surrender values and paid up nonforfeiture benefits provided by the plan must not be less than the minimum values and benefits required for the plan computed by a method consistent with the principles of this standard nonforfeiture law for life insurance, as determined by regulations promulgated by the commissioner of insurance.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.3-7. Proration of values  Net value of paid-up additions. Any cash surrender value and any paid-up nonforfeiture benefit, available under the policy in the event of default in a premium payment due at any time other than on the policy anniversary, shall be calculated with allowance for the lapse of time and the payment of fractional premiums beyond the last preceding policy anniversary. All values referred to in  27-4.3-3  27-4.3-5 may be calculated upon the assumption that any death benefit is payable at the end of the policy year of death. The net value of any paid-up additions, other than paid-up term additions, shall not be less than the amounts used to provide the additions. Notwithstanding the provisions of  27-4.3-3, additional benefits payable: (1) in the event of death or dismemberment by accident or accidental means, (2) in the event of total and permanent disability, (3) as reversionary annuity or deferred reversionary annuity benefits, (4) as term insurance benefits provided by a rider or supplemental policy provision to which, if issued as a separate policy, this chapter would not apply, (5) as term insurance on the life of a child or on the lives of children provided in a policy on the life of a parent of the child, if the term insurance expires before the childs age is twenty-six (26), is uniform in amount after the childs age is one, and has not become paid-up by reason of the death of a parent of the child, and (6) as other policy benefits additional to life insurance and endowment benefits, and premiums for all additional benefits, shall be disregarded in ascertaining cash surrender values and nonforfeiture benefits required by this chapter, and no additional benefits shall be required to be included in any paid-up nonforfeiture benefits.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.3-8. Consistency of progression of cash surrender values with increasing policy duration. (a) This section, in addition to all other applicable sections of this chapter, shall apply to all policies issued on or after January 1, 1994. Any cash surrender value available under the policy in the event of default in a premium payment due on any policy anniversary shall be in an amount which does not differ by more than two tenths of one percent (.2%) of either the amount of insurance, if the insurance is uniform in amount, or the average amount of insurance at the beginning of each of the first ten (10) policy years, from the sum of: (1) the greater of zero (0) and the basic cash value specified in subsection (b), and (2) the present value of any existing paid up additions less the amount of any indebtedness to the insurance company under the policy.  (b) The basic cash value shall be equal to the present value, on the anniversary, of the future guaranteed benefits which would have been provided for by the policy, excluding any existing paid-up additions and before deduction of any indebtedness to the insurance company, if there had been no default, less the then present value of the nonforfeiture factors, as defined in this section, corresponding to premiums which would have fallen due on and after the anniversary; provided, that the effects on the basic cash value of supplemental life insurance or annuity benefits or of family coverage, as described in  27-4.3-3 or 27-4.3-5, whichever is applicable, shall be the same as are the effects specified in  27-4.3-3 or 27-4.3-5, whichever is applicable, on the cash surrender values defined in that section.  (c) The nonforfeiture factor for each policy year shall be an amount equal to a percentage of the adjusted premium for the policy year, as defined in  27-4.3-5. Except as is required in this section, the percentage:  (1) Must be the same percentage for each policy year between the second policy anniversary and the later of: (i) the fifth policy anniversary, and (ii) the first policy anniversary at which there is available under the policy a cash surrender value in an amount, before including any paid-up additions and before deducting any indebtedness, of at least two tenths of one percent (.2%) of either the amount of insurance, if the insurance is uniform in amount, or the average amount of insurance at the beginning of each of the first ten (10) policy years; and  (2) Must be such that no percentage after the later of the two policy anniversaries specified in subdivision (c)(1) may apply to fewer than five (5) consecutive policy years.  (d) No basic cash value may be less than the value which would be obtained if the adjusted premiums for the policy, as defined in  27-4.3-5, were substituted for the nonforfeiture factors in the calculation of the basic cash value.  (e) All adjusted premiums and present values referred to in this section shall for a particular policy be calculated on the same mortality and interest bases as are used in demonstrating the policys compliance with the other sections of this chapter. The cash surrender values referred to in this section shall include any endowment benefits provided for by the policy.  (f) Any cash surrender value available other than in the event of default in a premium payment due on a policy anniversary, and the amount of any paid up nonforfeiture benefit available under the policy in the event of default in a premium payment, shall be determined in manners consistent with the manners specified for determining the analogous minimum amounts in  27-4.3-2  27-4.3-5 and 27-4.3-7. The amounts of any cash surrender values and of any paid up nonforfeiture benefits granted in connection with additional benefits such as those listed subdivisions (1)  (6) of  27-4.3-7 shall conform with the principles of this section.  History of Section.P.L. 1993, ch. 180,  1; P.L. 2002, ch. 292,  14. 
 27-4.3-9. Exceptions. (a) This chapter shall not apply to any of the following:  (1) Reinsurance;  (2) Group insurance;  (3) Pure endowment;  (4) Annuity or reversionary annuity contract;  (5) Term policy of uniform amount, which provides no guaranteed nonforfeiture or endowment benefits, or renewal of the policy, of twenty (20) years or less expiring before age seventy-one (71), for which uniform premiums are payable during the entire term of the policy;  (6) Term policy of decreasing amount, which provides no guaranteed nonforfeiture or endowment benefits, on which each adjusted premium, calculated as specified in  27-4.3-5, is less than the adjusted premium calculated, on a term policy of uniform amount, or renewal of it, which provides no guaranteed nonforfeiture or endowment benefits, issued at the same age and for the same initial amount of insurance and for a term of twenty (20) years or less expiring before age seventy-one (71), for which uniform premiums are payable during the entire term of the policy;  (7) A policy, which provides no guaranteed nonforfeiture or endowment benefits, for which no cash surrender value, if any, or present value of any paid up nonforfeiture benefit, at the beginning of any policy year, calculated as specified in  27-4.3-3  27-4.3-5, exceeds two and one-half percent (2.5%) of the amount of insurance at the beginning of the same policy year; nor  (8) A policy which shall be delivered outside this state through an insurance producer or other representative of the insurance company issuing the policy.  (b) For the purposes of determining the applicability of this chapter, the age at expiry for a joint term life insurance policy shall be the age at expiry of the oldest life.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-1. Short title. This chapter shall be known as the Standard Nonforfeiture Law for Individual Deferred Annuities Act.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-10. Inclusion of lapse of time considerations. Any paid-up annuity, cash surrender, or death benefits available at any time, other than on the contract anniversary under any contract with fixed scheduled considerations, shall be calculated with allowance for the lapse of time and the payment of any scheduled considerations beyond the beginning of the contract year in which cessation of payment of considerations under the contract occurs.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-11. Proration of values  Additional benefits. For any contract which provides, within the same contract by rider or supplemental contract provision, both annuity benefits and life insurance benefits that are in excess of the greater of cash surrender benefits or a return of the gross consideration with interest, the minimum nonforfeiture benefits shall be equal to the sum of the minimum nonforfeiture benefits for the annuity portion and the minimum nonforfeiture benefits, if any, for the life insurance portion computed as if each portion were a separate contract. Notwithstanding the provisions of  27-4.4-5  27-4.4-8 and 27-4.4-10, additional benefits payable (1) in the event of total and permanent disability, (2) as reversionary annuity or deferred reversionary annuity benefits, or (3) as other policy benefits additional to life insurance, endowment, and annuity benefits, and consideration for all additional benefits, shall be disregarded in ascertaining the minimum nonforfeiture amounts, paid-up annuity, cash surrender, and death benefits that may be required by this chapter. The inclusion of the benefits shall not be required in any paid-up benefits, unless the additional benefits separately would require minimum nonforfeiture amounts, paid-up annuity, cash surrender, and death benefits.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-12. Rules and regulations. The commissioner of insurance may adopt reasonable rules and regulations for the implementation of this chapter.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-2. Applicability. This chapter shall not apply to any reinsurance, group annuity purchased under a retirement plan or plan of deferred compensation established or maintained by an employer including a partnership or sole proprietorship or by an employee organization, or by both, other than a plan providing individual retirement accounts or individual retirement annuities under 26 U.S.C.  408, premium deposit fund, variable annuity, investment annuity, immediate annuity, any deferred annuity contract after annuity payments have commenced, or reversionary annuity, nor to any contract which shall be delivered outside this state through an insurance provider or other representative of the company issuing the contract.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-3. Nonforfeiture requirements. (a) In the case of contracts issued on or after July 7, 2004, no contract of annuity, except as stated in  27-4.4-2, shall be delivered or issued for delivery in this state unless it contains in substance the following provisions, or corresponding provisions which in the opinion of the commissioner of insurance are at least as favorable to the contract holder, upon cessation of payment of considerations under the contract:  (1) That upon cessation of payment of considerations under contract, or upon written request of the contract owner, the company shall grant a paid-up annuity benefit on a plan stipulated in the contract of such value as is specified in  27-4.4-5  27-4.4-8 and 27-4.4-10;  (2) If a contract provides for a lump sum settlement at maturity, or at any other time, that upon surrender of the contract at or prior to the commencement of any annuity payments, the company shall pay in lieu of any paid up annuity benefit a cash surrender benefit of such amount as is specified in  27-4.4-5, 27-4.4-6, 27-4.4-8 and 27-4.4-10. The company may reserve the right to defer the payment of the cash surrender benefit for a period not to exceed six (6) months after demand therefore with surrender of the contract after making a written request and receiving written approval of the commissioner. The request shall address the necessity and equitability to all policyholders of the deferral;  (3) A statement of the mortality table, if any, and interest rates used in calculating any minimum paid up annuity, cash surrender, or death benefits that are guaranteed under the contract, together with sufficient information to determine the amounts of the benefits; and  (4) A statement that any paid-up annuity, cash surrender, or death benefits that may be available under the contract are not less than the minimum benefits required by any statute of the state in which the contract is delivered and an explanation of the manner in which the benefits are altered by the existence of any additional amounts credited by the company to the contract, any indebtedness to the company on the contract, or any prior withdrawals from or partial surrenders of the contract.  (b) Notwithstanding the requirements of this section, any deferred annuity contract may provide that if no considerations have been received under a contract for a period of two (2) full years and the portion of the paid-up annuity benefit at maturity on the plan stipulated in the contract arising from considerations paid prior to the period would be less than twenty dollars ($20.00) monthly, the company may at its option terminate the contract by payment in cash of the then present value of the portion of the paid up annuity benefit, calculated on the basis on the mortality table, if any, and interest rate specified in the contract for determining the paid-up annuity benefit, and by the payment shall be relieved of any further obligation under the contract.  History of Section.P.L. 1993, ch. 180,  1; P.L. 2004, ch. 464,  1; P.L. 2004, ch. 609,  1; P.L. 2008, ch. 475,  74. 
 27-4.4-4. Minimum values. (a) The minimum values as specified in  27-4.4-5  27-4.4-8 and 27-4.4-10 of any paid-up annuity, cash surrender, or death benefits available under an annuity contract shall be based upon minimum nonforfeiture amounts as defined in this section.  (b) The minimum nonforfeiture amount at any time at or prior to the commencement of any annuity payments shall be equal to an accumulation up to that time at rates of interest as provided in subsection (d) of this section, the net considerations as defined in this section paid prior to that time, decreased by the sum of:  (1) Any prior withdrawals from or partial surrenders of the contract accumulated at rates of interest as provided in subsection (d) of this section;  (2) The amount of any indebtedness to the company on the contract, including interest due and accrued;  (3) An annual contract charge of fifty dollars ($50.00), accumulated at rates of interest as provided in subsection (d) of this section; and  (4) Any premium tax paid by the company for the contract, accumulated at rates of interest as provided in subsection (d) of this section.  (c) The net considerations for a given contract year used to define the minimum nonforfeiture amount shall be an amount equal to eighty-seven and one-half percent (87.5%) of the gross considerations credited to the contract during that contract year.  (d) The interest rate used in determining minimum nonforfeiture amounts shall be an annual rate of interest determined as the lesser of three percent (3%) per annum and the following, which shall be specified in the contract if the interest rate will be reset:  (1) The five-year (5) Constant Maturity Treasury Rate reported by the Federal Reserve as of a date, or average over a period, rounded to the nearest one twentieth of one percent (1/20%), specified in the contract no longer than fifteen (15) months prior to the contract issue date or redetermination date under subsection (d)(4) of this section;  (2) Reduced by one hundred twenty-five (125) basis points;  (3) Where the resulting interest rate is not less than one percent (1%); and  (4) The interest rate shall apply for an initial period and may be redetermined for additional periods. The redetermination date, basis and period, if any, shall be stated in the contract. The basis is the date or average over a specified period that produces the value of the five-year (5) Constant Maturity Treasury Rate to be used at each redetermination date.  (e) During the period or term that a contract provides substantive participation in an equity indexed benefit, it may increase the reduction described in subsection (d)(2) of this section above by up to an additional one hundred (100) basis points to reflect the value of the equity index benefit. The present value at the contract issue date, and at each redetermination date thereafter, of the additional reduction shall not exceed the market value of the benefit. The commissioner of insurance may require a demonstration that the present value of the reduction does not exceed the market value of the benefit. Lacking such a demonstration that is acceptable to the commissioner, the commissioner may disallow or limit the additional reduction.  (f) The commissioner of insurance may adopt rules to implement the provisions of subsection (e) of this section and to provide for further adjustments to the calculation of minimum nonforfeiture amounts for contracts that provide substantive participation in an equity index benefit and for other contracts that the commissioner determines adjustments are justified.  History of Section.P.L. 1993, ch. 180,  1; P.L. 2002, ch. 292,  15; P.L. 2004, ch. 464,  1; P.L. 2004, ch. 609,  1; P.L. 2022, ch. 404,  2, effective June 30, 2022; P.L. 2022, ch. 405,  2, effective June 30, 2022. 
 27-4.4-5. Computation of present value. Any paid up annuity benefit available under a contract shall be such that its present value on the date annuity payments are to commence is at least equal to the minimum nonforfeiture amount on that date. The present value shall be computed using the mortality table, if any, and the interest rate specified in the contract for determining the minimum paid up annuity benefits guaranteed in the contract.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-6. Calculation of cash surrender value. For contracts which provide cash surrender benefits, the cash surrender benefits available prior to maturity shall not be less than the present value as of the date of surrender of that portion of the maturity value of the paid-up annuity benefit which would be provided under the contract at maturity arising from consideration paid prior to the time of cash surrender reduced by the amount appropriate to reflect any prior withdrawals from or partial surrenders of the contract, the present value being calculated on the basis of an interest rate not more than one percent (1%) higher than the interest rate specified in the contract for accumulating the net considerations to determine the maturity value, decreased by the amount of any indebtedness to the company on the contract, including interest due and accrued, and increased by any existing additional amounts credited by the company to the contract. In no event shall any cash surrender benefit be less than the minimum nonforfeiture amount at that time. The death benefit under the contracts shall be at least equal to the cash surrender benefit.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-7. Calculation of paid-up annuity benefits. For contracts which do not provide cash surrender benefits, the present value of any paid-up annuity benefit available as a nonforfeiture option at any time prior to maturity shall not be less than the present value of that portion of the maturity value of the paid-up annuity benefit provided under the contract arising from considerations paid prior to the time the contract is surrendered in exchange for, or changed to, a deferred paid-up annuity, the present value being calculated for the period prior to the maturity date on the basis of the interest rate specified in the contract for accumulating the net consideration to determine the maturity value, and increased by any existing additional amount credited by the company to the contract. For contracts that do not provide any death benefits prior to the commencement of any annuity payments, the present values shall be calculated on the basis of the interest rate and the mortality table specified in the contract for determining the maturity value of the paid-up annuity benefit. In no event shall the present value of a paid-up annuity benefit be less than the minimum nonforfeiture amount at that time.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-8. Maturity date. For the purpose of determining the benefits calculated under  27-4.4-6 and 27-4.4-7, in the case of annuity contracts under which an election may be made to have annuity payments commence at optional maturity dates, the maturity date shall be deemed to be the latest date for which election shall be permitted by the contract, but shall not be deemed to be later than the anniversary of the contract next following the annuitants seventieth (70th) birthday or the tenth (10th) anniversary of the contract, whichever is later.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.4-9. Disclosure of limited death benefits. Any contract that does not provide cash surrender benefits or does not provide death benefits at least equal to the minimum nonforfeiture amount prior to the commencement of any annuity payments shall include a statement in a prominent place in the contract that those benefits are not provided.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.5-1. Short title and definitions. (a) This chapter shall be known as the Standard Valuation Law.  (b) For the purpose of this chapter, the following definitions shall apply on or after the operative date of the valuation manual:  (1) Accident and health insurance means contracts that incorporate morbidity risk and provide protection against economic loss resulting from accident, sickness, or medical conditions and as may be specified in the valuation manual.  (2) Appointed actuary means a qualified actuary who is appointed in accordance with the valuation manual to prepare the actuarial opinion required in  27-4.5-3(b).  (3) Commissioner of insurance means the director of the department of business regulation, or his or her designee.  (4) Company means an entity, that: (i) Has written, issued, or reinsured life insurance contracts, accident and health insurance contracts, or deposit-type contracts in this state and has at least one such policy in force or one claim; or (ii) Has written, issued, or reinsured life insurance contracts, accident and health insurance contracts, or deposit-type contracts in any state and is required to hold a certificate of authority to write life insurance, accident and health insurance, or deposit-type contracts in this state.  (5) Deposit-type contract means contracts that do not incorporate mortality or morbidity risks and as may be specified in the valuation manual.  (6) Life insurance means contracts that incorporate mortality risk, including annuity and pure endowment contracts, and as may be specified in the valuation manual.  (7) NAIC means the National Association of Insurance Commissioners.  (8) Policyholder behavior means any action a policyholder, contract holder, or any other person with the right to elect options, such as a certificate holder, may take under a policy or contract subject to this chapter including, but not limited to, lapse, withdrawal, transfer, deposit, premium payment, loan, annuitization, or benefit elections prescribed by the policy or contract, but excluding events of mortality or morbidity that result in benefits prescribed in their essential aspects by the terms of the policy or contract.  (9) Principle-based valuation means a reserve valuation that uses one or more methods or one or more assumptions determined by the insurer and is required to comply with  27-4.5-14 as specified in the valuation manual.  (10) Qualified actuary means an individual who is qualified to sign the applicable statement of actuarial opinion in accordance with the American Academy of Actuaries qualification standards for actuaries signing such statements and who meets the requirements specified in the valuation manual.  (11) Tail risk means a risk that occurs either where the frequency of low probability events is higher than expected under a normal probability distribution or where there are observed events of very significant size or magnitude.  (12) Valuation manual means the manual of valuation instructions adopted by the NAIC as specified in this chapter or as subsequently amended.  History of Section.P.L. 1993, ch. 180,  1; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2; P.L. 2014, ch. 91,  2; P.L. 2014, ch. 94,  2. 
 27-4.5-10. Minimum standards for accident and health insurance contracts. For accident and health insurance contracts issued on or after the operative date of the valuation manual, the standard prescribed in the valuation manual is the minimum standard of valuation required under  27-4.5-2(b). For accident and health insurance contracts issued on or after January 1, 1994 and prior to the operative date of the valuation manual the minimum standard of valuation is the standard adopted by the commissioner by regulation.  History of Section.P.L. 1993, ch. 180,  1; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.5-11. Rules and regulations. The commissioner of insurance may adopt reasonable rules and regulations for the implementation and administration of this chapter.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.5-12. Severability. If any provision of this chapter, or the application of the provision to any person or circumstances, shall be held invalid, the remainder of the chapter, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected by that invalidity.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.5-13. Valuation manual for policies issued on or after the operative date of the valuation manual. (a) For policies issued on or after the operative date of the valuation manual, the standard prescribed in the valuation manual is the minimum standard of valuation required under  27-4.5-2(b), except as provided under subsections (e) or (g) of this section.  (b) The operative date of the valuation manual is January 1 of the first calendar year following the first July 1 as of which all of the following have occurred:  (1) The valuation manual has been adopted by the NAIC by an affirmative vote of at least forty-two (42) members, or three-fourths (34) of the members voting, whichever is greater.  (2) The Standard Valuation Law, as amended by the NAIC in 2009, or legislation including substantially similar terms and provisions, has been enacted by states representing greater than seventy-five percent (75%) of the direct premiums written as reported in the following annual statements submitted for 2008: life, accident and health annual statements; health annual statements; or fraternal annual statements.  (3) The Standard Valuation Law, as amended by the NAIC in 2009, or legislation including substantially similar terms and provisions, has been enacted by at least forty-two (42) of the following fifty-five (55) jurisdictions: The fifty (50) States of the United States, American Samoa, the American Virgin Islands, the District of Columbia, Guam, and Puerto Rico.  (c) Unless a change in the valuation manual specifies a later effective date, changes to the valuation manual shall be effective on January 1 following the date when all of the following have occurred:  (1) The change to the valuation manual has been adopted by the NAIC by an affirmative vote representing:  (i) At least three-fourths (34) of the members of the NAIC voting, but not less than a majority of the total membership, and  (ii) Members of the NAIC representing jurisdictions totaling greater than seventy-five percent (75%) of the direct premiums written as reported in the following annual statements most recently available prior to the vote in subsection (c)(1)(i): life, accident and health annual statements; health annual statements; or fraternal annual statements.  (2) The valuation manual becomes effective pursuant to a regulation adopted by the commissioner.  (d) The valuation manual must specify all of the following:  (1) Minimum-valuation standards for and definitions of the policies or contracts subject to  27-4.5-2(b). Such minimum-valuation standards shall be:  (i) The commissioners reserve valuation method for life insurance contracts, other than annuity contracts, subject to  27-4.5-2(b);  (ii) The commissioners annuity reserve valuation method for annuity contracts subject to  27-4.5-2(b); and  (iii) Minimum reserves for all other policies or contracts subject to  27-4.5-2(b).  (2) Which policies or contracts or types of policies or contracts that are subject to the requirements of a principle-based valuation in  27-4.5-14(a) and the minimum-valuation standards consistent with those requirements;  (3) For policies and contracts subject to a principle-based valuation under  27-4.5-14:  (i) Requirements for the format of reports to the commissioner under  27-4.5-14(b)(3) and which shall include information necessary to determine if the valuation is appropriate and in compliance with this chapter;  (ii) Assumptions shall be prescribed for risks over which the company does not have significant control or influence.  (iii) Procedures for corporate governance and oversight of the actuarial function, and a process for appropriate waiver or modification of such procedures.  (4) For policies not subject to a principle-based valuation under  27-4.5-14, the minimum valuation standard shall either:  (i) Be consistent with the minimum standard of valuation prior to the operative date of the valuation manual; or  (ii) Develop reserves that quantify the benefits and guarantees, and the funding, associated with the contracts and their risks at a level of conservatism that reflects conditions that include unfavorable events that have a reasonable probability of occurring.  (5) Other requirements, including, but not limited to, those relating to reserve methods, models for measuring risk, generation of economic scenarios, assumptions, margins, use of company experience, risk measurement, disclosure, certifications, reports, actuarial opinions and memorandums, transition rules and internal controls; and  (6) The data and form of the data required under  27-4.5-15, with which the data must be submitted, and may specify other requirements including data analyses and reporting of analyses.  (e) In the absence of a specific-valuation requirement or if a specific-valuation requirement in the valuation manual is not, in the opinion of the commissioner, in compliance with this chapter, then the company shall, with respect to such requirements, comply with minimum-valuation standards prescribed by the commissioner by regulation.  (f) The commissioner may engage a qualified actuary, at the expense of the company, to perform an actuarial examination of the company and opine on the appropriateness of any reserve assumption or method used by the company, or to review and opine on a companys compliance with any requirement set forth in this chapter. The commissioner may rely upon the opinion, regarding provisions contained within this chapter, of a qualified actuary engaged by the commissioner of another state, district or territory of the United States. As used in this subsection, term engage includes employment and contracting.  (g) The commissioner may require a company to change any assumption or method that, in the opinion of the commissioner, is necessary in order to comply with the requirements of the valuation manual or this chapter; and the company shall adjust the reserves as required by the commissioner. The commissioner may take other disciplinary action as permitted pursuant to  42-14-16.  History of Section.P.L. 2013, ch. 17,  4; P.L. 2013, ch. 20,  4; P.L. 2014, ch. 91,  2; P.L. 2014, ch. 94,  2. 
 27-4.5-14. Requirements of a principle-based valuation. (a) A company must establish reserves using a principle-based valuation that meets the following conditions for policies or contracts as specified in the valuation manual:  (1) Quantify the benefits and guarantees, and the funding, associated with the contracts and their risks at a level of conservatism that reflects conditions that include unfavorable events that have a reasonable probability of occurring during the lifetime of the contracts. For policies or contracts with significant tail risk, reflects conditions appropriately adverse to quantify the tail risk.  (2) Incorporate assumptions, risk analysis methods and financial models and management techniques that are consistent with, but not necessarily identical to, those utilized within the companys overall risk assessment process, while recognizing potential differences in financial reporting structures and any prescribed assumptions or methods.  (3) Incorporate assumptions that are derived in one of the following manners:  (i) The assumption is prescribed in the valuation manual.  (ii) For assumptions that are not prescribed, the assumptions shall:  (A) Be established utilizing the companys available experience, to the extent it is relevant and statistically credible; or  (B) To the extent that company data is not available, relevant, or statistically credible, be established utilizing other relevant, statistically credible experience.  (4) Provide margins for uncertainty including adverse deviation and estimation error, such that the greater the uncertainty the larger the margin and resulting reserve.  (b) A company using a principle-based valuation for one or more policies or contracts subject to this section as specified in the valuation manual shall:  (1) Establish procedures for corporate governance and oversight of the actuarial valuation function consistent with those described in the valuation manual.  (2) Provide to the commissioner and the board of directors an annual certification of the effectiveness of the internal controls with respect to the principle-based valuation. Such controls shall be designed to assure that all material risks inherent in the liabilities and associated assets subject to such valuation are included in the valuation, and that valuations are made in accordance with the valuation manual. The certification shall be based on the controls in place as of the end of the preceding calendar year.  (3) Develop, and file with the commissioner upon request, a principle-based valuation report that complies with standards prescribed in the valuation manual.  (c) A principle-based valuation may include a prescribed formulaic reserve component.  History of Section.P.L. 2013, ch. 17,  4; P.L. 2013, ch. 20,  4. 
 27-4.5-15. Experience reporting for policies in force on or after the operative date of the valuation manual. A company shall submit mortality, morbidity, policyholder behavior, or expense experience and other data as prescribed in the valuation manual.  History of Section.P.L. 2013, ch. 17,  4; P.L. 2013, ch. 20,  4. 
 27-4.5-16. Confidentiality. (a) For purposes of this section, confidential information shall mean:  (1) A memorandum in support of an opinion submitted under  27-4-3 and any other documents, materials, and other information, including, but not limited to, all working papers, and copies thereof, created, produced, or obtained by, or disclosed to, the commissioner or any other person in connection with such memorandum;  (2) All documents, materials, and other information, including, but not limited to, all working papers, and copies thereof, created, produced, or obtained by, or disclosed to, the commissioner or any other person in the course of an examination made under  27-4.5-13(f); provided, however, that if an examination report or other material prepared in connection with an examination made under chapter 13.1 of title 27 is not held as private and confidential information under chapter 13.1 of this title, an examination report or other material prepared in connection with an examination made under  27-4.5-13(f) of this chapter shall not be confidential information to the same extent as if such examination report or other material had been prepared in accordance with chapter 13.1 of title 27;  (3) Any reports, documents, materials, and other information developed by a company in support of, or in connection with, an annual certification by the company under  27-4.5-14(b)(2) evaluating the effectiveness of the companys internal controls with respect to a principle-based valuation and any other documents, materials and other information, including, but not limited to, all working papers, and copies thereof, created, produced, or obtained by, or disclosed to, the commissioner or any other person in connection with such reports, documents, materials and other information;  (4) Any principle-based valuation report developed under  27-4.5-14(b)(3) and any other documents, materials, and other information, including, but not limited to, all working papers, and copies thereof, created, produced, or obtained by, or disclosed to, the commissioner or any other person in connection with such report; and  (5) Any documents, materials, data, and other information submitted by a company under  27-4.5-15 (collectively, experience data) and any other documents, materials, data, and other information, including, but not limited to, all working papers, and copies thereof, created or produced in connection with such experience data, in each case that include any potentially company-identifying or personally identifiable information, that is provided to, or obtained by, the commissioner (together with any experience data, the experience materials) and any other documents, materials, data, and other information, including, but not limited to, all working papers, and copies thereof, created, produced, or obtained by, or disclosed to, the commissioner or any other person in connection with such experience materials.  (b) Privilege for, and confidentiality of, confidential information.  (1) Except as provided in this  27-4.5-16, a companys confidential information is confidential by law and privileged and shall not be subject to chapter 2 of title 38, shall not be subject to subpoena and shall not be subject to discovery or admissible in evidence in any private civil action; provided, however, that the commissioner is authorized to use the confidential information in the furtherance of any regulatory or legal action brought against the company as a part of the commissioners official duties.  (2) Neither the commissioner, nor any person who received confidential information while acting under the authority of the commissioner, shall be permitted or required to testify in any private civil action concerning any confidential information.  (3) In order to assist in the performance of the commissioners duties, the commissioner may share confidential information:  (i) With other state, federal, and international regulatory agencies and with the NAIC and its affiliates and subsidiaries; and  (ii) In the case of confidential information specified in  27-4.5-16(a)(1) and 27-4.5-16(a)(4) only, with the actuarial board for counseling and discipline or its successor upon request stating that the confidential information is required for the purpose of professional disciplinary proceedings, and with state, federal, and international law enforcement officials; in the case of subsections (a) and (b), provided, that, such recipient agrees, and has the legal authority to agree, to maintain the confidentiality and privileged status of such documents, materials, data, and other information in the same manner, and to the same extent, as required for the commissioner.  (4) The commissioner may receive documents, materials, data, and other information, including otherwise confidential and privileged documents, materials, data, or information, from the NAIC and its affiliates and subsidiaries, from regulatory or law enforcement officials of other foreign or domestic jurisdictions and from the actuarial board for counseling and discipline or its successor and shall maintain as confidential or privileged any document, material, data, or other information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or other information.  (5) The commissioner may enter into agreements governing sharing and use of information consistent with  27-4.5-16(b).  (6) No waiver of any applicable privilege or claim of confidentiality in the confidential information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in  27-4.5-16(b)(3).  (7) A privilege established under the law of any state or jurisdiction that is substantially similar to the privilege established under  27-4.5-16(b) shall be available and enforced in any proceeding in, and in any court of, this state.  (8) In  27-4.5-16 regulatory agency, law enforcement agency and the NAIC include, but are not limited to, their employees, agents, consultants, and contractors.  (c) Notwithstanding  27-4.5-16(b), any confidential information specified in  27-4.5-16(a)(1) and 27-4.5-14(a)(4):  (1) May be subject to subpoena for the purpose of defending an action seeking damages from the appointed actuary submitting the related memorandum in support of an opinion submitted under  27-4.5-3 or principle-based valuation report developed under  27-4.5-14(b)(3) by reason of an action required by this chapter or by regulations promulgated hereunder;  (2) May otherwise be released by the commissioner with the written consent of the company; and  (3) Once any portion of a memorandum in support of an opinion submitted under  27-4.5-3 or a principle-based valuation report developed under  27-4.5-14(b)(3) is cited by the company in its marketing, or is publicly volunteered to or before a governmental agency other than a state insurance department, or is released by the company to the news media, all portions of such memorandum or report shall no longer be confidential.  History of Section.P.L. 2013, ch. 17,  4; P.L. 2013, ch. 20,  4; P.L. 2014, ch. 91,  2; P.L. 2014, ch. 94,  2. 
 27-4.5-17. Single state exemption. (a) The commissioner may exempt specific product forms or product lines of a domestic company that is licensed and doing business only in Rhode Island from the requirements of  27-4.5-13 provided:  (1) The commissioner has issued an exemption in writing to the company and has not subsequently revoked the exemption in writing; and  (2) The company computes reserves using assumptions and methods used prior to the operative date of the valuation manual in addition to any requirements established by the commissioner and promulgated by regulation.  (b) For any company granted an exemption under this section, and  27-4.5-3, 27-4.5-4, 27-4.5-4.1, 27-4.5-4.2, 27-4.5-5, 27-4.5-5.1, 27-4.5-6, 27-4.5-7, 27-4.5-8, 27-4.5-9 and 27-4.5-10 shall be applicable. With respect to any company applying this exemption, any reference to  27-4.5-13 found in  27-4.5-3, 27-4.5-4, 27-4.5-4.1, 27-4.5-4.2, 27-4.5-5, 27-4.5-5.1, 27-4.5-6, 27-4.5-7, 27-4.5-8, 27-4.5-9 and 27-4.5-10 shall not be applicable.  History of Section.P.L. 2013, ch. 17,  4; P.L. 2013, ch. 20,  4. 
 27-4.5-2. Reserve valuation. (a) Policies and contracts issued prior to the operative date of the valuation manual:(1) The commissioner of insurance shall annually value, or cause to be valued, the reserve liabilities, called reserves in this chapter, for all outstanding life insurance policies and annuity and pure endowment contracts of every life insurance company doing business in this state issued on or after January 1, 1994, and prior to the operative date of the valuation manual. In calculating the reserves, the commissioner may use group methods and approximate averages for fractions of a year or otherwise. In lieu of the valuation of the reserves required in this chapter of foreign or alien companies, the commissioner may accept the valuation made or caused to be made by the insurance supervisory official of any state or other jurisdiction when the valuation complies with the minimum standard provided in this chapter.  (2) The provisions set forth in  27-4.5-4, 27-4.5-4.1, 27-4.5-5, 27-4.5-5.1, 27-4.5-6, 27-4.5-7, 27-4.5-8, 27-4.5-9, and 27-4.5-10 shall apply to all policies and contracts, as appropriate, subject to this chapter issued on or after January 1, 1994, and prior to the operative date of the valuation manual and the provisions set forth in  27-4.5-13 and 27-4.5-14 shall not apply to any such policies and contracts.  (3) The minimum standard for the valuation of policies and contracts issued prior to January 1, 1994, shall be that provided by the laws in effect immediately prior to that date.   (b) Policies and contracts issued on or after the operative date of the valuation manual.(1) The commissioner shall annually value, or cause to be valued, the reserve liabilities (hereinafter called reserves) for all outstanding life insurance contracts, annuity and pure endowment contracts, accident and health contracts, and deposit-type contracts of every company issued on or after the operative date of the valuation manual. In lieu of the valuation of the reserves required of a foreign or alien company, the commissioner may accept a valuation made, or caused to be made, by the insurance supervisory official of any state or other jurisdiction when the valuation complies with the minimum standard provided in this chapter.  (2) The provisions set forth in  27-4.5-13 and 27-4.5-14 shall apply to all policies and contracts issued on or after the operative date of the valuation manual.   History of Section.P.L. 1993, ch. 180,  1; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.5-3. Actuarial opinion of reserves. (a) Actuarial opinion prior to the operative date of the valuation manual:(1) General. Every life insurance company doing business in this state shall annually submit the opinion of a qualified actuary as to whether the reserves and related actuarial items held in support of the policies and contracts specified by the commissioner of insurance by regulation are computed appropriately, are based on assumptions which satisfy contractual provisions, are consistent with prior reported amounts, and comply with applicable laws of this state. The commissioner of insurance by regulation shall define the specifics of this opinion and add any other items deemed to be necessary to its scope.  (2) Actuarial analysis of reserves and assets supporting reserves.(i) Every life insurance company, except as exempted by shall also annually include in the opinion required by subsection (a) above an opinion of the same qualified actuary as to whether the reserves and related actuarial items held in support of the policies and contracts specified by the commissioner of insurance by regulation, when considered in light of the assets held by the company with respect to the reserves and related actuarial items, including, but not limited to, the investment earnings on the assets and the considerations anticipated to be received and retained under the policies and contracts, make adequate provision for the companys obligations under the policies and contracts, including, but not limited to, the benefits under and expenses associated with the policies and contracts.  (ii) The commissioner of insurance may provide by regulation for a transition period for establishing any higher reserves that the qualified actuary may deem necessary in order to render the opinion required by this section.   (3) Requirement for opinion under subdivision (2) above. Each opinion required by subdivision (2) shall be governed by the following provisions:  (i) A memorandum, in form and substance acceptable to the commissioner of insurance as specified by regulation, shall be prepared to support each actuarial opinion; and  (ii) If the insurance company fails to provide a supporting memorandum at the request of the commissioner of insurance within a period specified by regulation or the commissioner of insurance determines that the supporting memorandum provided by the insurance company fails to meet the standards prescribed by the regulations or is otherwise unacceptable to the commissioner of insurance, the commissioner of insurance may engage a qualified actuary at the expense of the company to review the opinion and the basis for the opinion and prepare the supporting memorandum required by the commissioner of insurance.  (4) Requirement for all opinions subject to subsection (a). Every opinion required by subsection (a) shall be governed by the following provisions:  (i) The opinion shall be submitted with the annual statement reflecting the valuation of the reserve liabilities for each year ending on or after December 31, 1994;  (ii) The opinion shall apply to all business in force including individual and group health insurance plans, in a form and substance acceptable to the commissioner of insurance as specified by regulation;  (iii) The opinion shall be based on standards adopted by the actuarial standards board and on any additional standards as that commissioner of insurance may by regulation prescribe;  (iv) In the case of an opinion required to be submitted by a foreign or alien company, the commissioner of insurance may accept the opinion filed by that company with the insurance supervisory official of another state if the commissioner of insurance determines that the opinion reasonably meets the requirements applicable to a company domiciled in this state;  (v) For the purposes of this section, qualified actuary means a member in good standing of the American Academy of Actuaries who meets the requirements set forth in the regulations;  (vi) Except in cases of fraud or willful misconduct, the qualified actuary shall not be liable for damages to any person, other than the insurance company and the commissioner of insurance, for any act, error, omission, decision, or conduct with respect to the actuarys opinion;  (vii) Disciplinary action by the commissioner of insurance against the company or the qualified actuary shall be defined in regulations by the commissioner of insurance; and  (viii) Except as provided in paragraphs (xii), (xiii) and (xiv) below, documents, materials or other information in the possession or control of the department of insurance that are a memorandum in support of the opinion, and any other material provided by the company to the commissioner in connection with the memorandum, shall be confidential and privileged, shall not be subject to chapter 35 of title 42, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence as any private/civil action. However, the commissioner is authorized to use the documents, materials or other information in the furtherance of any regulatory or legal action brought as a part of the commissioners official duties.  (ix) Neither the commissioner nor any person who received documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials or information subject to paragraph (viii).  (x) In order to assist in the performance of the commissioners duties, the commissioner:  (A) May share documents, materials or other information, including the confidential and privileged documents, materials or information subject to paragraph (viii) with other state, federal and international regulatory agencies, with the NAIC and its affiliates and subsidiaries, and with state, federal and international law enforcement authorities, provided that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information;  (B) May receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the NAIC and its affiliates and subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and  (C) May enter into agreements governing sharing and use of information consistent with paragraphs (viii) through (x).  (xi) No waiver of any applicable privilege or claim of confidentiality in the documents, materials or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in paragraph (x).  (xii) A memorandum in support of the opinion, and any other material provided by the company to the commissioner in connection with the memorandum, may be subject to subpoena for the purpose of defending an action seeking damages from the actuary submitting the memorandum by reason of an action required by this section or by regulations promulgated hereunder.  (xiii) The memorandum or other material may otherwise be released by the commissioner with the written consent of the company or to the American Academy of Actuaries upon request stating that the memorandum or other material is required for the purpose of professional disciplinary proceedings and setting forth procedures satisfactory to the commissioner for preserving the confidentiality of the memorandum or other material.  (xiv) Once any portion of the confidential memorandum is cited by the company in its marketing or is cited before a governmental agency other than a state insurance department or is released by the company to the news media, all portions of the confidential memorandum shall be no longer confidential.   (b) Actuarial opinion of reserves after the operative date of the valuation manual.(1) General. Every company with outstanding life insurance contracts, accident and health insurance contracts or deposit-type contracts in this state and subject to regulation by the commissioner shall annually submit the opinion of the appointed actuary as to whether the reserves and related actuarial items held in support of the policies and contracts are computed appropriately, are based on assumptions that satisfy contractual provisions, are consistent with prior reported amounts and comply with applicable laws of this state. The valuation manual will prescribe the specifics of this opinion including any items deemed to be necessary to its scope.  (2) Actuarial analysis of reserves and assets supporting reserves. Every company with outstanding life insurance contracts, accident and health insurance contracts or deposit-type contracts in this state and subject to regulation by the commissioner, except as exempted in the valuation manual, shall also annually include in the opinion required by subdivision (1) of this section, an opinion of the same appointed actuary as to whether the reserves and related actuarial items held in support of the policies and contracts specified in the valuation manual, when considered in light of the assets held by the company with respect to the reserves and related actuarial items, including, but not limited to, the investment earnings on the assets and the considerations anticipated to be received and retained under the policies and contracts, make adequate provision for the companys obligations under the policies and contracts, including but not limited to the benefits under and expenses associated with the policies and contracts.  (3) Requirements for opinions subject to subdivision 27-4.5-3(b)(2). Each opinion required by subdivision 27-4.5-3(b)(2) shall be governed by the following provisions:  (i) A memorandum, in form and substance as specified in the valuation manual, and acceptable to the commissioner, shall be prepared to support each actuarial opinion.  (ii) If the insurance company fails to provide a supporting memorandum at the request of the commissioner within a period specified in the valuation manual or the commissioner determines that the supporting memorandum provided by the insurance company fails to meet the standards prescribed by the valuation manual or is otherwise unacceptable to the commissioner, the commissioner may engage a qualified actuary at the expense of the company to review the opinion and the basis for the opinion and prepare the supporting memorandum required by the commissioner.  (4) Requirement for all opinions subject to subsection 27-4.5-3(b). Every opinion shall be governed by the following provisions:  (i) The opinion shall be in form and substance as specified in the valuation manual and acceptable to the commissioner.  (ii) The opinion shall be submitted with the annual statement reflecting the valuation of such reserve liabilities for each year ending on or after the operative date of the valuation manual.  (iii) The opinion shall apply to all policies and contracts subject to subdivision 27-4.5-3(b)(2), plus other actuarial liabilities as may be specified in the valuation manual.  (iv) The opinion shall be based on standards adopted from time to time by the actuarial standards board or its successor, and on such additional standards as may be prescribed in the valuation manual.  (v) In the case of an opinion required to be submitted by a foreign or alien company, the commissioner may accept the opinion filed by that company with the insurance supervisory official of another state if the commissioner determines that the opinion reasonably meets the requirements applicable to a company domiciled in this state.  (vi) Except in cases of fraud or willful misconduct, the appointed actuary shall not be liable for damages to any person (other than the insurance company and the commissioner) for any act, error, omission, decision or conduct with respect to the appointed actuarys opinion.  (vii) Disciplinary action by the commissioner against the company or the appointed actuary shall be defined in regulations by the commissioner.   History of Section.P.L. 1993, ch. 180,  1; P.L. 2002, ch. 292,  16; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.5-4.1. Computation of minimum standard by calendar year of issue. (a) The interest rates used in determining the minimum standard for the valuation of the following shall be calendar year statutory valuation interest rates as defined in this section: (1) life insurance policies issued in a particular calendar year on or after January 1, 1994; (2) individual annuity and pure endowment contracts issued in a particular calendar year on or after January 1, 1994; (3) annuities and pure endowments purchased in a particular calendar year on or after January 1, 1994, under group annuity and pure endowment contracts; and (4) the net increase, if any, in a particular calendar year after January 1, 1994, in amounts held under guaranteed interest contracts;  (b) Calendar year statutory valuation interest rates.(1) The calendar year statutory valuation interest rates, I, shall be determined as follows and the results rounded to the nearer one-quarter of one percent (14 of 1%):  (i) For life insurance: I=.03+W(R1-.03)+W/2(R2-.09);  (ii) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and from guaranteed interest contracts with cash settlement options: I=.03+W(R-.03);  Where R1 is the lesser of R and .09, R2 is the greater of R and .09, R is the reference interest rate defined in this section, W is the weighting factor defined in this section; (iii) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on an issue year basis, except as stated in paragraph (ii) above, the formula for life insurance stated in paragraph (i) above shall apply to annuities and guaranteed interest contracts with guarantee durations in excess of ten (10) years and the formula for single premium immediate annuities stated in paragraph (ii) above shall apply to annuities and guaranteed interest contracts with guarantee duration of ten (10) years or less;  (iv) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the formula for single premium immediate annuities stated in paragraph (ii) above shall apply; and  (v) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, the formula for single premium immediate annuities stated in paragraph (b)(1)(ii) above shall apply; and  (2) However if the calendar year statutory valuation interest rate for any life insurance policies issued in any calendar year determined without reference to this sentence differs from the corresponding actual rate for similar policies issued in the immediately preceding calendar year by less than one-half of one percent (12 of 1%), the calendar year statutory valuation interest rate for the life insurance policies shall be equal to the corresponding actual rate for the immediately preceding calendar year.  For purposes of applying the immediately preceding sentence, the calendar year statutory valuation interest rate for life insurance policies issued in a calendar year shall be determined for 1980 (using the reference interest rate defined in 1979) and shall be determined for each subsequent calendar year regardless of when  27-4.3-5 becomes operative.  (c) Weighting factors.(1) The weighting factors referred to in the formulas stated above are given in the following tables:  (i) WEIGHTING FACTORS FOR LIFE INSURANCE:        Guarantee Duration (Years)   Weighting Factors   10 or less   .50   More than 10, but not more than 20   .45   More than 20   .35    For life insurance, the guarantee duration is the maximum number of years the life insurance can remain in force on a basis guaranteed in the policy or under options to convert to plans of life insurance with premium rates or nonforfeiture values or both which are guaranteed in the original policy;  (ii) Weighting factor for single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options is .80;  (iii) Weighting factors for other annuities and for guaranteed interest contracts, except as stated in paragraph (ii) above, shall be as specified in subparagraphs (A), (B) and (C) below, according to the rules and definitions in subparagraphs (D), (E) and (F) below:  (A) For annuities and guaranteed interest contracts valued on an issue year basis:           Guarantee Duration (Years)   Weighting Factor for Plan Type          A B C   5 or less:   .80 .60 .50   More than 5, but not more than 10:   .75 .60 .50   More than 10, but not more than 20:   .65 .50 .45   More than 20:   .45 .35 .35    (B) For annuities and guaranteed interest contracts valued on a change in fund basis, the factors show in paragraph (i) above increased by:            Plan Type         A B C     .15 .25 .05    (C) For annuities and guaranteed interest contracts valued on an issue year basis, other than those with no cash settlement options, which do not guarantee interest on considerations received more than one year after issue or purchase and for annuities and guaranteed interest contracts valued on a change in fund basis that do not guarantee interest rates on considerations received more than twelve (12) months beyond the valuation date, the factors shown in paragraph (i) or derived in paragraph (ii) increased by:            Plan Type         A B C     .05 .05 .05    (D) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the guarantee duration is the number of years for which the contract guarantees interest rates in excess of the calendar year statutory valuation interest rate for life insurance policies with guarantee durations in excess of twenty (20) years. For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the guaranteed duration is the number of years from the date of issue or date of purchase to the date annuity benefits are scheduled to commence;  (E) Plan Type as used in the tables in this subdivision is defined as follows:  (I) Plan Type A: At any time the policyholder may withdraw funds only (I) with an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company, or (II) without an adjustment but installments over five (5) years or more, or (III) as an immediate life annuity, or (IV) no withdrawal permitted;  (II) Plan Type B: Before expiration of the interest rate guarantee, the policyholder may withdraw funds only (I) with an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company, or (II) without an adjustment but in installments over five (5) years or more, or (III) no withdrawal permitted. At the end of the interest rate guarantee, funds may be withdrawn without an adjustment in a single sum or installments over less than five (5) years;  (III) Plan Type C: Policyholder may withdraw funds before the expiration of interest rate guarantee in a single sum or installments over less than five (5) years either (I) without adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company, or (II) subject only to a fixed surrender charge stipulated in the contract as a percentage of the fund; and  (F) A company may elect to value guaranteed interest contracts with cash settlement options and annuities with cash settlement options on either an issue year basis or on a change in fund basis. Guaranteed interest contracts with no cash settlement options and other annuities with no cash settlement options must be valued on an issue year basis. As used in this section, issue year basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard for the entire duration of the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of issue or year of purchase of the annuity or guaranteed interest contract, and change in fund basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard applicable to each change in the fund held under the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of the change in the fund.  (d) Reference interest rate. Reference interest rate referred to in subsection (b) is defined as follows:  (1) For life insurance, the lesser of the average over a period of thirty-six (36) months and the average over a period of twelve (12) months, ending on June 30 of the calendar year preceding the year of issue, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moodys Investors Service, Inc.;  (2) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or year of purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moodys Investors Service, Inc.;  (3) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in paragraph (2) above, with guarantee duration in excess of ten (10) years, the lesser of the average over a period of thirty-six (36) months and the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moodys Investors Service, Inc.;  (4) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in paragraph (2) above, with guarantee duration of ten (10) years or less, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moodys Investors Service, Inc.;  (5) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moodys Investors Service, Inc.; and  (6) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, except as stated in subdivision (d)(2), the average over a period of twelve (12) months, ending on June 30 of the calendar year of the change in the fund, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moodys Investors Service, Inc.  (e) Alternative method for determining reference interest rates. In the event that the monthly average of the composite yield on seasoned corporate bonds is no longer published by Moodys Investors Service, Inc., or in the event that the National Association of Insurance Commissioners determines that the monthly average of the composite yield on seasoned corporate bonds as published by Moodys Investors Service, Inc. is no longer appropriate for the determination of the reference interest rate, then an alternative method for determination of the reference interest rate, which is adopted by the National Association of Insurance Commissioners and approved by regulation promulgated by the commissioner of insurance, may be substituted.  History of Section.P.L. 1993, ch. 180,  1; P.L. 1994, ch. 404,  11; P.L. 2002, ch. 292,  16; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.5-4. Computation of minimum standard. (a) The minimum standard for valuation of all policies and contracts issued prior to the effective date of this chapter shall be that provided by the laws in effect immediately prior to that date. Except as otherwise provided in  27-4.5-4, 27-4.5-4.1 and 27-4.5-10, the minimum standard for the valuation of all policies and contracts issued on or after the effective date of this chapter and prior to the effective date of the valuation manual shall be the commissioners reserve valuation methods defined in  27-4.5-5, 27-4.5-5.1, 27-4.5-8 and 27-4.5-10 and the following tables:  (1) For ordinary policies of life insurance issued on the standard basis:  (i) The Commissioners 1980 Standard Ordinary Mortality Table;  (ii) At the election of the company for any one or more specified plans of life insurance, the Commissioners 1980 Standard Ordinary Mortality Table with Ten (10) Year Select Mortality Factors; or  (iii) Any ordinary mortality table, adopted after 1980 by the NAIC, which is approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for such policies;  (2) For industrial life insurance policies issued on the standard basis, excluding any disability and accidental death benefits in the policies: the 1941 Standard Industrial Mortality Table for policies issued prior to the operative date of  27-4.3-5.3, and for policies issued on or after the operative date of  27-4.3-5.3, the Commissioners 1961 Standard Industrial Mortality Table or any industrial mortality table adopted after 1980 by the NAIC that is approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for the policies;  (b) The valuation of all policies and contracts issued on or after January 1, 2000 shall be subject to  27-4.5-4.1 and 27-4.5-10 and the following tables:  (1) For individual annuity and pure endowment contracts, excluding any disability and accidental death benefits in those contracts, the Annuity 2000 Mortality Table or any individual annuity mortality table adopted after 2000 by the National Association of Insurance Commissioners, that is approved by regulation promulgated by the insurance commissioner for use in determining the minimum standard of valuation for those contracts;  (2) For all annuities and pure endowments purchased under group annuity and pure endowment contracts, excluding any disability and accidental death benefits purchased under those contracts, the 1994 Group Annuity Reserving Table, or any group annuity mortality table adopted after 2000 by the National Association of Insurance Commissioners that is approved by regulation promulgated by the insurance commissioner for use in determining the minimum standard of valuation for annuities and pure endowments, or any modification of these tables approved by the insurance commissioner; and  (c) For group life insurance, life insurance issued on the substandard basis and other special benefits and tables approved by the insurance commissioner.  History of Section.P.L. 1993, ch. 180,  1; P.L. 1999, ch. 137,  1; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.5-5.1. Reserve valuation method  Annuity and pure endowment benefits. (a) This section shall apply to all annuity and pure endowment contracts other than group annuity and pure endowment contracts purchased under a retirement plan or plan of deferred compensation, established or maintained by an employer, including a partnership or sole proprietorship, or by an employee organization, or by both, other than a plan providing individual retirement accounts or individual retirement annuities under 26 U.S.C.  408.  (b) Reserves according to the commissioners annuity reserve method for benefits under annuity or pure endowment contracts, excluding any disability and accidental death benefits in those contracts, shall be the greatest of the respective excesses of the present values, at the date of valuation, of the future guaranteed benefits, including guaranteed nonforfeiture benefits, provided for by the contracts at the end of each contract year, over the present value, at the date of valuation, of any future valuation considerations derived from future gross considerations, required by the terms of the contract, that become payable prior to the end of each contract year. The future guaranteed benefits shall be determined by using the mortality table, if any, and the interest rate, or rates, specified in the contracts for determining guaranteed benefits. The valuation considerations are the portions of the gross considerations applied under the terms of the contracts to determine nonforfeiture values.  History of Section.P.L. 1993, ch. 180,  1. 
 27-4.5-5. Reserve valuation method  Life insurance and endowment benefits. (a) Except as provided in  27-4.5-5.1, 27-4.5-8 and 27-4.5-10, reserves according to the commissioners reserve valuation method for the life insurance and endowment benefits of policies providing for a uniform amount of insurance and requiring the payment of uniform premiums shall be the excess, if any, of the present value, at the date of valuation, of the future guaranteed benefits provided for by the policies therefor, over the then present value of any future modified net premiums. The modified net premiums for any policy shall be the uniform percentage of the respective contract premiums for the benefits such that the present value, at the date of issue of the policy, of all modified net premiums shall be equal to the sum of the then present value of the benefits provided for by the policy and the excess of (1) over (2), as follows:  (1) A net level annual premium equal to the present value, at the date of issue, of the benefits provided for after the first policy year, divided by the present value, at the date of issue, of an annuity of one per annum payable on the first and each subsequent anniversary of the policy on which a premium falls due; however, that the net level annual premium shall not exceed the net level annual premium on the nineteen (19) year premium whole life plan for insurance of the same amount at an age one year higher than the age at issue of the policy; and  (2) A net one year term premium for the benefits provided for in the first policy year.  (b) For any life insurance policy issued on or after January 1, 1994 for which the contract premium in the first policy year exceeds that of the second year and for which no comparable additional benefit is provided in the first year for the excess, and which provides an endowment benefit or a cash surrender value or a combination in an amount greater than the excess premium, the reserve according to the commissioners reserve valuation method as of any policy anniversary occurring on or before the assumed ending date, defined herein as the first policy anniversary on which the sum of any endowment benefit and any cash surrender value then available is greater than the excess premium, shall, except as provided in  27-4.5-8, be the greater of the reserve as of the policy anniversary calculated as described in subsection (a) and the reserve as of the policy anniversary calculated as described in subsection (a), but with:  (1) the value defined in subsection (a) being reduced by fifteen percent (15%) of the amount of such excess first year premium,  (2) all present values of benefits and premiums being determined without reference to premiums or benefits provided for by the policy after the assumed ending date,  (3) the policy being assumed to mature on that date as an endowment, and  (4) the cash surrender value provided on that date being considered as an endowment benefit. In making the above comparison the mortality and interest bases stated in  27-4.5-4 and 27-4.5-4.1 shall be used.  (c) Reserves according to the commissioners reserve valuation method shall be calculated by a method consistent with the principles of the preceding paragraphs of this section for: (1) life insurance policies providing for a varying amount of insurance or requiring the payment of varying premiums; (2) group annuity and pure endowment contracts purchased under a retirement plan or plan of deferred compensation, established or maintained by an employer including a partnership or sole proprietorship or by an employee organization, or by both, other than a plan providing individual retirement accounts or individual retirement annuities under 26 U.S.C.  408 as now or hereafter amended; (3) disability and accidental death benefits in all policies and contracts; and (4) all other benefits, except life insurance and endowment benefits in life insurance policies and benefits provided by all other annuity and pure endowment contracts.  History of Section.P.L. 1993, ch. 180,  1; P.L. 1994, ch. 404,  11; P.L. 2002, ch. 292,  16; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.5-6. Minimum reserves. (a) In no event shall a companys aggregate reserves for all life insurance policies, excluding disability and accidental death benefits, issued on or after January 1, 1994, be less than the aggregate reserves calculated in accordance with the methods set forth in  27-4.5-5, 27-4.5-5.1, 27-4.5-8 and 27-4.5-9 and the mortality table or tables and rate or rates of interest used in calculating nonforfeiture benefits for the policies.  (b) In no event shall the aggregate reserves for all policies, contracts, and benefits be less than the aggregate reserves determined by the appointed actuary to be necessary to render the opinion required by  27-4.5-3.  History of Section.P.L. 1993, ch. 180,  1; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.5-7. Optional reserve calculation. (a) Reserves for all policies and contracts issued prior to January 1, 1994, may be calculated, at the option of the company, according to any standards that produce greater aggregate reserves for all such policies and contracts than the minimum reserves required by the laws in effect immediately prior to that date.  (b) Reserves for any category of policies, contracts, or benefits as established by the commissioner of insurance, issued on or after the January 1, 1994, may be calculated, at the option of the company, according to any standards which produce greater aggregate reserves for the category than those calculated according to the minimum standard provided in this chapter, but the rate or rates of interest used for policies and contracts, other than annuity and pure endowment contracts, shall not be greater than the corresponding rate or rates of interest used in calculating any nonforfeiture benefits provided in the policies or contracts.  (c) A company which adopts at any time a standard of valuation producing greater aggregate reserves than those calculated according to the minimum standard provided in this chapter may adopt a lower standard of valuation, with the approval of the commissioner of insurance, but not lower than the minimum provided in this chapter; provided that, for the purposes of this section, the holding of additional reserves previously determined by the appointed actuary to be necessary to render the opinion required by  27-4.5-3 shall not be deemed to be the adoption of a higher standard of valuation.  History of Section.P.L. 1993, ch. 180,  1; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.5-8. Reserve calculation  Valuation net premium exceeding the gross premium charged. (a) If in any contract year the gross premium charged by the company on any policy or contract is less than the valuation net premium for the policy or contract calculated by the method used in calculating the reserve but using the minimum valuation standards of mortality and rate of interest, the minimum reserve required for the policy or contract shall be the greater of either the reserve calculated according to the mortality table, rate of interest, and method actually used for the policy or contract, or the reserve calculated by the method actually used for the policy or contract but using the minimum valuation standards of mortality and rate of interest and replacing the valuation net premium by the actual gross premium in each contract year for which the valuation net premium exceeds the actual gross premium. The minimum valuation standards of mortality and rate of interest referred to in this section are those standards stated in  27-4.5-4 and 27-4.5-4.1.  (b) For any life insurance policy issued on or after January 1, 1994, for which the gross premium in the first policy year exceeds that of the second year and for which no comparable additional benefit is provided in the first year for the excess, and which provides an endowment benefit or a cash surrender value or a combination in an amount greater than the excess premium, the provisions of this section shall be applied as if the method actually used in calculating the reserve for the policy were the method described in  27-4.5-5, ignoring  27-4.5-5(b). The minimum reserve at each policy anniversary of such a policy shall be the greater of the minimum reserve calculated in accordance with  27-4.5-5, including  27-4.5-5(b), and the minimum reserve calculated in accordance with this section.  History of Section.P.L. 1993, ch. 180,  1; P.L. 1994, ch. 404,  11; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.5-9. Reserve calculation  Indeterminate premium plans. In the case of plan of life insurance that provides for future premium determination, the amounts of which are to be determined by the insurance company based on the then estimates of future experience, or in the case of any plan of life insurance or annuity that is of such a nature that the minimum reserves cannot be determined by the methods described in  27-4.5-5, 27-4.5-5.1 and 27-4.5-8, the reserves that are held under the plan shall:  (1) Be appropriate in relation to the benefits and the pattern of premiums for that plan; and  (2) Be computed by a method that is consistent with the principles of this chapter, as determined by regulations promulgated by the commissioner of insurance.  Notwithstanding any other provision in the laws of this state, a policy, contract or certificate providing life insurance under such a plan shall be affirmatively approved by the commissioner before it can be marketed, issued, delivered or used in this state.  History of Section.P.L. 1993, ch. 180,  1; P.L. 2013, ch. 17,  2; P.L. 2013, ch. 20,  2. 
 27-4.6-1. Definitions. As used in this chapter: (1) Adjusted RBC report means an RBC report adjusted by the commissioner in accordance with  27-4.6-2(e).  (2) Corrective order means an order issued by the commissioner specifying corrective actions that the commissioner has determined are required.  (3) Domestic insurer means any insurance company domiciled in this state.  (4) Foreign insurer means any insurance company licensed to do business in this state under chapter 2 of this title but is not domiciled in this state.  (5) Life and/or health insurer means any insurance company licensed under chapters 1 or 2 of this title and: (i) authorized to transact the business of life insurance or annuities as defined in chapter 4 of this title, or (ii) authorized to write policies of accident and sickness as defined in  27-18-1, or (iii) a licensed property and casualty insurer writing only accident and health insurance.  (6) NAIC means the National Association of Insurance Commissioners.  (7) Negative trend means, with respect to a life and/or health insurer, negative trend over a period of time, as determined in accordance with the trend test calculation included in the RBC instructions.  (8) Property and casualty insurer means all other insurance companies licensed under chapters 1 or 2 of this title but shall not include mono-line mortgage guaranty insurers, financial guaranty insurers and title insurers.  (9) RBC instructions means the RBC report including risk-based capital instructions adopted by the NAIC, as the RBC instructions may be amended by the NAIC in accordance with the procedures adopted by the NAIC.  (10) RBC level means an insurers company action level RBC, regulatory action level RBC, authorized control level RBC, or mandatory control level RBC where:  (i) Company action level RBC means, with respect to any insurer, the product of two (2.0) and its authorized control level RBC;  (ii) Regulatory action level RBC means the product of one and one-half (1.5) and its authorized control level RBC;  (iii) Authorized control level RBC means the number determined under the risk-based capital formula in accordance with the RBC instructions;  (iv) Mandatory control level RBC means the product of seven-tenths (.70) and the authorized control level RBC.  (11) RBC plan means a comprehensive financial plan containing the elements specified in  27-4.6-3(b). If the commissioner rejects the RBC plan, and it is revised by the insurer, with or without the commissioners recommendation, the plan shall be called the revised RBC plan.  (12) RBC report means the report required in  27-4.6-2.  (13) Total adjusted capital means the sum of:  (i) An insurers statutory capital and surplus; and  (ii) Those other items, if any, as the RBC instructions may provide.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-10. Foreign insurers. (a)(1) Any foreign insurer shall, upon the written request of the commissioner, submit to the commissioner an RBC report as of the end of the calendar year just ended the later of:  (i) The date an RBC report would be required to be filed by a domestic insurer under this chapter; or  (ii) Fifteen (15) days after the request is received by the foreign insurer.  (2) Any foreign insurer shall, at the written request of the commissioner, promptly submit to the commissioner a copy of any RBC plan that is filed with the insurance commissioner of any other state.  (b) In the event of a company action level event, regulatory action level event or authorized control level event with respect to any foreign insurer as determined under the RBC statute applicable in the state of domicile of the insurer (or, if no RBC statute is in force in that state, under the provisions of this chapter), if the insurance commissioner of the state of domicile of the foreign insurer fails to require the foreign insurer to file an RBC plan in the manner specified under that states RBC statute (or, if no RBC statute is in force in that state, under  27-4.6-3), the commissioner may require the foreign insurer to file an RBC plan with the commissioner. In that event, the failure of the foreign insurer to file an RBC plan with the commissioner shall be grounds to order the insurer to cease and desist from writing new insurance business in this state.  (c) In the event of a mandatory control level event with respect to any foreign insurer, if no domiciliary receiver has been appointed with respect to the foreign insurer under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign insurer, the commissioner may make application to the Superior Court for Providence County permitted under chapter 14.3 of this title with respect to the liquidation of property of foreign insurers found in this state, and the occurrence of the mandatory control level event shall be considered adequate grounds for the application.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-11. Immunity. There shall be no liability on the part of, and no cause of action shall arise against, the commissioner or the insurance department or its employees or agents for any action taken by them in the performance of their powers and duties under this chapter.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-12. Notices. All notices by the commissioner to an insurer which may result in regulatory action under this chapter shall be effective upon dispatch if transmitted by registered or certified mail, or in the case of any other transmission shall be effective upon the insurers receipt of the notice.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-13. Severability. If any provision of this chapter, or the application of it to any person or circumstance, is held invalid, that determination shall not affect the provisions or applications of this chapter which can be given effect without the invalid provision or application, and to that end the provisions of this chapter are severable.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-2. RBC reports. (a) Every domestic insurer shall, on or prior to each March 1 (the filing date), prepare and submit to the commissioner a report of its RBC levels as of the end of the calendar year just ended, in a form and containing any information required by the RBC instructions. In addition, every domestic insurer shall file its RBC report:  (1) With the NAIC in accordance with the RBC instructions; and  (2) With the insurance commissioner in any state in which the insurer is authorized to do business, if the insurance commissioner has notified the insurer of its request in writing, in which case the insurer shall file its RBC report not later than the later of:  (i) Fifteen (15) days from the receipt of notice to file its RBC report with that state; or  (ii) The filing date.  (b) A life and health insurers RBC shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take into account (and may adjust for the covariance between): (1) the risk with respect to the insurers assets; (2) the risk of adverse insurance experience with respect to the insurers liabilities and obligations; (3) the interest rate risk with respect to the insurers business; and (4) all other business risks and any other relevant risks set forth in the RBC instructions; determined in each case by applying the factors in the manner set forth in the RBC instructions.  (c) A property and casualty insurers RBC shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take into account (and may adjust for the covariance between): (1) asset risk; (2) credit risk; (3) underwriting risk; and (4) all other business risks and any other relevant risks set forth in the RBC Instructions; determined in each case by applying the factors in the manner set forth in the RBC instructions.  (d) An excess of capital over the amount produced by the risk-based capital requirements contained in this chapter and the formulas, schedules and instructions referenced in this chapter is desirable in the business of insurance. Insurers should seek to maintain capital above the RBC levels required by this chapter. Additional capital is used and useful in the insurance business and helps to secure an insurer against various risks inherent in, or affecting, the business of insurance and not accounted for or only partially measured by the risk-based capital requirements contained in this chapter.  (e) If a domestic insurer files an RBC report, which in the judgment of the commissioner is inaccurate, then the commissioner shall adjust the RBC report to correct the inaccuracy and shall notify the insurer of the adjustment. The notice shall contain a statement of the reason for the adjustment. An RBC report adjusted in this manner is referred to as an adjusted RBC report.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-3. Company action level event. (a) Company action level event means any of the following events:  (1) The filing of an RBC report by an insurer that indicates that:  (i) The insurers total adjusted capital is greater than or equal to its regulatory action level RBC but less than its company action level RBC;  (ii) If a life and/or health insurer, the insurer has total adjusted capital that is greater than or equal to its company action level RBC but less than the product of its authorized control level RBC and 3.0 and has a negative trend; or  (iii) If a property and casualty insurer, the insurer has total adjusted capital that is greater than or equal to its company action level RBC but less than the product of its authorized control level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the property and casualty RBC instructions.  (2) The notification by the commissioner to the insurer of an adjusted RBC report that indicates an event in subdivision (a)(1), provided the insurer does not challenge the adjusted RBC report under  27-4.6-7; or  (3) If, pursuant to  27-4.6-7, an insurer challenges an adjusted RBC report that indicates the event in subdivision (a)(1), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurers challenge.  (b) In the event of a company action level event, the insurer shall prepare and submit to the commissioner an RBC plan that shall:  (1) Identify the conditions that contribute to the company action level event;  (2) Contain proposals of corrective actions that the insurer intends to take and would be expected to result in the elimination of the company action level event;  (3) Provide projections of the insurers financial results in the current year and at least the four (4) succeeding years, both in the absence of proposed corrective actions and giving effect to the proposed corrective actions, including projections of statutory operating income, net income, capital, and/or surplus. (The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense, and benefit component);  (4) Identify the key assumptions impacting the insurers projections and the sensitivity of the projections to the assumptions; and  (5) Identify the quality of, and problems associated with, the insurers business, including, but not limited to: its assets; anticipated business growth and associated surplus strain; extraordinary exposure to risk; mix of business; and use of reinsurance, if any, in each case.  (c) The RBC plan shall be submitted:  (1) Within forty-five (45) days of the company action level event; or  (2) If the insurer challenges an adjusted RBC report pursuant to  27-4.6-7, within forty-five (45) days after notification to the insurer that the commissioner has, after a hearing, rejected the insurers challenge.  (d) Within sixty (60) days after the submission by an insurer of an RBC plan to the commissioner, the commissioner shall notify the insurer whether the RBC plan shall be implemented or is, in the judgment of the commissioner, unsatisfactory. If the commissioner determines that the RBC plan is unsatisfactory, the notification to the insurer shall set forth the reasons for the determination, and may set forth proposed revisions that will render the RBC plan satisfactory in the judgment of the commissioner. Upon notification from the commissioner, the insurer shall prepare a revised RBC plan, which may incorporate by reference any revisions proposed by the commissioner, and shall submit the revised RBC plan to the commissioner:  (1) Within forty-five (45) days after the notification from the commissioner; or  (2) If the insurer challenges the notification from the commissioner under  27-4.6-7, within forty-five (45) days after a notification to the insurer that the commissioner has, after a hearing, rejected the insurers challenge.  (e) In the event of a notification by the commissioner to an insurer that the insurers RBC plan or revised RBC plan is unsatisfactory, the commissioner may at the commissioners discretion, subject to the insurers right to a hearing under  27-4.6-7, specify in the notification that the notification constitutes a regulatory action level event.  (f) Every domestic insurer that files an RBC plan or revised RBC plan with the commissioner shall file a copy of the RBC plan or revised RBC plan with the insurance commissioner in any state in which the insurer is authorized to do business if:  (1) That state has an RBC provision substantially similar to  27-4.6-8(a); and  (2) The insurance commissioner of that state has notified the insurer of its request for the filing in writing, in which case the insurer shall file a copy of the RBC plan or revised RBC plan in that state no later than the later of:  (i) Fifteen (15) days after the receipt of notice to file a copy of its RBC plan or revised RBC plan with the state; or  (ii) The date on which the RBC plan or revised RBC plan is filed under subsections (c) and (d) of this section.  History of Section.P.L. 1996, ch. 187,  2; P.L. 2010, ch. 49,  1; P.L. 2010, ch. 65,  1; P.L. 2021, ch. 162, art. 3,  2, effective July 6, 2021; P.L. 2021, ch. 230,  2, effective July 8, 2021; P.L. 2021, ch. 231,  2, effective July 8, 2021. 
 27-4.6-4. Regulatory action level event. (a) Regulatory action level event means, with respect to any insurer, any of the following events:  (1) The filing of an RBC report by the insurer which indicates that the insurers total adjusted capital is greater than or equal to its authorized control level RBC but less than its regulatory action level RBC;  (2) The notification by the commissioner to an insurer of an adjusted RBC report that indicates the event in subdivision (a)(1), provided the insurer does not challenge the adjusted RBC report under  27-4.6-7;  (3) If, pursuant to  27-4.6-7, the insurer challenges an adjusted RBC report that indicates the event in subdivision (a)(1), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurers challenge;  (4) The failure of the insurer to file an RBC report by the filing date, unless the insurer has provided an explanation for that failure which is satisfactory to the commissioner and has cured the failure within ten (10) days after the filing date;  (5) The failure of the insurer to submit an RBC plan to the commissioner within the time period set forth in  27-4.6-3(c);  (6) Notification by the commissioner to the insurer that:  (i) The RBC plan or revised RBC plan submitted by the insurer is, in the judgment of the commissioner, unsatisfactory; and  (ii) The notification constitutes a regulatory action level event with respect to the insurer, provided the insurer has not challenged the determination under  27-4.6-7;  (7) If, pursuant to  27-4.6-7, the insurer challenges a determination by the commissioner under subdivision (a)(6), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected those challenges;  (8) Notification by the commissioner to the insurer that the insurer has failed to adhere to its RBC plan or revised RBC plan, but only if that failure has a substantial adverse effect on the ability of the insurer to eliminate the company action level event in accordance with its RBC plan or revised RBC plan and the commissioner has stated this in the notification, provided the insurer has not challenged the determination under  27-4.6-7; or  (9) If, pursuant to  27-4.6-7, the insurer challenges a determination by the commissioner under subdivision (a)(8), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the challenge.  (b) In the event of a regulatory action level event the commissioner shall:  (1) Require the insurer to prepare and submit an RBC plan or, if applicable, a revised RBC plan;  (2) Perform any examination or analysis as the commissioner deems necessary of the assets, liabilities and operations of the insurer including a review of its RBC plan or revised RBC plan; and  (3) Subsequent to the examination or analysis, issue an order specifying any corrective actions as the commissioner shall determine are required (a corrective order).  (c) In determining corrective actions, the commissioner may take into account any factors as are deemed relevant with respect to the insurer based upon the commissioners examination or analysis of the assets, liabilities and operations of the insurer, including, but not limited to, the results of any sensitivity tests undertaken pursuant to the RBC instructions. The RBC plan or Revised RBC plan shall be submitted:  (1) Within forty-five (45) days after the occurrence of the regulatory action level event;  (2) If the insurer challenges an adjusted RBC report pursuant to  27-4.6-7 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing, rejected the insurers challenge; or  (3) If the insurer challenges a revised RBC plan pursuant to  27-4.6-7 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing, rejected the insurers challenge.  (d) The commissioner may retain actuaries and investment experts and other consultants necessary in the judgment of the commissioner to review the insurers RBC plan or revised RBC plan, examine or analyze the assets, liabilities and operations of the insurer and formulate the corrective order with respect to the insurer. The fees, costs and expenses relating to consultants shall be borne by the affected insurer or any other party as directed by the commissioner.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-5. Authorized control level event. (a) Authorized control level event means any of the following events:  (1) The filing of an RBC report by the insurer which indicates that the insurers total adjusted capital is greater than or equal to its mandatory control level RBC but less than its authorized control level RBC;  (2) The notification by the commissioner to the insurer of an adjusted RBC report that indicates the event in subdivision (a)(1), provided the insurer does not challenge the adjusted RBC report under  27-4.6-7;  (3) If, pursuant to  27-4.6-7, the insurer challenges an adjusted RBC report that indicates the event in subdivision (a)(1), notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurers challenge;  (4) The failure of the insurer to respond, in a manner satisfactory to the commissioner, to a corrective order (provided the insurer has not challenged the corrective order under  27-4.6-7); or  (5) If the insurer has challenged a corrective order under  27-4.6-7 and the commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the insurer to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner.  (b) In the event of an authorized control level event with respect to an insurer, the commissioner shall:  (1) Take any actions as are required under  27-4.6-4 regarding an insurer with respect to which a regulatory action level event has occurred; or  (2) If the commissioner deems it to be in the best interests of the policyholders and creditors of the insurer and of the public, take any actions as are necessary to cause the insurer to be placed under regulatory control under chapter 14.3 of this title, the Insurers Rehabilitation and Liquidation Act. In the event the commissioner takes actions, the authorized control level event shall be deemed sufficient grounds for the commissioner to take action under chapter 14.3 of this title, and the commissioner shall have the rights, powers and duties with respect to the insurer as are set forth in chapter 14.3 of this title. In the event the commissioner takes actions under this subdivision pursuant to an adjusted RBC report, the insurer shall be entitled to any protections as are afforded to insurers under the provisions of chapter 14.3 of this title pertaining to summary proceedings.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-6. Mandatory control level event. (a) Mandatory control level event means any of the following events:  (1) The filing of an RBC report which indicates that the insurers total adjusted capital is less than its mandatory control level RBC;  (2) Notification by the commissioner to the insurer of an adjusted RBC report that indicates the event in subdivision (a)(1), provided the insurer does not challenge the adjusted RBC report under  27-4.6-7; or  (3) If, pursuant to  27-4.6-7, the insurer challenges an adjusted RBC report that indicates the event in subdivision (a)(1), notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurers challenge.  (b) In the event of a mandatory control level event:  (1) Concerning a life insurer, the commissioner shall take any actions as are necessary to place the insurer under regulatory control under chapter 14.3 of this title, the Insurers Rehabilitation and Liquidation Act. In that event, the mandatory control level event shall be deemed sufficient grounds for the commissioner to take action under chapter 14.3 of this title, and the commissioner shall have the rights, powers and duties with respect to the insurer as are set forth in chapter 14.3 of this title. If the commissioner takes actions pursuant to an adjusted RBC report, the insurer shall be entitled to the protections of chapter 14.3 of this title pertaining to summary proceedings. Notwithstanding any of these provisions, the commissioner may forego action for up to ninety (90) days after the mandatory control level event if the commissioner finds there is a reasonable expectation that the mandatory control level event may be eliminated within the ninety (90) day period.  (2) Concerning a property and casualty insurer, the commissioner shall take any actions as are necessary to place the insurer under regulatory control under chapter 14.3 of this title, or, in the case of an insurer which is writing no business and which is running-off its existing business, may allow the insurer to continue its run-off under the supervision of the commissioner. In either event, the mandatory control level event shall be deemed sufficient grounds for the commissioner to take action under chapter 14.3 of this title and the commissioner shall have the rights, powers and duties with respect to the insurer as are set forth in chapter 14.3 of this title. If the commissioner takes actions pursuant to an adjusted RBC report, the insurer shall be entitled to the protections of chapter 14.3 of this title pertaining summary proceedings. Notwithstanding any of these provisions, the commissioner may forego action for up to ninety (90) days after the mandatory control level event if the commissioner finds there is a reasonable expectation that the mandatory control level event may be eliminated within the ninety (90) day period.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-7. Hearings. Upon: (1) Notification to an insurer by the commissioner of an adjusted RBC report; or (2) notification to an insurer by the commissioner that: (i) the insurers RBC plan or revised RBC plan is unsatisfactory; and (ii) that notification constitutes a regulatory action level event with respect to the insurer; or (3) notification to any insurer by the commissioner that the insurer has failed to adhere to its RBC plan or revised RBC plan and that that failure has a substantial adverse effect on the ability of the insurer to eliminate the company action level event with respect to the insurer in accordance with its RBC plan or revised RBC plan; or (4) notification to an insurer by the commissioner of a corrective order with respect to the insurer; the insurer shall have the right to a departmental hearing, on a record, at which the insurer may challenge any determination or action by the commissioner. The insurer shall notify the commissioner of its request for a hearing within five (5) days after the notification by the commissioner under subdivision (1), (2), (3) or (4). Upon receipt of the insurers request for a hearing, the commissioner shall set a date for the hearing, which date shall be within a reasonable amount of time but no less than ten (10) days after the date of the insurers request.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-8. Confidentiality  Prohibition on announcements  Prohibition on use in ratemaking. (a) All RBC reports (to the extent the information in them is not required to be set forth in a publicly available annual statement schedule) and RBC plans (including the results or report or any examination or analysis of an insurer performed pursuant to this chapter and any corrective order issued by the commissioner pursuant to that examination or analysis) with respect to any domestic insurer or foreign insurer which are filed with the commissioner constitute information that might be damaging to the insurer if made available to its competitors, and shall be kept confidential by the commissioner. This information shall not be made public and/or be subject to subpoena, other than by the commissioner and then only for the purpose of enforcement actions taken by the commissioner pursuant to this chapter or any other provision of the insurance laws of this state. All RBC reports and RBC plans filed with the insurance commissioner shall not be deemed public records and shall not be subject to the Access to Public Records Act, chapter 2 of title 38.  (b) It is the judgment of the legislature that the comparison of an insurers total adjusted capital to any of its RBC levels is a regulatory tool which may indicate the need for possible corrective action with respect to the insurer, and is not intended as a means to rank insurers generally. Except as required under the provisions of this chapter, the making, publishing, disseminating, circulating or placing before the public, or causing, directly or indirectly to be made, published, disseminated, circulated or placed before the public, in a newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio or television station, or in any other way, an advertisement, announcement or statement containing an assertion, representation or statement with regard to the RBC levels of any insurer, or of any component derived in the calculation, by any insurer, agent, broker or other person engaged in any manner in the insurance business would be misleading and is prohibited; provided, that if any materially false statement with respect to the comparison regarding an insurers total adjusted capital to its RBC levels (or any of them) or an inappropriate comparison of any other amount to the insurers RBC levels is published in any written publication and the insurer is able to demonstrate to the commissioner with substantial proof the falsity of that statement, or the inappropriateness, then the insurer may publish an announcement in a written publication if the sole purpose of the announcement is to rebut the materially false statement.  (c) It is the judgment of the legislature that the RBC instructions, RBC reports, adjusted RBC reports, RBC plans and revised RBC plans are intended solely for use by the commissioner in monitoring the solvency of insurers and the need for possible corrective action with respect to insurers and shall not be used by the commissioner for ratemaking nor considered or introduced as evidence in any rate proceeding nor used by the commissioner to calculate or derive any elements of an appropriate premium level or rate of return for any line of insurance which an insurer or any affiliate is authorized to write.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.6-9. Supplemental provisions  Rules  Exemption. (a) The provisions of this chapter are supplemental to any other provisions of the laws of this state, and shall not preclude or limit any other powers or duties of the commissioner under those laws, including, but not limited to, chapter 14.3 and chapter 14.2 of this title.  (b) The commissioner may adopt reasonable rules and regulations necessary for the implementation of this chapter.  (c) The commissioner may exempt from the application of this chapter any domestic property and casualty insurer which:  (1) Writes direct business only in this state;  (2) Writes direct annual premiums of two million dollars ($2,000,000) or less; and  (3) Assume no reinsurance in excess of five percent (5%) of direct premium written.  History of Section.P.L. 1996, ch. 187,  2. 
 27-4.7-1. Short title. This chapter shall be known and may be cited as the Rhode Island Risk-Based Capital (RBC) for Health Organizations Act.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-10. Supplemental provisions  Rules  Exemption. (a) The provisions of this chapter are supplemental to any other provisions of the laws of this state, and shall not preclude or limit any other powers or duties of the commissioner under those laws, including, but not limited to, chapters 41, 19, 20, 20.1, 20.2, 20.3, 14.1, 14.2, and 14.3 of this title. The provisions of this chapter shall supersede any provisions of this title in conflict with this chapter.  (b) The commissioner may adopt reasonable rules necessary for the implementation of this chapter.  (c) The commissioner may exempt from the application of this chapter or modify the requirements of this chapter for:  (1) A domestic health organization that:  (i) Writes direct business only in this state;  (ii) Assumes no reinsurance in excess of five percent (5%) of direct premium written; and  (iii) Writes direct annual premiums for comprehensive medical business of two million dollars ($2,000,000) or less; or  (iv) Is a limited health service organization that covers less than two thousand (2,000) lives; or  (2) A domestic health organization that provides a plan of health insurance, health benefits, or health services to members, eighty-five percent (85%) or greater of which are participants in the RIte Care program administered by the State of Rhode Island, if the health organization has contracts with insurers, hospital or medical service corporations, governments, or other organizations that are sufficient to reasonably assure the performance of its obligations; provided, that in no event shall the net worth or total adjusted capital requirement be less than one hundred thousand dollars ($100,000).  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11; P.L. 2008, ch. 475,  75. 
 27-4.7-11. Foreign health organizations. (a)(1) A foreign health organization shall, upon the written request of the commissioner, submit to the commissioner an RBC report as of the end of the calendar year just ended the later of:  (i) The date an RBC report would be required to be filed by a domestic health organization under this chapter;  (ii) Fifteen (15) days after the request is received by the foreign health organization.  (2) A foreign health organization shall, at the written request of the commissioner, promptly submit to the commissioner a copy of any RBC plan that is filed with the insurance commissioner of any other state.  (b) In the event of a company action level event, regulatory action level event, or authorized control level event with respect to a foreign health organization as determined under the RBC statute applicable in the state of domicile of the health organization (or, if no RBC statute is in force in that state, under the provisions of this chapter), if the insurance commissioner of the state of domicile of the foreign health organization fails to require the foreign health organization to file an RBC plan in the manner specified under that states RBC statute (or, if no RBC statute is in force in that state, under  27-4.7-4), the commissioner may require the foreign health organization to file an RBC plan with the commissioner. In that event, the failure of the foreign health organization to file an RBC plan with the commissioner is grounds to order the health organization to cease and desist from writing new insurance business in this state.  (c) In the event of a mandatory control level event with respect to a foreign health organization, if no domiciliary receiver has been appointed with respect to the foreign health organization under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign health organization, the commissioner may make application to the superior court of the county of Providence permitted under chapter 14.3 of this title with respect to the liquidation of property of foreign health organizations found in this state, and the occurrence of the mandatory control level event shall be considered adequate grounds for the application.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11; P.L. 2008, ch. 475,  75. 
 27-4.7-12. Immunity. There shall be no liability on the part of, and no cause of action shall arise against, the commissioner or the insurance department or its employees or agents for any action taken by them in the performance of their powers and duties under this chapter.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-13. Severability. If any provision of this chapter, or its application to any person or circumstance, is held invalid, that determination shall not affect the provisions or applications of this chapter that can be given effect without the invalid provision or application, and to that end the provisions of this chapter are severable.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-14. Notices. All notices by the commissioner to a health organization that may result in regulatory action under this chapter shall be effective upon dispatch if transmitted by registered or certified mail, or in the case of any other transmission shall be effective upon the health organizations receipt of notice.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-15. Repealed.
 27-4.7-16. Prior notification of discontinuance of health insurance coverage. (a) At any time that a health organization elects to discontinue providing all health benefit plans to either individual or group policyholders in this state, the health organization shall provide written notice of this decision to the director of health and the director of the department of business regulation and to all affected health benefit plan group and individual policyholders at least one hundred eighty (180) days prior to the planned date of discontinuation of all health benefit plans by the health organization. Notice to the director of health and the director of the department of business regulation shall be provided at least five (5) working days prior to the notice to affected enrollees.  (b) Any health organization in violation of this notification requirement is subject to an administrative penalty in an amount not less than five hundred dollars ($500) nor more than fifty thousand dollars ($50,000).  History of Section.P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-2. Definitions. As used in this chapter: (1) Adjusted RBC report means an RBC report that has been adjusted by the commissioner in accordance with  27-4.7-3;  (2) Corrective order means an order issued by the commissioner specifying corrective actions which the commissioner has determined are required;  (3) Commissioner means the director of the department of business regulation;  (4) Domestic health organization means a health organization domiciled in this state;  (5) Foreign health organization means a health organization that is licensed or authorized to do business in this state pursuant to this title but is not domiciled in this state;  (6) NAIC means the National Association of Insurance Commissioners;  (7) Health organization means a health maintenance organization, limited health service organization, dental or vision plan, hospital, medical, and dental indemnity or service corporation or other managed care organization or any other entity providing a plan of health insurance, health benefits, or health services subject to this title. This definition does not include an organization that is licensed as either a life and health insurer or a property and casualty insurer pursuant to chapter 1 or chapter 2 of this title and that is subject to either the life or property and casualty RBC requirements;  (8) RBC means risk-based capital;  (9) RBC instructions means the RBC report, including risk-based capital instructions adopted by the NAIC, as these RBC instructions may be amended by the NAIC in accordance with the procedures adopted by the NAIC;  (10) RBC level means a health organizations company action level RBC, regulatory action level RBC, authorized control level RBC, or mandatory control level RBC where:  (i) Company action level RBC means, with respect to any health organization, the product of two (2.0) and its authorized control level RBC;  (ii) Regulatory action level RBC means the product of one and one-half (1.5) and its authorized control level RBC;  (iii) Authorized control level RBC means the number determined under the risk-based capital formula in accordance with the RBC instructions;  (iv) Mandatory control level RBC means the product of seven tenths (.70) and the authorized control level RBC.  (11) RBC plan means a comprehensive financial plan containing the elements specified in  27-4.7-4(b). If the commissioner rejects the RBC plan, and it is revised by the health organization, with or without the commissioners recommendation, the plan shall be called the revised RBC plan;  (12) RBC report means the report required in  27-4.7-3;  (13) Total adjusted capital means the sum of:  (i) A health organizations statutory capital and surplus (i.e., net worth) as determined in accordance with the statutory accounting applicable to the annual and quarterly financial statements required to be filed by health organizations pursuant to applicable sections of this title; and  (ii) Any other items, if any, that the RBC instructions may provide.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-3. RBC reports. (a) A domestic health organization shall, on or prior to each March 1 (the filing date), prepare and submit to the commissioner a report of its RBC levels as of the end of the calendar year just ended, in a form and containing any information that is required by the RBC instructions. In addition, a domestic health organization shall file its RBC report:  (1) With the NAIC in accordance with the RBC instructions; and  (2) With the insurance commissioner in any state in which the health organization is authorized to do business, if the insurance commissioner has notified the health organization of its request in writing, in which case the health organization shall file its RBC report not later than the later of:  (i) Fifteen (15) days from the receipt of notice to file its RBC report with that state; or  (ii) The filing date.  (b) A health organizations RBC shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take the following into account (and may adjust for the covariance between) determined in each case by applying the factors in the manner set forth in the RBC instructions:  (1) Asset risk;  (2) Credit risk;  (3) Underwriting risk; and  (4) All other business risks and any other relevant risks that are set forth in the RBC instructions.  (c) An excess of capital (i.e., net worth) over the amount produced by the risk-based capital requirements contained in this chapter and the formulas, schedules, and instructions referenced in this chapter is desirable in the business of health insurance. Health organizations should seek to maintain capital above the RBC levels required by this chapter. Additional capital is used and useful in the insurance business and helps to secure a health organization against various risks inherent in, or affecting, the business of insurance and not accounted for, or only partially measured by, the risk-based capital requirements contained in this chapter.  (d) If a domestic health organization files an RBC report that in the judgment of the commissioner is inaccurate, then the commissioner shall adjust the RBC report to correct the inaccuracy and shall notify the health organization of the adjustment. The notice shall contain a statement of the reason for the adjustment. An RBC report adjusted in this manner is referred to as an adjusted RBC report.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-4. Company action level event. (a) Company action level event means any of the following events:  (1) The filing of an RBC report by a health organization that indicates that the health organizations total adjusted capital is greater than or equal to its regulatory action level RBC but less than its company action level RBC;  (i) If a health organization has total adjusted capital which is greater than or equal to its company action level RBC but less than the product of its authorized control level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the health RBC instructions;  (2) Notification by the commissioner to the health organization of an adjusted RBC report that indicates an event in subdivision (a)(1) of this section, provided the health organization does not challenge the adjusted RBC report under  27-4.7-8; or  (3) If, pursuant to  27-4.7-8, a health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1) of this section, the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organizations challenge.  (b) In the event of a company action level event, the health organization shall prepare and submit to the commissioner an RBC plan that shall:  (1) Identify the conditions that contribute to the company action level event;  (2) Contain proposals of corrective actions that the health organization intends to take and that would be expected to result in the elimination of the company action level event;  (3) Provide projections of the health organizations financial results in the current year and at least the two (2) succeeding years, both in the absence of proposed corrective actions and giving effect to the proposed corrective actions, including projections of statutory balance sheets, operating income, net income, capital and surplus, and RBC levels. The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense, and benefit component;  (4) Identify the key assumptions impacting the health organizations projections and the sensitivity of the projections to the assumptions; and  (5) Identify the quality of, and problems associated with, the health organizations business, including, but not limited to, its assets, anticipated business growth and associated surplus strain, extraordinary exposure to risk, mix of business, and use of reinsurance, if any, in each case.  (c) The RBC plan shall be submitted:  (1) Within forty-five (45) days of the company action level event; or  (2) If the health organization challenges an adjusted RBC report pursuant to  27-4.7-8 within forty-five (45) days after notification to the health organization that the commissioner has, after a hearing, rejected the health organizations challenge.  (d) Within sixty (60) days after the submission by a health organization of an RBC plan to the commissioner, the commissioner shall notify the health organization whether the RBC plan shall be implemented or is, in the judgment of the commissioner, unsatisfactory. If the commissioner determines the RBC plan is unsatisfactory, the notification to the health organization shall set forth the reasons for the determination, and may set forth proposed revisions which will render the RBC plan satisfactory in the judgment of the commissioner. Upon notification from the commissioner, the health organization shall prepare a revised RBC plan, which may incorporate by reference any revisions proposed by the commissioner, and shall submit the revised RBC plan to the commissioner:  (1) Within forty-five (45) days after the notification from the commissioner; or  (2) If the health organization challenges the notification from the commissioner under  27-4.7-8, within forty-five (45) days after a notification to the health organization that the commissioner has, after a hearing, rejected the health organizations challenge.  (e) In the event of a notification by the commissioner to a health organization that the health organizations RBC plan or revised RBC plan is unsatisfactory, the commissioner may, at the commissioners discretion, subject to the health organizations right to a hearing under  27-4.7-8, specify in the notification that the notification constitutes a regulatory action level event.  (f) Every domestic health organization that files an RBC plan or revised RBC plan with the commissioner shall file a copy of the RBC plan or revised RBC plan with the insurance commissioner in any state in which the health organization is authorized to do business if:  (1) The state has an RBC provision substantially similar to  27-4.7-9(a); and  (2) The insurance commissioner of that state has notified the health organization of its request for the filing in writing, in which case the health organization shall file a copy of the RBC plan or revised RBC plan in that state no later than the later of:  (i) Fifteen (15) days after the receipt of notice to file a copy of its RBC plan or revised RBC plan with the state; or  (ii) The date on which the RBC plan or revised RBC plan is filed under subsections (c) and (d) of this section.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11; P.L. 2010, ch. 49,  2; P.L. 2010, ch. 65,  2. 
 27-4.7-5. Regulatory action level event. (a) Regulatory action level event means, with respect to a health organization, any of the following events:  (1) The filing of an RBC report by the health organization that indicates that the health organizations total adjusted capital is greater than or equal to its authorized control level RBC but less than its regulatory action level RBC;  (2) Notification by the commissioner to a health organization of an adjusted RBC report that indicates the event in subdivision (a)(1) of this section, provided the health organization does not challenge the adjusted RBC report under  27-4.7-8;  (3) If, pursuant to  27-4.7-8, the health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1) of this section, the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organizations challenge;  (4) The failure of the health organization to file an RBC report by the filing date, unless the health organization has provided an explanation for the failure that is satisfactory to the commissioner and has cured the failure within ten (10) days after the filing date;  (5) The failure of the health organization to submit an RBC plan to the commissioner within the time period set forth in  27-4.7-4(c);  (6) Notification by the commissioner to the health organization that:  (i) The RBC plan or revised RBC plan submitted by the health organization is, in the judgment of the commissioner, unsatisfactory; and  (ii) Notification constitutes a regulatory action level event with respect to the health organization, provided the health organization has not challenged the determination under  27-4.7-8.  (7) If, pursuant to  27-4.7-8, the health organization challenges a determination by the commissioner under subdivision (6) of this subsection, the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the challenge;  (8) Notification by the commissioner to the health organization that the health organization has failed to adhere to its RBC plan or revised RBC plan, but only if the failure has a substantial adverse effect on the ability of the health organization to eliminate the company action level event in accordance with its RBC plan or revised RBC plan and the commissioner has stated this in the notification, provided the health organization has not challenged the determination under  27-4.7-8; or  (9) If, pursuant to  27-4.7-8, the health organization challenges a determination by the commissioner under subdivision (8) of this subsection, the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the challenge.  (b) In the event of a regulatory action level event the commissioner shall:  (1) Require the health organization to prepare and submit an RBC plan or, if applicable, a revised RBC plan;  (2) Perform any examination or analysis that the commissioner deems necessary of the assets, liabilities and operations of the health organization including a review of its RBC plan or revised RBC plan; and  (3) Subsequent to the examination or analysis, issue an order specifying any corrective actions that the commissioner determines are required (a corrective order).  (c) In determining corrective actions, the commissioner may take into account factors the commissioner deems relevant with respect to the health organization based upon the commissioners examination or analysis of the assets, liabilities, and operations of the health organization, including, but not limited to, the results of any sensitivity tests undertaken pursuant to the RBC instructions. The RBC plan or revised RBC plan shall be submitted:  (1) Within forty-five (45) days after the occurrence of the regulatory action level event;  (2) If the health organization challenges an adjusted RBC report pursuant to  27-4.7-8 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the health organization that the commissioner has, after a hearing, rejected the health organizations challenge; or  (3) If the health organization challenges a revised RBC plan pursuant to  27-4.7-8 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the health organization that the commissioner has, after a hearing, rejected the health organizations challenge.  (d) The commissioner may retain actuaries and investment experts and other consultants that may be necessary in the judgment of the commissioner to review the health organizations RBC plan or revised RBC plan, examine or analyze the assets, liabilities, and operations (including contractual relationships) of the health organization and formulate the corrective order with respect to the health organization. The fees, costs, and expenses relating to consultants shall be borne by the affected health organization or any other party as directed by the commissioner.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-6. Authorized control level event. (a) Authorized control level event means any of the following events:  (1) The filing of an RBC report by the health organization that indicates that the health organizations total adjusted capital is greater than or equal to its mandatory control level RBC but less than its authorized control level RBC;  (2) The notification by the commissioner to the health organization of an adjusted RBC report that indicates the event in subdivision (a)(1) of this section, provided the health organization does not challenge the adjusted RBC report under  27-4.7-8;  (3) If, pursuant to  27-4.7-8, the health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1) of this section, notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organizations challenge;  (4) The failure of the health organization to respond, in a manner satisfactory to the commissioner, to a corrective order (provided the health organization has not challenged the corrective order under  27-4.7-8); or  (5) If the health organization has challenged a corrective order under  27-4.7-8 and the commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the health organization to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner.  (b) In the event of an authorized control level event with respect to a health organization, the commissioner shall:  (1) Take any actions that are required under  27-4.7-5 regarding a health organization with respect to which a regulatory action level event has occurred; or  (2) If the commissioner deems it to be in the best interests of the policyholders and creditors of the health organization and of the public, take any actions that are necessary to cause the health organization to be placed under regulatory control pursuant to chapters 14.1, 14.2, and 14.3 of this title. In the event the commissioner takes these actions, the authorized control level event shall be deemed sufficient grounds for the commissioner to take action under chapters 14.1, 14.2, and 14.3 of this title, and the commissioner has the rights, powers, and duties with respect to the health organization that are set forth in chapters 14.1, 14.2, and 14.3 of this title. In the event the commissioner takes actions under this subdivision pursuant to an adjusted RBC report, the health organization is entitled to any protections that are afforded to health organizations under the provisions of chapter 35 of title 42 pertaining to summary proceedings.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-7. Mandatory control level event. (a) Mandatory control level event means any of the following events:  (1) The filing of an RBC report which indicates that the health organizations total adjusted capital is less than its mandatory control level RBC;  (2) Notification by the commissioner to the health organization of an adjusted RBC report that indicates the event in subdivision (a)(1) of this section, provided the health organization does not challenge the adjusted RBC report under  27-4.7-8; or  (3) If, pursuant to  27-4.7-8, the health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1) of this section, notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organizations challenge.  (b) In the event of a mandatory control level event, the commissioner shall take any actions that are necessary to place the health organization under regulatory control pursuant to chapters 14.1, 14.2, and 14.3 of this title. In that event, the mandatory control level event shall be deemed sufficient grounds for the commissioner to take action under chapters 14.1, 14.2, and 14.3 of this title, and the commissioner has the rights, powers, and duties with respect to the health organization that are set forth in chapters 14.1, 14.2, and 14.3 of this title. If the commissioner takes actions pursuant to an adjusted RBC report, the health organization is entitled to the protections of chapter 35 of title 42 pertaining to summary proceedings. Notwithstanding any of these provisions, the commissioner may forego action for up to ninety (90) days after the mandatory control level event if the commissioner finds there is a reasonable expectation that the mandatory control level event may be eliminated within the ninety (90) day period.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-8. Hearings. Upon the occurrence of any of the following events the health organization has the right to a confidential department hearing, on the record, at which the health organization may challenge any determination or action by the commissioner. The health organization shall notify the commissioner of its request for a hearing within five (5) days after the notification by the commissioner under subdivisions (1), (2), (3), or (4) of this section. Upon receipt of the health organizations request for a hearing, the commissioner shall set a date for the hearing, which shall be no less than ten (10) days nor more than thirty (30) days after the date of the health organizations request. The events include:  (1) Notification to a health organization by the commissioner of an adjusted RBC report;  (2) Notification to a health organization by the commissioner that:  (i) The health organizations RBC plan or revised RBC plan is unsatisfactory; and  (ii) Notification constitutes a regulatory action level event with respect to the health organization;  (3) Notification to a health organization by the commissioner that the health organization has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health organization to eliminate the company action level event with respect to the health organization in accordance with its RBC plan or revised RBC plan; or  (4) Notification to a health organization by the commissioner of a corrective order with respect to the health organization.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.7-9. Confidentiality  Prohibition on announcements  Prohibition on use in ratemaking. (a) All RBC reports (to the extent the information is not required to be set forth in a publicly available annual statement schedule) and RBC plans (including the results or report of any examination or analysis of a health organization performed pursuant to this chapter and any corrective order issued by the commissioner pursuant to examination or analysis) with respect to a domestic health organization or foreign health organization that are filed with the commissioner constitute information that might be damaging to the health organization if made available to its competitors, and shall be kept confidential by the commissioner. This information shall not be made public or be subject to subpoena, other than by the commissioner and then only for the purpose of enforcement actions taken by the commissioner pursuant to this chapter or any other provision of the insurance laws of this state.  (b) It is the judgment of the legislature that the comparison of a health organizations total adjusted capital to any of its RBC levels is a regulatory tool which may indicate the need for corrective action with respect to the health organization, and is not intended as a means to rank health organizations generally. Except as required under the provisions of this chapter, the making, publishing, disseminating, circulating, or placing before the public, or causing, directly or indirectly to be made, published, disseminated, circulated, or placed before the public, in a newspaper, magazine, or other publication, or in the form of a notice, circular, pamphlet, letter, or poster, or over a radio or television station, or in any other way, an advertisement, announcement, or statement containing an assertion, representation, or statement with regard to the RBC levels of any health organization, or of any component derived in the calculation, by any health organization, agent, broker, or other person engaged in any manner in the insurance business, would be misleading and is prohibited; provided, that if any materially false statement with respect to the comparison regarding a health organizations total adjusted capital to its RBC levels (or any of them) or an inappropriate comparison of any other amount to the health organizations RBC levels is published in any written publication and the health organization is able to demonstrate to the commissioner with substantial proof the falsity of the statement, or the inappropriateness, then the health organization may publish an announcement in a written publication, if the sole purpose of the announcement is to rebut the materially false statement.  History of Section.P.L. 2000, ch. 178,  1; P.L. 2000, ch. 200,  11; P.L. 2000, ch. 229,  11. 
 27-4.8-1. Group life insurance definitions. Except as provided in  27-4.8-2, no policy of group life insurance shall be delivered in this state unless it conforms to one of the following descriptions:  (1) A policy issued to an employer, or to the trustees of a fund established by an employer, which employer or trustees shall be deemed the policyholder, to insure employees of the employer for the benefit of persons other than the employer, subject to the following requirements:  (i) The employees eligible for insurance under the policy shall be all of the employees of the employer, or all of any class or classes thereof. The policy may provide that the term employees shall include the employees of one or more subsidiary corporations, and the employees, individual proprietors, and partners of one or more affiliated corporations, proprietorships, or partnerships if the business of the employer and of the affiliated corporations, proprietorships, or partnerships is under common control. The policy may provide that the term employees shall include the individual proprietor or partners if the employer is an individual proprietorship or partnership. The policy may provide that the term employees may include retired employees, former employees, and directors of a corporate employer. A policy issued to insure the employees of a public body may provide that the term employees shall include elected or appointed officials.  (ii) The premium for the policy shall be paid either from the employers funds or from funds contributed by the insured employees, or from both. Except as provided in subsection (1)(iii), a policy on which no part of the premium is to be derived from funds contributed by the insured employees shall insure all eligible employees, except those who reject the coverage in writing.  (iii) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer; provided, however, that any exclusion or limitation shall not be based solely on the fact that the person has a prescription to carry or possess the drug naloxone.  (2) A policy issued to a creditor or its parent holding company or to a trustee or trustees or agent designated by two (2) or more creditors, which creditor, holding company, affiliate, trustee, trustees, or agent shall be deemed the policyholder, to insure debtors of the creditor or creditors subject to the following requirements:  (i) The debtors eligible for insurance under the policy shall be all of the debtors of the creditor or creditors, or all of any class or classes thereof. The policy may provide that the term debtors shall include:  (A) Borrowers of money or purchasers or lessees of goods, services, or property for which payment is arranged through a credit transaction;  (B) The debtors of one or more subsidiary corporations; and  (C) The debtors of one or more affiliated corporations, proprietorships, or partnerships if the business of the policyholder and of the affiliated corporations, proprietorships, or partnerships is under common control.  (ii) The premium for the policy shall be paid either from the creditors funds, or from charges collected from the insured debtors, or from both. Except as provided in subsection (2)(iii), a policy on which no part of the premium is to be derived from the funds contributed by insured debtors specifically for their insurance shall insure all eligible debtors.  (iii) An insurer may exclude any debtors as to whom evidence of individual insurability is not satisfactory to the insurer; provided, however, that any exclusion shall not be based solely on the fact that the person has a prescription to carry or possess the drug naloxone.  (iv) The amount of the insurance on the life of any debtor shall at no time exceed the greater of the scheduled or actual amount of unpaid indebtedness to the creditor, except that insurance written in connection with open-end credit having a credit limit exceeding ten thousand dollars ($10,000) may be in an amount not exceeding the credit limit.  (v) The insurance may be payable to the creditor or any successor to the right, title, and interest of the creditor. The payment shall reduce or extinguish the unpaid indebtedness of the debtor to the extent of the payment and any excess of the insurance shall be payable to the estate of the insured.  (vi) Notwithstanding the provisions of the above subsections, insurance on agricultural credit transaction commitments may be written up to the amount of the loan commitment on a non-decreasing or level term plan. Insurance on educational credit transaction commitments may be written up to the amount of the loan commitment less the amount of any repayments made on the loan.  (3) A policy issued to a labor union, or similar employee organization, which shall be deemed to be the policyholder, to insure members of the union or organization for the benefit of persons other than the union or organization or any of its officials, representatives, or agents, subject to the following requirements:  (i) The members eligible for insurance under the policy shall be all of the members of the union or organization, or all of any class or classes thereof.  (ii) The premium for the policy shall be paid either from funds of the union or organization, or from funds contributed by the insured members specifically for their insurance, or from both. Except as provided in subsection (3)(iii), a policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for their insurance shall insure all eligible members, except those who reject the coverage in writing.  (iii) An insurer may exclude or limit the coverage on any persons as to whom evidence of individual insurability is not satisfactory to the insurer; provided, however, that any exclusion or limitation shall not be based solely on the fact that the person has a prescription to carry or possess the drug naloxone.  (4) A policy issued to a trust or to the trustees of a fund established or adopted by two (2) or more employers, or by one or more labor unions or similar employee organizations, or by one or more employers and one or more labor unions or similar employee organizations, which trust or trustees shall be deemed the policyholder, to insure employees of the employers or members of the unions or organizations for the benefit of person other than the employers or the unions or organizations, subject to the following requirements:  (i) The persons eligible for insurance shall be all of the employees of the employers or all of the members of the unions or organizations, or all of any class or classes thereof. The policy may provide that the term employees shall include the employees of one or more subsidiary corporations, and the employees, individual proprietors, and partners of one or more affiliated corporations, proprietorships, or partnerships if the business of the employer and of the affiliated corporations, proprietorships, or partnerships is under common control. The policy may provide that the term employees shall include the individual proprietor or partners if the employer is an individual proprietorship or partnership. The policy may provide that the term employees shall include retired employees, former employees, and directors of a corporate employer. The policy may provide that the term employees shall include the trustees or their employees, or both, if their duties are principally connected with the trusteeship.  (ii) The premium for the policy shall be paid from funds contributed by the employer or employers of the insured persons, or by the union or unions or similar employee organizations, or by both, or from funds contributed by the insured persons or from both the insured persons and the employers or unions or similar employee organizations. Except as provided in subsection (4)(iii), a policy on which no part of the premium is to be derived from funds contributed by the insured persons specifically for their insurance shall insure all eligible persons, except those who reject the coverage in writing.  (iii) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer; provided, however, that any exclusion or limitation shall not be based solely on the fact that the person has a prescription to carry or possess the drug naloxone.  (5) A policy issued to an association or to a trust or to the trustees of a fund established, created, or maintained for the benefit of members of one or more associations. The association or associations shall have at the outset a minimum of one hundred (100) persons; shall have been organized and maintained in good faith for purposes other than obtaining insurance; shall have been in active existence for at least two (2) years; and shall have a constitution and bylaws that provide that:  (i) The association or associations hold regular meetings not less than annually to further purposes of the members;  (ii) Except for credit unions, the association or associations, collect dues or solicit contributions from members; and  (iii) The members have voting privileges and representation on the governing board and committees. The policy shall be subject to the following requirements:  (A) The policy may insure members of the association or associations, employees thereof, or employees of members, or one or more of the preceding or all of any class or classes thereof for the benefit of persons other than the employees employer.  (B) The premium for the policy shall be paid from funds contributed by the association or associations, or by employer members, or by both, or from funds contributed by the covered persons or from both the covered persons and the association, associations, or employer members.  (C) Except as provided in subsection (5)(iii)(D), a policy on which no part of the premium is to be derived from funds contributed by the covered persons specifically for the insurance shall insure all eligible persons, except those who reject the coverage in writing.  (D) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer; provided, however, that any exclusion or limitation shall not be based solely on the fact that the person has a prescription to carry or possess the drug naloxone.  (6) A policy issued to a credit union or to a trustee or trustees or agent designated by two (2) or more credit unions, which credit union, trustee, trustees, or agent shall be deemed policyholder, to insure members of the credit union or credit unions for the benefit of persons other than the credit union or credit unions, trustee or trustees, or agent or any of their officials, subject to the following requirements:  (i) The members eligible for insurance shall be all of the members of the credit union or credit unions, or all of any class or classes thereof.  (ii) The premium for the policy shall be paid by the policyholder from the credit unions funds and, except as provided in subsection (6)(iii), shall insure all eligible members.  (iii) An insurer may exclude or limit the coverage on any member as to whom evidence of individual insurability is not satisfactory to the insurer; provided, however, that any exclusion or limitation shall not be based solely on the fact that the person has a prescription to carry or possess the drug naloxone.  History of Section.P.L. 2009, ch. 299,  1; P.L. 2009, ch. 300,  1; P.L. 2019, ch. 121,  2; P.L. 2019, ch. 149,  2; P.L. 2020, ch. 79, art. 2,  15. 
 27-4.8-2. Limits of group life insurance. Group life insurance offered to a resident of this state under a group life insurance policy issued to a group other than one described in section 27-4.8-1 shall be subject to the following requirements:  (1) A group life insurance policy shall not be delivered in this state unless the commissioner finds that:  (i) The issuance of the group policy is not contrary to the best interest of the public;  (ii) The issuance of the group policy would result in economies of acquisition or administration; and  (iii) The benefits are reasonable in relation to the premiums charged.  (2) A group life insurance coverage may not be offered in this state by an insurer under a policy issued in another state unless this state or another state having requirements substantially similar to those contained in subdivisions (i), (ii), and (iii) has made a determination that the requirements have been met.  (3) The premium for the policy shall be paid either from the policyholders funds or from funds contributed by the covered persons, or from both.  (4) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.  History of Section.P.L. 2009, ch. 299,  1; P.L. 2009, ch. 300,  1. 
 27-4.8-3. Notice of compensation. (a) With respect to a program of insurance which, if issued on a group basis, would not qualify under  27-4.8-1 of this act, the insurer shall cause to be distributed to prospective insureds a written notice that compensation will or may be paid, if compensation of any kind will or may be paid to:  (1) A policyholder or sponsoring or endorsing entity in the case of a group policy; or  (2) A sponsoring or endorsing entity in the case of individual, blanket or franchise policies marketed by means of direct response solicitation.  (b) The notice shall be distributed:  (1) Whether compensation is direct or indirect; and  (2) Whether the compensation is paid to or retained by the policyholder or sponsoring or endorsing entity, or paid to or retained by a third-party at the direction of the policyholder or sponsoring or endorsing entity, or an entity affiliated therewith by way of ownership, contract or employment.  (c) The notice required by this section shall be placed on or accompany an application or enrollment form provided to prospective insureds.  (d) The following terms shall have the meanings indicated:  (1) Direct response solicitation means a solicitation through a sponsoring or endorsing entity through the mails, telephone or other mass communications media;  (2) Sponsoring or endorsing entity means an organization that has arranged for the offering of a program of insurance in a manner that communicates that eligibility for participation in the program is dependent upon affiliation with the organization or that it encourages participation in the program.  History of Section.P.L. 2009, ch. 299,  1; P.L. 2009, ch. 300,  1. 
 27-4.8-4. Dependent group life insurance. Except for a policy issued under  27-4.8-1(2), a group life insurance policy may be extended to insure the employees or members against loss due to the death of their spouses and dependent children, or any class or classes thereof, subject to the following:  (1) The premium for the insurance shall be paid either from funds contributed by the employer, union, association or other person to whom the policy has been issued, or from funds contributed by the covered persons, or from both. Except as provided in subdivision (2), a policy on which no part of the premium for the spouses and dependent childs coverage is to be derived from funds contributed by the covered persons shall insure all eligible employees or members with respect to their spouses and dependent children, or any class or classes thereof.  (2) An insurer may exclude or limit the coverage on any spouse or dependent child as to whom evidence of individual insurability is not satisfactory to the insurer.  (3) [Deleted by P.L. 2013, ch. 31,  3, and P.L. 2013, ch. 36,  3].  History of Section.P.L. 2009, ch. 299,  1; P.L. 2009, ch. 300,  1; P.L. 2013, ch. 31,  3; P.L. 2013, ch. 36,  3. 
 27-4.8-5. Group life insurance standard provision. (a) No policy of group life insurance shall be delivered in this state unless it contains in substance the following provisions, or provisions which in the opinion of the commissioner are more favorable to the persons insured, or at least as favorable to the persons insured and more favorable to the policyholder, however:  (1) Subsections (f) to (k) inclusive shall not apply to policies insuring the lives of debtors;  (2) The standard provisions required for individual life insurance policies shall not apply to group life insurance policies; and  (3) If the group life insurance policy is on a plan of insurance other than the term plan, it shall contain a nonforfeiture provision or provisions which, in the opinion of the commissioner, is or are equitable to the insured persons and to the policyholder. Nothing herein shall be construed to require that group life insurance policies contain the same nonforfeiture provisions as are required for individual life insurance policies.  (b) The policy shall contain a provision that the policyholder is entitled to a grace period of thirty-one (31) days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder gives the insurer written notice of discontinuance in advance of the date of discontinuous and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during the grace period.  (c) The policy shall contain a provision that the validity of the policy shall not be contested except for nonpayment of premiums after it has been in force for two (2) years from its date of issue; and that no statement made by any person insured under the policy relating to his or her insurability shall be used in contesting the validity of the insurance with respect to which the statement was made after the insurance has been in force prior to the contest for a period of two (2) years during the persons lifetime nor unless it is contained in a written instrument signed by him or her. This provision shall not preclude the assertion at any time of defenses based upon provisions in the policy that relate to eligibility for coverage.  (d) The policy shall contain a provision that a copy of the application, if any, of the policy holder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties and that no statement made by any person insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to the person or, in the event of death or incapacity of the insured person, to his or her beneficiary or personal representative.  (e) The policy shall contain a provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of his coverage.  (f) The policy shall contain a provision specifying an equitable adjustment of premiums or benefits, or both, to be made in the event the age of a person insured has been misstated. The provision to contain a clear statement of the method of adjustment to be made.  (g) The policy shall contain a provision that any sum becoming due by reason of the death of the person insured shall be payable to the beneficiary designated by the person insured, except that, where the policy contains conditions pertaining to family status, the beneficiary may be the family member specified by the policy terms, subject to the provisions of the policy in the event there is no designated beneficiary, as to all or any part of the sum, living at the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of the sum not exceeding two thousand dollars ($2000) to any person appearing to the insurer to be equitably entitled to it by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured.  (h) The policy shall contain a provision that the insurer will issue to the policyholder for delivery to each person insured a certificate setting forth a statement as to the insurance protection to which he or she is entitled, to whom the insurance benefits are payable, a statement as to any dependents coverage included in the certificate, and the rights and conditions set forth in subsections (h), (i), (j) and (k) following.  (i) The policy shall contain a provision that, if the insurance, or any portion of it, on a person covered under the policy or on the dependent of a person covered, ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, the person shall be entitled to have issued to him or her by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits, provided application for the individual policy shall be made, and the first premium paid to the insurer, within thirty-one (31) days after termination and provided further that:  (1) The individual policy shall, at the option of the person, be on any one of the forms then customarily issued by the insurer at the age and for the amount applied for, except that the group policy may exclude the option to elect term insurance;  (2) The individual policy shall be in an amount not in excess of the amount of life insurance that ceases because of termination, less the amount of any life insurance for which the person becomes eligible under the same or any other group policy within thirty-one (31) days after termination, provided that any amount of insurance that shall have matured on or before the date of termination as an endowment payable to the person insured, whether in one sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount that is considered to cease because of termination; and  (3) The premium on the individual policy shall be at the insurers then customary rate applicable to the form and amount of the individual policy, to the class of risk to which the person then belongs, and to the individual age attained on the effective date of the individual policy. Subject to the same conditions set forth above, the conversion privilege shall be available:  (i) To a surviving dependent, if any, at the death of an employee or member, with respect to the coverage under the group policy that terminates by reason of the death; and  (ii) To the dependent of the employee or member upon termination of coverage of the dependent, while the employee or member remains insured under the group policy, by reason of the dependent ceasing to be a qualified family member under the group policy.  (j) The policy shall contain a provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured thereunder at the date of termination whose insurance terminates, including the insured dependent of a covered person, and who has been so insured for at least five (5) years prior to the termination date shall be entitled to have issued by the insurer an individual policy of life insurance, subject to the same conditions and limitations as are provided by subsection (h) above, except that the group policy may provide that the amount of the individual policy shall not exceed the smaller of:  (1) The amount of the persons life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which the person is or becomes eligible under a group policy issued or reinstated by the same or another insurer within thirty-one (31) days after termination; or  (2) Ten thousand dollars ($10,000).  (k) The policy shall contain a provision that, if a person insured under the group policy, or the insured dependent of a covered person, dies during the period within which the individual would have been entitled to have an individual policy issued in accordance with subsection (h) or (i) above and before the individual policy shall have become effective, the amount of life insurance which he or she would have been entitled to have issued under the individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium therefore has been made.  (l) Where active employment is a condition of insurance, the policy shall contain a provision that an insured may continue coverage during the insureds total disability by timely payment to the policyholder of that portion, if any, of the premium that would have been required from the insured had total disability not occurred. The continuation shall be on a premium paying basis for a period of six (6) months from the date on which the total disability started, but not beyond the earlier of:  (i) Approval by the insurer of continuation of the coverage under any disability provision which the group insurance policy may contain; or  (ii) The discontinuance of the group insurance policy.  (m) In the case of a policy insuring the lives of debtors, the policy shall contain a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a certificate of insurance describing the coverage and specifying that the death benefit shall first be applied to reduce or extinguish the indebtedness.  History of Section.P.L. 2009, ch. 299,  1; P.L. 2009, ch. 300,  1; P.L. 2011, ch. 157,  3; P.L. 2011, ch. 275,  3. 
 27-4.8-6. Supplementary bill relating to conversion privileges. If an individual insured under a group life-insurance policy hereafter delivered in this state becomes entitled under the terms of the policy to have an individual policy of life insurance issued without evidence of insurability, subject to making of application and payment of the first premium within the period specified in the policy, and if the individual is not given notice of the existence of the right at least fifteen (15) days prior to the expiration date of the period, then in that event, the individual shall have an additional period within which to exercise the right, but nothing herein contained shall be construed to continue any insurance beyond the period provided in the policy. This additional period shall expire fifteen (15) days next after the individual is given notice, but in no event shall the additional period extend beyond sixty (60) days after the expiration date of the period provided in the policy. The notice shall clearly set forth the required conversion process. The notice may include the conversion provisions of the policy and certificate, but the notice may not just make reference to these provisions. The notice does not require prior approval, but the insurer is responsible to assure that the notice is clear and provides all the necessary information. If the insurer allows the conversion notice to be delivered by the employer, the insurer shall ensure that no other employer notice is included with the conversion notice. Written notice presented to the individual or mailed by the policy holder to the last-known address of the individual or mailed by the insurer to the last-known address of the individual as furnished by the policyholder shall constitute notice for the purpose of this paragraph.  History of Section.P.L. 2009, ch. 299,  1; P.L. 2009, ch. 300,  1; P.L. 2016, ch. 376,  3; P.L. 2016, ch. 392,  3. 
 27-4.9-1. Short title. This chapter shall be known and may be cited as the Beneficiaries Bill of Rights Act of 2011.  History of Section.P.L. 2011, ch. 339,  1; P.L. 2011, ch. 370,  1. 
 27-4.9-2. Purpose. The purpose of this chapter is to require complete and proper disclosure, transparency, and accountability relating to any method of payment for life insurance death benefits and require that beneficiaries are fully informed in bold type and in laymans language of their options.  History of Section.P.L. 2011, ch. 339,  1; P.L. 2011, ch. 370,  1. 
 27-4.9-3. Definitions. As used in this section: (1) Policy means any policy or certificate of life insurance that provides a death benefit.  (2) Retained asset account means any mechanism whereby the settlement of proceeds payable under a life insurance policy, including, but not limited to, the payment of cash surrender value, is accomplished by the insurer or an entity acting on behalf of the insurer depositing the proceeds into an account, where those proceeds are retained by the insurer, pursuant to a supplementary contract not involving annuity benefits.  History of Section.P.L. 2011, ch. 339,  1; P.L. 2011, ch. 370,  1. 
 27-4.9-4. General requirements. (a) An insurer may not use a retained asset account as the mode of settlement unless the insurer discloses such option to the beneficiary or the beneficiarys legal representative prior to the transfer of the death benefit to a retained asset account.  (b) A beneficiary shall be informed of his or her rights to receive a lump-sum payment of life insurance proceeds in the form of a bank check or other form of immediate full payment of benefits.  History of Section.P.L. 2011, ch. 339,  1; P.L. 2011, ch. 370,  1. 
 27-4.9-5. Disclosure requirements. (a) A complete listing and clear explanation of all of the life insurance proceeds payment options available to the beneficiary in written or electronic format shall accompany the tender of other than a lump sum payment of a life insurance death benefit.  (b) The use of a retained asset account shall require in the description and explanation pursuant to subsection (a) herein the following:  (1) The recommendation to consult a tax, investment, or other financial advisor regarding tax liability and investment options;  (2) The initial interest rate, when and how interest rates may change, and any dividends and other gains that may be paid or distributed to the account holder;  (3) The custodian of the funds or assets of the account;  (4) The coverage guaranteed by the Federal Deposit Insurance Corporation (FDIC), if any, and the amount of such coverage;  (5) The limitations, if any, on the numbers and amounts of withdrawals of funds from the account, including any minimum or maximum benefit payment amounts;  (6) The delays, if any, that the account holder may encounter in completing authorized transactions and the anticipated duration of such delays;  (7) The services provided for a fee, including a list of the fees or the method of their calculation;  (8) The nature and frequency of statements of account;  (9) The payment of some or all of the proceeds of the death benefit may be by the delivery of checks, drafts, or other instruments to access the available funds;  (10) The entire proceeds are available to the account holder by the use of one such check, draft, or other instrument;  (11) The insurer or a related party may derive income, in addition to any fees charged on the account, from the total gains received on the investment of the balance of funds in the account;  (12) The telephone number, address, and other contact information, including website address, to obtain additional information regarding the account; and  (13) The following statement: For further information, please contact the department of business regulation.  (c) The writings produced to satisfy the requirements of this section shall be in easy-to-understand language and bold or at least twelve (12) point type.  History of Section.P.L. 2011, ch. 339,  1; P.L. 2011, ch. 370,  1. 
 27-4.9-6. Insurer reporting. (a) Insurers shall, on an annual basis, report the following information to the insurance commissioner within the department of business regulation:  (1) The number and dollar balance of retained asset accounts in force at the beginning of the year;  (2) The number and dollar amount of retained asset accounts issued/added during the year;  (3) The number and dollar amount of retained asset accounts closed out/withdrawn during the year;  (4) The number and dollar balance of retained asset accounts in force at the end of the year;  (5) The investment earnings or interest credited to retained asset accounts;  (6) Fees and other charges assessed during the year;  (7) A narrative description of how the accounts are structured. The description shall include:  (i) All of the different interest rates paid to retained asset account holders during the reporting year and the number of times changes were made during the reporting year;  (ii) A list of all applicable fees charged by the reporting entity directly or indirectly associated with the retained asset accounts; and  (iii) Whether the retained asset accounts were the default method for satisfying life insurance claims;  (8) The number and balance of retained asset accounts in force at the end of the current year and prior year segregated within aging categories of up to twelve (12) months, thirteen (13) to twenty-four (24) months, twenty-five (25) to thirty-six (36) months, thirty-seven (37) to forty-eight (48) months, forty-nine (49) to sixty (60) months, and over sixty (60) months;  (9) The identity of any entity or financial institution that administers retained asset accounts on the insurers behalf;  (10) The number and amounts of retained asset accounts that are transferred annually to the state unclaimed property funds under abandoned property laws; and  (11) Any other information relating to retained asset accounts as prescribed by the department of business regulation.  (b) An insurer shall immediately return any remaining balance held in a retained asset account to the beneficiary when the account becomes inactive. A retained asset account shall become inactive for purposes of this subsection if no funds are withdrawn from the account, and if no affirmative directive has been provided to the insurer by the beneficiary, during any continuous three (3) year period.  (c) All marketing materials, disclosure statements, and supplemental contract forms utilized in connection with retained asset accounts shall be filed with the state insurance department prior to their use. The commissioner shall disapprove any materials, statements, or forms submitted under this section that are inconsistent with  27-4.9-5 or are otherwise untrue, deceptive, or misleading.  History of Section.P.L. 2011, ch. 339,  1; P.L. 2011, ch. 370,  1. 
 27-4.9-7. Effective date. This chapter shall apply to claims for a death benefit under any policy or certificate of life insurance subject to the insurance laws of the state where the beneficiary resides submitted on or after September 1, 2011.  History of Section.P.L. 2011, ch. 339,  1; P.L. 2011, ch. 370,  1. 
 27-4-0.1. Definitions. (a) Annuities means all agreements to make periodic payments for a certain period or where the making or continuance of all or some of a series of the payments, or the amount of any payment, depends on the continuance of human life, except payments made in connection with a life insurance policy. Amounts paid the insured to provide annuities and proceeds applied under optional modes of settlement or under dividend options may be allocated by the insurer to one or more separate accounts pursuant to provisions of the annuity contract.  (b)(1) Funding agreements means agreements where an insurer may accept and accumulate funds and make one or more payments at future dates in amounts that are not based on mortality or morbidity contingencies. Funding agreements do not constitute annuities as defined in subsection (a) of this section or life insurance as defined in subsection (c) of this section;  (2) Any insurer authorized to issue annuity contracts in Rhode Island may issue one or more funding agreements, in fixed or variable dollar amounts or in both. The issuance of a funding agreement under this section is deemed to be doing insurance business. Funding agreements may be issued to fund:  (i) Benefits under any employee benefit plan as defined in the federal Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002;  (ii) The activities of any organization exempt from taxation under  501(c) of the Internal Revenue Code, 26 U.S.C.  501(c), or any similar organization in any foreign country;  (iii) Any program of the government of the United States, the government of any state or political subdivision of the state, or of a foreign country, or any agency or instrumentality of any foreign government, political subdivision or foreign country;  (iv) agreement providing for periodic payments in satisfaction of a claim; or  (v) Any program of any institution that has assets in excess of twenty-five million dollars ($25,000,000).  (3) A funding agreement shall be for a total amount of not less than one million dollars ($1,000,000). An amount under a funding agreement shall not be guaranteed or credited except upon reasonable assumptions as to investment income and expenses and on a basis equitable to all holders of funding agreement of a given class. Funding agreements shall not provide for payments to or by the insurer based on mortality or morbidity contingencies.  (4) Amounts paid to the insurer under funding agreements may be allocated by the insurer to its general account or to one or more separate accounts pursuant to  27-32-1.  (5) A funding agreement is a Class 3 claim under  27-14.3-46.  (6) Notwithstanding any provision in this title to the contrary, no funding agreement or portion of it, except to the extent the funding agreement may be considered an unallocated annuity contract, in accordance with the definition found in  27-34.3-5, and except to the extent the funding agreement or portion of it has been issued to or in connection with a specific employee, union or association of natural persons benefit plan, not protected under the federal Pension Benefit Guaranty Corporation, or a government lottery, and except to the extent the funding agreement or portion of it is not limited or excluded under  27-34.3-3(b)(2), shall qualify as a policy or contract as to which coverage is provided pursuant to chapter 34.3 of this title.  (7) The commissioner shall have the authority to regulate the sale and issuance of funding agreements and to promulgate regulations governing the sale and issuance of funding agreements.  (c) Life insurance means every insurance upon the lives of human beings and every insurance appertaining to that life, including the granting of endowment benefits, additional benefits in the event of death by accident, additional benefits to safeguard the contract from lapse, accelerated payments of part or all of the death benefit, or a special surrender value upon diagnosis of terminal illness, defined as a life expectancy of twelve (12) months or less, or of a medical condition requiring extraordinary medical care or treatment regardless of life expectancy, or a special surrender value upon total and permanent disability of the insured, and optional modes of settlement of proceeds. Amounts paid the insurer for life insurance and proceeds applied under optional modes of settlement or under dividend options may be allocated by the insurer to one or more separate accounts pursuant to provisions contained in the policy.  History of Section.P.L. 1993, ch. 180,  6; P.L. 2001, ch. 247,  1; P.L. 2001, ch. 367,  1. 
 27-4-1.1. Denial of applicant based on naloxone prescription. (a) No life insurance company organized or doing business within this state shall:  (1) Deny the application of an individual seeking coverage for any life insurance policy pursuant to this chapter solely on the basis that the applicant has a prescription to carry or possess the drug naloxone;  (2) Otherwise discriminate in the offering, issuance, cancellation, amount of coverage, price, or any other condition of a life insurance policy based solely and without any additional actuarial justification upon the fact that an individual has been issued a prescription for naloxone or has purchased naloxone.  (b) Any denial of insurance coverage in violation of the provisions of this section:  (i) Shall be void;  (ii) The insurer shall reopen the application and underwriting process for consideration of coverage and the life insurance company shall be deemed to have provided coverage to the eligible person retroactive to the date of the initial application.  History of Section.P.L. 2019, ch. 121,  1; P.L. 2019, ch. 149,  1. 
 27-4-1. Discrimination in rates or amounts payable on death. No life insurance company organized or doing business within this state shall make any distinction or discrimination as to the premiums or rates charged for policies upon the lives of persons insured, except any distinction or discrimination that shall apply to all persons of the same age, sex, general condition of health, and hope of longevity; nor shall any company make or permit the rejection of an individuals application for life insurance coverage, and the determination of the rate class for that individual, on the basis of a disability unless that disability is relevant to the risk of loss, nor shall any company make or require any rebate, diminution, or discount upon the sum to be paid on any policy in case of the death of the person insured; nor insert in the policy any condition, nor make any stipulation, where the person insured shall bind himself or herself, his or her heirs, executors, administrators, and assigns, to accept any less sum than the full value or amount of the policy in case of a claim accruing on it by reason of the death of the person insured, other than the conditions or stipulations that are imposed upon all persons in similar cases. Any stipulation or condition made or inserted in this manner shall be void.  History of Section.P.L. 1931, ch. 1757,  6; G.L. 1938, ch. 153,  6; G.L. 1956,  27-4-1; P.L. 1977, ch. 58,  1. 
 27-4-10. Effect of misstatements in application for policy. No misstatement made in procuring a policy of life insurance shall be deemed material or render the policy void unless this matter represented shall have actually contributed to the contingency or event on which the policy is to become due and payable. Whether this matter represented contributed to that contingency or event shall be a question for the jury.  History of Section.P.L. 1931, ch. 1757,  12; G.L. 1938, ch. 153,  12; G.L. 1956,  27-4-10. 
 27-4-11. Rights of beneficiaries to proceeds of policy as against creditors  Premiums paid in fraud of creditors. If a policy of insurance is effected by any person on that persons own life or on another life in favor of a person other than himself or herself, or, except in cases of transfer with intent to defraud creditors, if a policy of life insurance is assigned or in any way made payable to any person, the lawful beneficiary or assignee of the policy, other than the insured or the person effecting that insurance or the executors or administrators of that insured or the person effecting that insurance, shall be entitled to its proceeds and avails against the creditors and representatives of the insured and of the person effecting the insurance, whether or not the right to change the beneficiary is reserved or permitted, and whether or not the policy is made payable to the person whose life is insured if the beneficiary or assignee shall predecease that person; provided, that, subject to the statute of limitations, the amount of any premiums for that insurance paid with intent to defraud creditors, with interest on it, shall inure to their benefit from the proceeds of the policy. The company issuing the policy shall be discharged of all liability on the policy by payment of its proceeds in accordance with its terms, unless before that payment the company shall have written notice, by or in behalf of a creditor, of a claim to recover for a transfer made or premiums paid with intent to defraud creditors, with a specification of the amount claimed.  History of Section.P.L. 1931, ch. 1757,  13; G.L. 1938, ch. 153,  13; P.L. 1947, ch. 1883,  1; G.L. 1956,  27-4-11. 
 27-4-12. Provision for exemption from encumbrance, transfer, or claims of creditors. Any policy of life or endowment insurance or any annuity contract may provide that the proceeds of or payments under it shall not be subject to transfer, anticipation, or commutation or encumbrance by any beneficiary other than the insured or the purchaser of the annuity, and shall not be subject to the claims of a creditor of any beneficiary or any legal process against the beneficiary.  History of Section.P.L. 1931, ch. 1757,  14; G.L. 1938, ch. 153,  14; G.L. 1956,  27-4-12. 
 27-4-13.1. Policy loan interest rates. (a) Published monthly average means:  (1) Moodys corporate bond yield average  monthly average corporates, as published by Moodys Investors Service, Inc. or any successor; or  (2) In the event that the Moodys corporate bond yield average  monthly average corporates is no longer published, a substantially similar average, established by regulation issued by the commissioner.  (b)(1) Policies issued on or after May 25, 1982, shall provide for policy loan interest rates as follows:  (i) A provision permitting a maximum interest rate of not more than eight percent (8%) per annum; or  (ii) A provision permitting an adjustable maximum interest rate established from time to time by the life insurer as permitted by law.  (2) The rate of interest charged on a policy loan made under paragraph (1)(ii) of this subsection shall not exceed the higher of the following:  (i) The published monthly average for the calendar month ending two (2) months before the date on which the rate is determined; or  (ii) The rate used to compute the cash surrender values under the policy during the applicable period plus one percent (1%) per annum.  (3) If the maximum rate of interest is determined pursuant to paragraph (1)(ii) of this subsection, the policy shall contain a provision setting forth the frequency at which the rate is to be determined for that policy.  (4) The maximum rate for each policy must be determined at regular intervals at least once every twelve (12) months, but not more frequently than once in any three (3) month period. At the intervals specified in the policy:  (i) The rate being charged may be increased when an increase as determined under subdivision (2) of this subsection would increase that rate by one half of one percent (.5%) or more per annum;  (ii) The rate being charged must be reduced when a reduction as determined under subdivision (2) of this subsection would decrease that rate by one half of one percent (.5%) or more per annum.  (5) The life insurer shall:  (i) Notify the policyholder at the time a cash loan is made of the initial rate of interest on the loan;  (ii) Notify the policyholder with respect to premium loans of the initial rate of interest on the loan as soon as it is reasonably practical to do so after making the initial loan. Notice does not need to be given to the policyholder when a further premium loan is added, except as provided in paragraph (iii) of this subdivision;  (iii) Send to policyholders with loans reasonable advance notice of any increase in the rate; and  (iv) Include in the notices required in this subdivision the substance of the pertinent provisions of subdivisions (1) and (3) of this subsection.  (6) No policy shall terminate in a policy year as the sole result of a change in the interest rate during that policy year, and the life insurer shall maintain coverage during that policy year until the time at which it would have terminated if there had been no change during that policy year.  (7) The substance of the pertinent provisions of subdivisions (1) and (3) of this subsection shall be set forth in the policies to which they apply.  (8) For purposes of this section:  (i) The rate of interest on policy loans permitted under this section includes the interest rate charged on the reinstatement of policy loans for the period during and after any lapse of a policy;  (ii) Policy loan includes any premium loan made under a policy to pay one or more premiums that were not paid to the life insurer as they became due;  (iii) Policyholder includes the owner of the policy or the person designated to pay premiums as shown on the records of the life insurer; and  (iv) Policy includes certificates issued by a fraternal benefit society and annuity contracts that provide for policy loans.  (9) No other provision of law shall apply to policy loan interest rates unless made specifically applicable to those rates.  (c) The provisions of this section shall not apply to any insurance contract issued before May 25, 1982, unless the policyholder agrees in writing to the applicability of this section.  History of Section.P.L. 1982, ch. 410,  1; P.L. 2002, ch. 292,  12. 
 27-4-13. Deprivation of court jurisdiction  Limitation of actions. No life insurance company and no officer or insurance producer of the company shall make, issue, or deliver any policy or contract of insurance containing any condition, stipulation, or agreement depriving the courts of the state of jurisdiction of actions against it, nor limiting the time for commencing any action at law or in equity against it to a period of less than three (3) years from the time when the cause of action shall accrue.  History of Section.P.L. 1931, ch. 1757,  15; G.L. 1938, ch. 153,  15; G.L. 1956,  27-4-13. 
 27-4-14, 27-4-15. Repealed.
 27-4-16. Preliminary term policies. Policies issued by companies doing business in this state may provide for not more than one year preliminary term insurance; provided, that if the premium charged for term insurance under a limited payment life preliminary term policy providing for the payment of all premiums on the policy in less than twenty (20) years from the date of the policy, or under an endowment preliminary term policy, exceeds that charged for life insurance under whole life preliminary term policies of the same company, then the reserve on the policy at the end of any year, including the first, shall not be less than the reserve on a whole life preliminary term policy issued in the same year and at the same age, together with an amount which shall be equivalent to the accumulation of a net level premium sufficient to provide for a pure endowment at the end of the premium payment period equal to the difference between the value at the end of that period of a whole life preliminary term policy and the full level net premium reserve at that time of a limited payment life or endowment policy.  History of Section.P.L. 1931, ch. 1757,  4; G.L. 1938, ch. 153,  4; G.L. 1956,  27-4-16. 
 27-4-17. Repealed. History of Section.P.L. 1931, ch. 1757,  1; G.L. 1938, ch. 153,  1; P.L. 1947, ch. 1973,  1; G.L. 1956,  27-4-17; P.L. 1959, ch. 36,  1; P.L. 1963, ch. 36,  1; P.L. 1975, ch. 25,  1; P.L. 1979, ch. 54,  1; P.L. 1981, ch. 209,  1; P.L. 1994, ch. 134,  10; P.L. 2002, ch. 292,  12; Repealed by P.L. 2013, ch. 17,  5, effective May 20, 2013; P.L. 2013, ch. 20,  5, effective May 20, 2013. 
 27-4-18. Repealed. History of Section.P.L. 1931, ch. 1757,  1; G.L. 1938, ch. 153,  1; P.L. 1947, ch. 1973,  1; G.L. 1956,  27-4-18; P.L. 2002, ch. 292,  12; Repealed by P.L. 2013, ch. 17,  5, effective May 20, 2013; P.L. 2013, ch. 20,  5, effective May 20, 2013. 
 27-4-19. Repealed. History of Section.P.L. 1931, ch. 1757,  5; G.L. 1938, ch. 153,  5; impl. am. P.L. 1939, ch. 660,  120; G.L. 1956,  27-4-19; Repealed by P.L. 2013, ch. 17,  5, effective May 20, 2013; P.L. 2013, ch. 20,  5, effective May 20, 2013. 
 27-4-2. Preexisting contracts unaffected by discrimination provisions. Sections 27-4-1 and 27-4-4 shall not affect any contracts existing on April 24, 1931. History of Section.P.L. 1931, ch. 1757,  8; G.L. 1938, ch. 153,  8; G.L. 1956,  27-4-2. 
 27-4-20. Repealed. History of Section.P.L. 1931, ch. 1757,  2; G.L. 1938, ch. 153,  2; impl. am. P.L. 1939, ch. 660,  120; G.L. 1956,  27-4-20; Repealed by P.L. 2013, ch. 17,  5, effective May 20, 2013; P.L. 2013, ch. 20,  5, effective May 20, 2013. 
 27-4-21. Repealed. History of Section.P.L. 1931, ch. 1757,  3; G.L. 1938, ch. 153,  3; impl. am. P.L. 1939, ch. 660,  120; G.L. 1956,  27-4-21; Repealed by P.L. 2013, ch. 17,  5, effective May 20, 2013; P.L. 2013, ch. 20,  5, effective May 20, 2013. 
 27-4-22.1. Continuation of group life insurance  Labor disputes  Involuntary layoffs. (a) No group life insurance policy shall be issued or delivered in this state where the premium or any part of the premium is paid or is to be paid in whole or in part by an employer pursuant to the terms of a collective bargaining agreement unless the policy provides that in the event of a cessation of work by the employees covered by the policy as the result of a labor dispute or involuntary layoff, the policy, upon timely payment of the premium, shall continue in effect with respect to all employees insured by the policy on the date of the cessation of work who continue to pay their individual contribution and who assume and pay the contribution from the employer, for the period of cessation of work, under the following conditions:  (1) If the policyholder is not a trustee or the trustees of a fund established or maintained in whole or in part by the employer, the policy shall provide that the employees individual contribution shall be the rate in the policy, on the date cessation of work occurs, applicable to an individual in the class to which the employee belongs as set forth in the policy;  (2) If the policyholder is a trustee or the trustees of a fund established or maintained in whole or in part by the employer, the employees contribution shall be the amount which he or she and the employer would have been required to contribute to the trust for the employee if (i) the cessation of work had not occurred and (ii) the agreement requiring the employer to make contributions to the trust were in full force;  (3) The policy may provide that the continuation of insurance is contingent upon the collection of individual contributions by the union or unions representing the employees for policies referred to in subdivision (a)(1), and by the policyholder or the policyholders agent with respect to policies referred to in subdivision (a)(2);  (4) The policy may provide that the continuation of insurance on each employee is contingent upon timely payment of contributions by the individual and timely payment of the premium by the entity responsible for collecting the individual contributions;  (5) The policy may provide that each individual premium rate shall be increased by an amount up to six percent (6%) of the premium rate of that shown in the policy during the cessation of work in order to cover increased administrative costs and increased mortality and morbidity. If the policy does provide for an increase, this shall have the effect of increasing the employees contribution by a similar percent;  (6) Nothing in this section shall be deemed to limit any right which the insurer may have in accordance with the terms of the policy to increase or decrease the premium rates before, during, or after a cessation of work if, in fact, the insurer would have had the right to increase the premium rate had the cessation of work not occurred. If this premium rate change is made, it shall be effective, notwithstanding any other provisions of this section, on a date the insurer shall determine in accordance with the terms of the policy;  (7) The policy may provide that, if a premium is unpaid at the date of cessation of work and the premium became due prior to the cessation of work, the continuation of insurance is contingent upon payment of the premium prior to the date the next premium becomes due under the terms of the policy; and  (8) Nothing contained in this section shall be deemed to require continuation of any group life insurance policy unless or until the greater of (i) one hundred (100) employees and (ii) at least fifty-one percent (51%) of the employees in the group eligible to continue the coverage under this section satisfy all of the requirements to do so.  (b) No individual employee shall be eligible to continue coverage under this section after he or she becomes employed full time with the same or any other employer.  History of Section.P.L. 1992, ch. 167,  1. 
 27-4-22. Assignment of interest under group life insurance. Subject to the terms of the policy relating to assignment of incidents of ownership under the policy, a person whose life is insured under a policy of group life insurance may assign any or all incidents of ownership granted that person under the policy, including but not limited to any right to designate a beneficiary, to have an individual policy issued to him or her, and to pay premiums. Any assignment by the insured shall be valid for the purpose of vesting in the assignee, in accordance with any provisions included in the policy as to the time at which it is to be effective, all of the incident of ownership assigned, but without prejudice to the insurer on account of any payment it may make or individual policy it may issue without notice of the assignment.  History of Section.P.L. 1970, ch. 210,  1; P.L. 2002, ch. 292,  12. 
 27-4-23. Rules and regulations. The insurance commissioner shall make reasonable rules and regulations necessary to effect the purposes of this chapter.  History of Section.P.L. 1971, ch. 269. 
 27-4-24.1. Waiting period  Effective date of filings. (a) Each filing shall be on file for a waiting period of thirty (30) days before it becomes effective, which period may be extended by the commissioner for an additional period not to exceed thirty (30) days if the commissioner gives written notice within the waiting period to the insurer or organization which made the filing that he or she needs additional time for the consideration of the filing. Upon written application by the insurer or organization, the commissioner may authorize a filing that he or she has reviewed to become effective before the expiration of the waiting period or any extension. A filing shall be deemed to meet the requirements of this chapter and to become effective unless disapproved by the commissioner, as provided in this chapter, within the waiting period or any extension.  (b) Section (a) above does not apply to filings made through the Interstate Insurance Product Commission pursuant to chapter 2.5 of this title.  History of Section.P.L. 1973, ch. 264,  1; P.L. 2005, ch. 173,  2. 
 27-4-24.2. Notice of disapproval. If within the waiting period or any extension of it as provided in  27-4-24.1 the commissioner finds that a filing does not meet the requirements of this chapter, the commissioner shall send to the insurer or organization which made that filing written notice of disapproval of that filing specifying in the notice in what respects he or she finds that filing fails to meet the requirements of this chapter and stating that that filing shall not become effective.  History of Section.P.L. 1973, ch. 264,  1. 
 27-4-24.3. Suspension or revocation of licenses. (a) The commissioner may revoke or suspend the license of any organization or insurer which fails to comply with an order of the commissioner within the time limited by the order, or any extension of it which the commissioner may grant. The commissioner shall not revoke or suspend the license of any organization or insurer for failure to comply with an order until the time prescribed for an appeal has expired or, if an appeal has been taken, until the order has been affirmed.  (b) The commissioner may determine when a suspension of license shall become effective, and it shall remain in effect for the period fixed by the commissioner, unless he or she modifies or rescinds the suspension, or until the order upon which the suspension is based is modified, rescinded, or reversed.  (c) No license shall be suspended or revoked except upon a written order of the commissioner, stating the commissioners findings, made after a hearing held in accordance with  42-35-9 upon not less than ten (10) days written notice to the insurer or organization.  History of Section.P.L. 1973, ch. 264,  1; P.L. 2007, ch. 134,  1; P.L. 2007, ch. 210,  1. 
 27-4-24.4. Hearing on decisions of commissioner. Any organization or insurer aggrieved by any order or decision of the commissioner, or by any rule or regulation promulgated and adopted by the commissioner, may, within thirty (30) days after notice of the order or decision to the organization or insurer, make written request to the commissioner for a hearing on the order or decision. The commissioner shall provide a hearing and issue a decision in accordance with the Administrative Procedures Act, chapter 42-35.  History of Section.P.L. 1973, ch. 264,  1; P.L. 2007, ch. 134,  1; P.L. 2007, ch. 210,  1; P.L. 2008, ch. 475,  4. 
 27-4-24.5. Judicial review of orders and decisions. Any final order or decision of the commissioner, including any order made after a hearing under the provisions of  27-4-24.3 or 27-4-24.4, shall be subject to review in accordance with the Administrative Procedures Act, chapter 42-35.  History of Section.P.L. 1973, ch. 264,  1; P.L. 2007, ch. 134,  1; P.L. 2007, ch. 210,  1; P.L. 2008, ch. 475,  4. 
 27-4-24.6. Severability. If any subsection, subdivision, paragraph, sentence, or clause of this chapter is held invalid or unconstitutional, that decision shall not affect the remaining portions of the section or sections.  History of Section.P.L. 1973, ch. 264,  1; P.L. 2007, ch. 134,  1; P.L. 2007, ch. 210,  1. 
 27-4-24. Filing of life insurance policy forms. (a) Any insurance company authorized to do a life insurance and/or annuities business within this state in accordance with the provisions of this title shall file all life insurance policy forms and annuity contract forms used by it in the state with the insurance commissioner. The commissioner may also require any company to file the forms of any rider, endorsement, application blank, and other matter generally used or incorporated by reference in its policies or contracts of insurance or annuities. Any organization, bureau, or association of which the company is a member may, on behalf of the company, make the filings required by this section. If the commissioner finds from an examination of any form filed that it is contrary to the public interest, he or she shall forbid the use of the form, and shall notify the company in writing as provided in  27-4-24.2.  (b) Alternatively, a carrier may obtain authorization to use a life insurance policy form or annuity contract by obtaining authorization through the Interstate Insurance Product Compact Commission provided in chapter 2.5 of this title, provided that:  (1) The state of Rhode Island has not opted out of the compact with regard to the line in question; and  (2) The appropriate filing fee, as set forth in  42-14-18 and the regulations thereunder, has been paid.  History of Section.P.L. 1973, ch. 264,  1; P.L. 1994, ch. 404,  7; P.L. 2005, ch. 173,  2. 
 27-4-25. Physical exam by insurance company. Any applicant for life insurance with any company organized or doing business within this state shall be provided, upon request, any and all medical reports by a physician or other medical personnel that were performed at the request or the direction of that company. These reports shall only be provided to a physician of the applicants 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.  History of Section.P.L. 1981, ch. 412,  1. 
 27-4-26. Interest upon proceeds of life insurance policies. An insurer of a life insurance contract or annuity contract shall pay to the beneficiary or policyholder, respectively, interest on the proceeds at the rate of nine percent (9%) per annum from the date of the death of an insured or annuitant in connection with a death claim on a life insurance policy or annuity contract and from the date of maturity of an endowment contract to the date of payment and the interest shall be added to and be a part of the total sum paid.  History of Section.P.L. 1984, ch. 343,  1; P.L. 1987, ch. 78,  15. 
 27-4-27. Insurable interest. (a) Any individual of competent legal capacity may procure or effect an insurance contract upon his or her life or body for the benefit of any person. Any life insurance company doing business within the state may issue policies of insurance predicated upon the life or lives of any person or persons with the consent of the insured, payable at maturity to any educational, religious, benevolent, or charitable corporation or association which can legally take and receive testamentary legacies and which are exempt from taxation under 26 U.S.C.  501(c), irrespective of a financial interest on the part of the corporation in the life of the person or persons insured. No person shall procure or cause to be procured any insurance contract upon the life or body of another individual unless the benefits under the contract are payable to the individual insured or his or her personal representatives, or to a person having, at the time when the contract was made, an insurable interest in the individual insured.  (b) If the beneficiary, assignee, or other payee under any contract made in violation of this section receives from the insurer any benefits under that contract accruing upon the death, disablement, or injury of the individual insured, the individual insured or his or her executor or administrator may maintain an action to recover the benefits from the person so receiving them.  (c) Insurable interest as to personal insurance means that every individual has an insurable interest in the life, body, and health of himself or herself and of other persons as follows:  (1) In the case of individuals related closely by blood or by law, a substantial interest engendered by love and affection;  (2) In the case of other persons, a lawful and substantial economic interest in having the life, health, or bodily safety of the individual insured continue, as distinguished from an interest which would arise only by, or would be enhanced in value by the death, disablement, or injury of the individual insured;  (3) In the case of employees of public and private corporations, with respect to whom the corporate employer or an employer-sponsored trust is the beneficiary under the insurance contract, a lawful and substantial economic interest exists in:  (i) Key employees; and  (ii) Employees other than those identified in subdivision (c)(3)(i), and former employees and retirees for the purpose of funding, in the aggregate, all or part of the corporations cost for pre-retirement and post-retirement benefits; provided, (A) that the amount of insurance coverage on these employees will be limited to an amount commensurate with employer-provided benefits to those employees, (B) that an insurance program used to finance these employee benefits includes former employees, retirees, or a broad class of employees selected by objective standards related to age, service, sex, or category of employment, and (C) that the proceeds created by that insurance program used for the sole purpose of funding the corporations pre-retirement or post-retirement benefit programs; and  (4) An individual party to a contract or option for the purchase or sale of an interest in business, partnership, or firm or of shares of stock of a corporation or of an interest in the shares, has an insurable interest in the life of each individual party to the contract and for the purposes of the contract only, in addition to any insurable interest which may exist as to the life of that individual.  (d) Insurance effectuated under a group life insurance policy pursuant to the program described in subdivision (c)(3)(ii) need not comply with the provisions of  27-4-22 to the extent the provisions of that section would be inconsistent or would conflict with the purposes expressed in subdivision (c)(3)(ii).  (e) An insurer shall be entitled to rely upon all statements, declarations, and representations made by an applicant for insurance relative to insurable interest of the applicant in the insured, and no insurer shall incur legal liability except as set forth in the policy by virtue of any untrue statements, declarations, or representations relied upon in good faith by the insurer.  History of Section.P.L. 1990, ch. 263,  1; P.L. 1992, ch. 373,  1. 
 27-4-28. Discretionary clauses. (a) No new or existing policy or certificate may contain any provision:  (1) Purporting to reserve sole discretion to the insurance company to determine eligibility for benefits or interpret the terms of a policy or certificate; or  (2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.  (b) Any such clause or language included in a contract, policy or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.  (c) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.  History of Section.P.L. 2013, ch. 85,  1; P.L. 2013, ch. 94,  1. 
 27-4-29. Life insurance database. (a) The department of business regulation shall maintain a central database of electronic contact information for each life insurer having policies in force in this state.  (b) On and after January 1, 2013, any member of the immediate family of a decedent searching for life insurance policies covering the decedent may file a request with the department for a search pursuant to this section, provided the decedent was a resident or former resident of this state. Any such request shall include a copy of the subject decedents death certificate. The right to file a request for a search pursuant to this section may not be assigned.  (c) The department shall transmit any such request to all life insurers having policies in force in this state, along with information necessary for responding directly to the person filing the request. Each such insurer shall examine its books and records to make a determination as to the existence of coverage of the subject decedent, and upon a finding that such coverage does exist, shall directly notify the person filing the request.  (d) The department may adopt such rules and regulations as may be necessary to implement the provisions of this section.  (e) Insurers of credit life insurance are exempt from inclusion in the central database and shall not be subject to the requirements of  27-4-28.  History of Section.P.L. 2012, ch. 296,  1; P.L. 2012, ch. 326,  1. 
 27-4-3. Distinctions by insurance producers as to collections. It shall not be lawful for any insurance producer of any life insurance company to make any distinction as to the time and manner of collecting dues upon policies.  History of Section.P.L. 1931, ch. 1757,  9; G.L. 1938, ch. 153,  9; G.L. 1956,  27-4-3. 
 27-4-30. Unintentional policy lapse. (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 applicants 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 insurers 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.  History of Section.P.L. 2016, ch. 376,  2; P.L. 2016, ch. 392,  2. 
 27-4-4. Penalty for unlawful discrimination. Any life insurance company, and any officer or agent of any life insurance company, violating any of the provisions of  27-4-1 and 27-4-3 shall be subject to penalties determined in accordance with  42-14-16.  History of Section.P.L. 1931, ch. 1757,  7; G.L. 1938, ch. 153,  7; G.L. 1956,  27-4-4; P.L. 2007, ch. 134,  1; P.L. 2007, ch. 210,  1; P.L. 2008, ch. 475,  4. 
 27-4-5. Misrepresentation as to policies  Penalty  Revocation of license. No life insurance corporation doing business in this state, and no officer, director, or agent of that corporation, shall issue or circulate, or cause or permit to be issued or circulated, any estimate, illustration, circular, or statement of any sort misrepresenting the terms of any policy issued by it, or the benefits or advantages promised by it; nor shall any corporation or agent of the corporation orally or in writing make any misrepresentation or incomplete comparisons regarding the cost or terms or conditions or benefits contained in any policy or contract of insurance to any person insured in any other corporation, for the purpose of inducing or tending to induce that person to lapse, forfeit, or surrender his or her insurance in any other corporation. The director of business regulation is empowered to revoke the license of the corporation or insurance producer violating these provisions or access whatever penalty is appropriate in accordance with  42-14-16 in accordance with the Administrative Procedures Act, chapter 35 of title 42; the license is not to be reinstated until at least three (3) years have elapsed since the date of revocation, but the license may be renewed after a shorter period after revocation, at the discretion of the director of business regulation.  History of Section.P.L. 1931, ch. 1757,  10; P.L. 1936, ch. 2423,  1; G.L. 1938, ch. 153,  10; impl. am. P.L. 1939, ch. 660,  120; G.L. 1956,  27-4-5; P.L. 1979, ch. 140,  1; P.L. 2007, ch. 134,  1; P.L. 2007, ch. 210,  1. 
 27-4-6.1. Right to examine and return policy. Every individual life insurance policy delivered or issued for delivery in this state after July 1, 1978, and every individual annuity contract delivered in this state after January 1, 1995, shall contain a provision, or in a separate rider attached when delivered, stating in substance that the person to whom the policy or contract is issued shall be permitted to return the policy or contract within a minimum of ten (10) days of its delivery to that person and to have a refund of the premium paid, if after examination of the policy or contract the purchaser is not satisfied with it for any reason. Every individual life insurance policy and every individual annuity contract delivered in this state after January 1, 2008, shall contain a provision, or in a separate rider attached when delivered, stating in substance that the person to whom the policy or contract is issued shall be permitted to return the policy or contract within a minimum of twenty (20) days of its delivery to that person and to have a refund of the premium paid, if after examination of the policy or contract the purchaser is not satisfied with it for any reason. The provision shall be set forth in the policy or contract under an appropriate caption and, if not printed on the face page of the policy or contract, adequate notice of the provision shall be printed or stamped conspicuously on the face page. The policy or contract may be returned to the insurer at its home or branch office or to the insurance producer through whom it was applied for, and then shall be void as from the beginning and as if the policy or contract had not been issued.  History of Section.P.L. 1977, ch. 206,  1; P.L. 1994, ch. 404,  7; P.L. 2007, ch. 134,  1; P.L. 2007, ch. 210,  1; P.L. 2008, ch. 240,  2; P.L. 2008, ch. 310,  2. 
 27-4-6.2. Individual life insurance policy standard provisions. (a) All individual life insurance policies, except as otherwise stated herein, delivered or issued for delivery in this state on or after January 1, 2008 shall contain in substance the following provisions, or provisions which the director deems to be more favorable to policyholders.  (1) Grace period. A provision that, after payment of the first premium, the policyholder is entitled to a grace period of thirty-one (31) days or of one month following any subsequent premium due date within which to make payment of the premium then due, during which grace period the policy shall continue in full force, and the policy shall further provide that if the death of the insured occurs within the grace period provided in the policy, the insurer may deduct from the policy proceeds the portion of any unpaid premium applicable to the period ending with the last day of the policy month in which such death occurred, and if the death of the insured occurs during a period for which the premium has been paid, the insurer shall add to the policy proceeds a refund of any premium actually paid for any period beyond the end of the policy month in which such death occurred, provided such premium was not waived under any policy provision for waiver of premiums benefit. This subsection shall not apply to single premium or paid-up policies.  (2) Incontestability. A provision that the policy shall be incontestable after being in force during the lifetime of the insured for a period of two (2) years from its date of issue, and that, if the policy provides that the death benefit provided by the policy may be increased, or other policy provisions changed, upon the application of the policyholder and the production of evidence of insurability, the policy with respect to each such increase or change shall be incontestable after two (2) years from the effective date of such increase or change, except in each case for nonpayment of premiums. At the option of the insurer, provisions relating to benefits for total and permanent disability and additional benefits for accidental death may be excepted.  (b) Individual life insurance policies delivered or issued for delivery in this state on or after January 1, 2008 may contain in substance the following provision, or a provision which the director deems to be more favorable to policyholders: Suicide  a provision that excludes death from suicide, sane or insane. The suicide exclusion period for the initial coverage shall not exceed two (2) years from the date of issue of the policy. The policy may allow a separate suicide period, no greater than two (2) years from the date of any increase, for any increase in specified amount that was requested by the owner and subject to evidence of insurability. The suicide limitation shall be limited to the amount of the increase. At a minimum, a refund of all premiums paid, less dividends paid, any indebtedness and any partial withdrawals, shall be paid by the company in the event of death by suicide during the initial suicide exclusion period. For each increase in specified amount, the settlement for suicide shall be the return of all premium paid, reduced as specified above for the initial coverage, applicable to the increased amount.  History of Section.P.L. 2007, ch. 134,  3; P.L. 2007, ch. 210,  3; P.L. 2008, ch. 240,  2; P.L. 2008, ch. 310,  2. 
 27-4-6. [Repealed.] History of Section.P.L. 1931, ch. 1757,  11; G.L. 1938, ch. 153,  11; G.L. 1956,  27-4-6; P.L. 2002, ch. 292,  12; repealed by P.L. 2022, ch. 404,  9, effective June 30, 2022; repealed by P.L. 2022, ch. 405,  9, effective June 30, 2022. 
 27-4-7. Privilege against self-incrimination. 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 him or her of a crime or subject him or her 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 him or her upon any criminal investigation or proceeding.  History of Section.P.L. 1931, ch. 1757,  11; G.L. 1938, ch. 153,  11; G.L. 1956,  27-4-7. 
 27-4-8. Repealed.
 27-4-9. Preexisting contracts unaffected by policy terms provisions. The provisions of  27-4-6  27-4-8 shall not affect any contract existing on April 24, 1931. History of Section.P.L. 1931, ch. 1757,  11; G.L. 1938, ch. 153,  11; G.L. 1956,  27-4-9. 
 27-40-1  27-40-9. Repealed.
 27-41-1. Short title. This chapter may be cited as the Health Maintenance Organization Act. History of Section.P.L. 1983, ch. 225,  2; P.L. 2002, ch. 292,  85. 
 27-41-10. Information to enrollees. Every health maintenance organization shall promptly provide to its enrollees notice of any material change in the operation of the organization that will affect them directly. New enrollees shall receive at least the following information:  (1) The most recent annual statement of financial condition including a balance sheet and summary of receipts and disbursements;  (2) A description of the organizational structure and operation of the health maintenance organization;  (3) A description of services and information as to where and how to secure them; and  (4) A clear and understandable description of the health maintenance organizations method for resolving enrollee complaints.  History of Section.P.L. 1983, ch. 225,  2. 
 27-41-11. Complaint system. (a) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the director after consultation with the director of health to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services.  (b) The health maintenance organization shall maintain records of written complaints filed with it.  (c) The director of business regulation and/or the director of health may examine any complaint system.  History of Section.P.L. 1983, ch. 225,  2. 
 27-41-12. Investments. 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 Moodys Investors Service, Inc. In the event that the Moodys bond ratings are no longer published by Moodys Investors Service, Inc., or in the event that the director determines that the Moodys bond ratings as published by Moodys 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 Moodys Investors Service, Inc.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1985, ch. 406,  1; P.L. 1988, ch. 609,  1; P.L. 1996, ch. 352,  1. 
 27-41-13.1. Initial net worth and capital requirements. (a) Before the director issues a certificate of authority in accordance with  27-41-4 of this act, an applicant seeking to establish or operate a health maintenance organization shall have the greater of:  (1) The amount of capital required for a health organization under chapter 4.7 of this title;  (2) An initial net worth of three million dollars ($3,000,000); or  (3) At the commissioners discretion, an amount greater than required under subparagraph (1) or (2), as indicated by a business plan and a projected risk-based capital calculation after the first full year of operation based on the most current National Association of Insurance Commissioners Health Annual Statements Bank.  History of Section.P.L. 2005, ch. 176,  2. 
 27-41-13.2. Ongoing net worth and capital requirements. (a) A health maintenance organization shall maintain minimum net worth equal to the greater of two million five hundred thousand dollars ($2,500,000) or the amount necessary to maintain capital required pursuant to chapter 4.7 of this title.  (b) The amount in subsection (a) may be adjusted annually for inflation at the directors discretion.  History of Section.P.L. 2005, ch. 176,  2. 
 27-41-13.3. Waiver, surplus notes, and risk based capital requirements. (a) The director may waive any of the net worth and/or total adjusted capital requirements as set forth in  27-41-13.1 or 27-41-13.2 whenever satisfied that the health maintenance organization has sufficient net worth and/or total adjusted capital and an adequate history of generating net income to assure 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, are not considered a liability and are 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.  History of Section.P.L. 2005, ch. 176,  2. 
 27-41-13. Protection against insolvency. (a) Unless otherwise provided, each health maintenance organization shall deposit with the general treasurer of the state of Rhode Island securities having a market value at all times of at least the amount set forth in this section, which are to be held for the benefit and protection of all the enrollees of the health maintenance organization.  (b)(1) The amount for an organization that is applying for initial licensure shall be the greater of:  (i) Five percent (5%) of its estimated expenditures for health care services for its first year of operation;  (ii) Twice its estimated average monthly uncovered expenditures for its first year of operation; or  (iii) One hundred thousand dollars ($100,000);  (2) At the beginning of each succeeding year, unless not applicable, that organization shall deposit with the general treasurer securities in an amount equal to four percent (4%) of its estimated annual uncovered expenditures for that year.  (c)(1) An organization that is licensed as a health maintenance organization on May 17, 1983, shall make a deposit equal to the larger of:  (i) One percent (1%) of the preceding twelve (12) months of uncovered expenditures; or  (ii) One hundred thousand dollars ($100,000), within six (6) months of May 17, 1983;  (2) On the first day of the organizations first fiscal year beginning six (6) months or more after May 17, 1983, the organization shall make an additional deposit equal to two percent (2%) of its estimated annual uncovered expenditures. In the second fiscal year, if applicable, the additional deposit shall be equal to three percent (3%) of its estimated annual uncovered expenditures for that year, and in the third fiscal year and subsequent years, if applicable, the additional deposit shall be equal to four percent (4%) of its estimated annual uncovered expenditures for each year. Each years estimate, after the first year of operation, shall reasonably reflect the prior years operating experience and delivery arrangements.  (d) The director may waive any of the deposit requirements as set forth in subsections (b) and (c) of this section whenever satisfied that the organization has sufficient net worth and an adequate history of generating net income to assure 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 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.  (e)(1) When an organization has achieved a net worth not including land, buildings, and equipment of at least one million dollars ($1,000,000), or has achieved a net worth including plan related land, buildings, and equipment of at least five million dollars ($5,000,000), the annual deposit requirement shall not apply;  (2) The annual deposit requirement shall not apply to an organization if the total amount of the deposit of securities is equal to twelve percent (12%) of the HMOs estimated annual uncovered expenditures for the next calendar year, or the capital and surplus requirements for the formation and admittance of an accident and health insurer in this state, whichever is less;  (3) If the organization has a guaranteeing organization which has been in operation for at least five (5) years and has a net worth not including land, buildings, and equipment of at least one million dollars ($1,000,000), or which has been in operation for at least ten (10) years and has a net worth including plan related land, buildings, and equipment of at least five million dollars ($5,000,000), the annual deposit requirement shall not apply; provided, that if the guaranteeing organization is sponsoring more than the one organization, the net worth requirement shall be increased by a multiple equal to the number of organizations. This requirement to maintain a deposit in excess of the deposit required of an accident and health insurer shall not apply during any time that the guaranteeing organization maintains a net worth at least equal to the capital and surplus requirements for an accident and health insurer.  (f) All income from the deposit with the general treasurer shall belong to the depositing organization and shall be paid to it as it becomes available. A health maintenance organization that has made a securities deposit with the general treasurer may, at its option, withdraw the securities deposit or any part of the deposit, first having deposited, in lieu of it, a deposit of securities of equal amount and value to that withdrawn.  (g) In any year in which an annual deposit is not required of an organization, at its request, the director shall lower its required deposit by one hundred thousand dollars ($100,000) for each two hundred fifty thousand dollars ($250,000) of net worth not including land, buildings, and equipment, if it, or a guaranteeing organization on its behalf and not for another organization, has in excess of one million dollars ($1,000,000) or in excess of five million dollars ($5,000,000) of net worth, including only health maintenance organization related land, buildings, and equipment contributing to the delivery of health care services; provided, that the reductions never bring the required deposit below one hundred thousand dollars ($100,000). If the net worth of an organization or guaranteeing organization no longer supports a reduction of its required deposit, the organization shall immediately redeposit one hundred thousand dollars ($100,000) for each two hundred fifty thousand dollars ($250,000) of reduction, provided that its total deposit does not exceed the maximum required under this section.  (h) Each health maintenance organization shall maintain written contracts or other arrangements satisfactory to the director with providers of services, insurers, hospital or medical service corporations, governments, or other organizations to satisfy the director that in the event of insolvency enrollees will not be liable for charges for covered health services received before the time of insolvency and those contracts and other arrangements shall assure that:  (1) Benefits, including professional services, for all enrollees who are confined at the time of insolvency in hospitals, skilled nursing facilities, intermediate care facilities, or home health agencies receiving services covered by the health maintenance organization shall continue to be paid without interruption until the earlier of discharge or ninety (90) days, or in the alternative, for federally qualified health maintenance organizations which are licensed pursuant to this chapter, confinement coverage shall be provided which meets federal standards for federally qualified health maintenance organization plans;  (2) All enrollees will be covered without interruption by the lesser of their current coverage or a fully qualified program as defined in  42-62-10, or its equivalent as approved by the director, for a period of thirty (30) days following the insolvency, unless enrollees are afforded an opportunity to enroll in another insurance plan as defined in subdivision (3) of this subsection without waiting periods or exclusions or limitations based on health status; and  (3) Enrollees and enrolled groups will be afforded the opportunity within thirty (30) days to purchase other health insurance equivalent to the lesser of their current coverage or a fully qualified program as defined in  42-62-10 on a group basis if they are enrolled in the health maintenance organization on a group basis and on a direct pay basis otherwise, with full credit for all prepaid premiums without waiting periods or exclusions or limitations based on health status. In the event that a contract providing for coverage commensurate with the lesser of current coverage or a fully qualified program as defined in  42-62-10 is not reasonably available, the health maintenance organization shall maintain the best insolvency conversion insurance reasonably available in the market place. The director, upon application of the health maintenance organization, must be satisfied before approving any alternate coverage that that alternate coverage reasonably protects enrollees and is in the public interest. The term insurance as used in this section means an insurance policy or a contract of insurance with an entity acceptable to the director other than the health maintenance organization, which other entity is available to cover the enrollees of the health maintenance organization in the event of its insolvency. If insolvency conversion protection commensurate with the lesser of current coverage or a fully qualified program as defined in  42-62-10 becomes available, the lesser shall be obtained by the health maintenance organization within a reasonable time.  (i) All insurance contracts, and other arrangements to satisfy the conditions in this section, shall be evidenced by copies of the insurance contracts and arrangements and by a certificate from the insurers and other parties to the contracts or arrangements submitted to the director, which certificate must contain provisions requiring the insurer, and all other parties to the contracts, to notify the director and the health maintenance organization ninety (90) days in advance of any revocation or cancellation or of any significant change in status giving the reason of the action. All insurance contracts shall remain in full force and effect for at least ninety (90) days following written notice by registered mail of cancellation by either party to the director. Each health maintenance organization must present the director with evidence of premium payment in a form and manner acceptable to the director for each premium payment for any insurance arrangement certifying that all premiums are prepaid ninety (90) days in advance and subsequently the health maintenance organization must follow up within a time period acceptable to the director with other evidence of premium payment satisfactory to the director.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1984, ch. 91,  1; P.L. 1999, ch. 254,  1; P.L. 2002, ch. 292,  85; P.L. 2005, ch. 176,  1. 
 27-41-14.1. Prohibition against restraint on provider  Patient communications. No health maintenance organization shall refuse to contract with or compensate for covered services an otherwise eligible health care provider solely because the provider has in good faith communicated with one or more of his or her current, former or prospective patients regarding the provisions, terms, requirements, restrictions or other treatment options not provided by the health maintenance organization and of the health maintenance organizations products and/or services as they relate to the needs of the providers patients. By way of illustration only, and without limiting the protections afforded in this section, the communications within this section may involve hospital stays, emergency room use, and referral to specialists. Any provision contained in any contract between a health maintenance organization and a health care provider which violates the provisions of this section shall be null and void, and any attempt by a health maintenance organization to enforce that provision shall subject the health maintenance organization to assessment of a penalty of up to five thousand dollars ($5,000). These penalties shall be enforced by the consumer protection division of the department of the attorney general in the district court.  History of Section.P.L. 1997, ch. 352,  1. 
 27-41-14. Prohibited practices. (a) No health maintenance organization, or representative of a health maintenance organization, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. For the purposes of this chapter:  (1) A statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect that is or may be significant to an enrollee of, or a person considering enrollment with, a health maintenance organization;  (2) A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue, if, in the total context in which the statement is made or the item of information is communicated, the statement or item of information may be reasonably understood by a reasonable person, not possessing special knowledge regarding health care coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation, or disadvantage of possible significance to an enrollee of, or a person considering enrollment in, a health maintenance organization, if the benefit or advantage or absence of limitation, exclusion, or disadvantage does not in fact exist; and  (3) An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography, format and language, shall be such as to cause a reasonable person, not possessing special knowledge regarding health maintenance organizations and evidences of coverage for them, to expect benefits, services, charges, or other advantages which the evidence of coverage does not provide or which the health maintenance organization issuing the evidence of coverage does not regularly make available for enrollees covered under the evidence of coverage.  (b) Section 42-62-12 and regulations pursuant to that section and chapter 29 of this title, relating to unfair competition and practices, shall be construed to apply to health maintenance organizations and evidences of coverage except to the extent that the director of business regulation determines that the nature of health maintenance organizations, and evidences of coverage, render those sections clearly inappropriate.  (c) An enrollee may not be cancelled or nonrenewed except for reasons stated in the rules of the health maintenance organization applicable to all enrollees, for the failure to pay the charge for coverage, or for the other reasons as may be approved by the director of business regulation.  (d) No health maintenance organization, unless licensed as an insurer, may use in its name, contracts, or literature any of the words insurance, casualty, surety, or mutual, or any words descriptive of the insurance, casualty, or surety business or deceptively similar to the name or description of any insurance or surety corporation doing business in this state.  (e) No person, unless in possession of a valid license as a health maintenance organization pursuant to the laws of this state, shall hold himself or herself out as a health maintenance organization or HMO or shall do business as a health maintenance organization or a HMO in the state of Rhode Island, and no person shall do business in this state under a name deceptively similar to the name of any health maintenance organization possessing a valid license pursuant to this chapter.  (f) No health maintenance organization shall fail to contract with any provider who is licensed by this state to provide the services delineated in  27-41-2(h)(1) solely because that provider is a podiatrist as defined in chapter 29 of title 5.  (g) Except as provided in  27-41-13(i), no contract between a health maintenance organization and a physician for the provision of services to patients may require that the physician indemnify or hold harmless the health maintenance organization for any expenses and liabilities, including without limitation, judgments, settlements, attorneys fees, court costs, and any associated charges, incurred in connection with any claim or action brought against the plan based on the health maintenance organizations management decisions or utilization review provisions for any patient.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1985, ch. 170,  1; P.L. 1987, ch. 107,  2; P.L. 1996, ch. 309,  1. 
 27-41-15. Powers of insurers and hospital and medical service corporations. An insurance company licensed in this state may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this chapter. Notwithstanding any other law that may be inconsistent with this section, any two (2) or more state insurance companies, or subsidiaries or affiliates of those companies, may jointly organize and operate a health maintenance organization. A hospital or medical service corporation may own and operate a health maintenance organization. With respect to those corporations, operation of a health maintenance organization shall not be deemed to be participation in the business of insurance. The business of insurance is deemed to include the providing of health care by a health maintenance organization owned or operated by an insurer or a subsidiary of an insurer.  History of Section.P.L. 1983, ch. 225,  2. 
 27-41-16. Examination. (a) The director of business regulation may make an examination of the affairs of any health maintenance organization and the providers with whom the organization has contracts, agreements, or other arrangements pursuant to its health care plan as often as is reasonably necessary for the protection of the interests of the people of this state. The examination shall be performed and the associated costs shall be borne by the company in accordance with all the provisions of  27-13.1.  (b) The director of health may make an examination concerning the quality of health care services of any health maintenance organization and the providers with whom the organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state.  (c) Each health maintenance organization shall establish and maintain on an ongoing basis a quality assurance program which involves the assessment of all quality assurance activities conducted in the provision of its health care services to its subscribers, which shall include no less than:  (1) Assessment of health outcomes;  (2) Ongoing review of health services by physicians and other health professionals; and  (3) Utilization and systematic data collection.  (d) Every health maintenance organization and provider shall submit its books and records to those examinations and in every way facilitate them. For the purpose of examinations, the director of business regulation and the director of health may administer oaths to, and examine, the officers and agents of the health maintenance organization and the principals of their providers concerning their business.  (e) The expenses of examinations under this section shall be assessed against the organization being examined and remitted to the director of the department for whom the examination is being conducted. The total cost of those examinations, whether made by the director of business regulation or by the director of health, shall be borne by the examined health maintenance organizations and shall be in the same amount as provided for in  27-13-1, and shall be paid to the director of the department conducting the examination for deposit as general revenues. That assessment shall be in addition to any taxes and fees payable to the state. In instances where the examination is performed by outside accountants, the expenses of the examination shall be borne by the examined health maintenance organization.  (f) In lieu of any state examination, the director of business regulation or the director of health may accept the report of an examination made by the director of business regulation or the director of health of another state.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1992, ch. 133, art. 24,  1; P.L. 1994, ch. 404,  13; P.L. 1995, ch. 370, art. 40,  88. 
 27-41-17. Suspension or revocation of license. (a) The director may suspend or revoke any license issued to a health maintenance organization under this chapter if the director finds that any of the following conditions exist:  (1) The health maintenance organization is operating significantly in contravention of its basic organizational document, or in a manner contrary to that described in and reasonably inferred from any other information submitted under  27-41-3, unless amendments to those submissions have been filed with and approved by the director;  (2) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services that do not comply with the requirements of  27-41-8;  (3) The health maintenance organization does not provide or arrange for basic health care services;  (4) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;  (5) The health maintenance organization has failed to implement a mechanism affording the enrollees an opportunity to participate in matters of policy and operation under  27-41-6;  (6) The health maintenance organization has failed to implement the complaint system required by  27-41-11 in a manner to reasonably resolve valid complaints;  (7) The health maintenance organization, or any person on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;  (8) The continued operation of the health maintenance organization would be hazardous to its enrollees; or  (9) The health maintenance organization has failed to substantially comply with this chapter.  (b) The director of business regulation shall suspend or revoke any license issued to a health maintenance organization upon certification by the director of health to the director of business regulation that:  (1) The health maintenance organization does not meet the requirements of  27-41-4(a)(2); or  (2) The health maintenance organization is unable to fulfill its obligations to furnish health care services.  (c) A license shall be suspended or revoked only after compliance with the requirements of  27-41-20.  (d) When the license of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of that suspension, enroll any additional enrollees except newborn children or other newly acquired dependents of existing enrollees, and shall not engage in any advertising or solicitation.  (e) When the license of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs, and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the organization. It shall engage in no further advertising or solicitation. The director of business regulation may, by written order, permit any further operation of the organization that the director may find to be in the best interest of enrollees, to the end that enrollees will be afforded the greatest practical opportunity to obtain continuing health care coverage.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1989, ch. 542,  85. 
 27-41-18.1. Summary orders and supervision. (a) Whenever the director determines that the financial condition of a health maintenance organization is such that its continued operation must be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision of this act, the director may, after notice and hearing, order the health maintenance organization to take action reasonably necessary to rectify the condition or violation, including, but not limited to, one or more of the following:  (1) Reduce the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the director;  (2) Reduce the volume of new business being accepted;  (3) Reduce expenses by specified methods;  (4) Suspend or limit the writing of new business for a period of time;  (5) Increase the health maintenance organizations capital and surplus by contribution;  (6) Initiate administrative supervision proceedings against the health maintenance organization in accordance with chapter 14.1 of this title; or  (7) Take other steps the director may deem appropriate under the circumstances.  (b) For purposes of this section, the violation by a health maintenance organization of any law of this state to which the health maintenance organization is subject shall be deemed a violation of this act.  (c) The director is authorized to adopt regulations to set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors, or the general public and to set standards for evaluating the financial condition of any health maintenance organization.  (d) The remedies and measures available to the director under this section shall be in addition to, and not in lieu of, the remedies and measures available to the director under the provisions of chapters 14.1, 14.2 and 14.3 of this title.  History of Section.P.L. 2005, ch. 176,  2. 
 27-41-18. Rehabilitation, liquidation, or conservation of health maintenance organization. (a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director to rehabilitate, liquidate, or conserve a health maintenance organization upon any one or more of the grounds included in chapter 14.3 of this title or upon any one or more of the following grounds:  (1) That the health maintenance organization is insolvent;  (2) That the health maintenance organization is in an unsound financial condition;  (3) That the health maintenance organizations business policies are unsound or improper;  (4) That the health maintenance organizations condition or management is such as to render its further transaction of business hazardous to the public or its enrollees;  (5) That the health maintenance organizations funds, net cash, or contingent assets are deficient; or  (6) That the health maintenance organization is conducting its business fraudulently or refuses or neglects to comply with the laws of this state.  (b) A claim by a health care provider who agrees not to assert that claim against any enrollee of the health maintenance organization for an uncovered expenditure has priority over other providers of services.  (c) For purposes of determining the priority of distribution of general assets, claims of enrollees and enrollees beneficiaries shall have the same priority as established in chapter 14.3 of this title for policyholders and beneficiaries of insureds of insurance companies. If an enrollee is liable to a provider for services provided pursuant to and covered by the health benefit plan, that liability shall have the status of an enrollee claim for distribution of general assets. A provider who is obligated by statute or agreement to hold enrollees harmless from liability for services provided pursuant to and covered by a health benefit plan shall have a priority of distribution of the general assets immediately following that of enrollees and enrollees beneficiaries as described herein, and immediately preceding the priority of distribution for priority Class 7 described in  27-14.3-46.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1991, ch. 370,  4; P.L. 2005, ch. 176,  1. 
 27-41-19. Rules and regulations. The director of business regulation and the director of health shall, after notice and hearing, promulgate reasonable rules and regulations that are necessary or proper to carry out the provisions of this chapter. Those rules and regulations shall be subject to review in accordance with the provisions of chapter 35 of title 42.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1995, ch. 334,  1; P.L. 2002, ch. 292,  85. 
 27-41-2. Definitions. As used in this chapter: (a) Adverse benefit determination means any of the following: a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of a an individuals eligibility to participate in a plan or to receive coverage under a plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit resulting from the application of any utilization review, as well as a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate. The term also includes a rescission of coverage determination.  (b) Affordable Care Act means the federal Patient Protection and Affordable Care act of 2010, as amended by the federal Health Care and Education Reconciliation Act of 2010, and federal regulations adopted thereunder;  (c) Commissioner or health insurance commissioner means that individual appointed pursuant to  42-14.5-1.  (d) Covered health services means the services that a health maintenance organization contracts with enrollees and enrolled groups to provide or make available to an enrolled participant.  (e) Director means the director of the department of business regulation or his or her duly appointed agents.  (f) Employee means any person who has entered into the employment of or works under a contract of service or apprenticeship with any employer. It shall not include a person who has been employed for less than thirty (30) days by his or her employer, nor shall it include a person who works less than an average of thirty (30) hours per week. For the purposes of this chapter, the term employee means a person employed by an employer as defined in subsection (g) of this section. Except as otherwise provided in this chapter the terms employee and employer are to be defined according to the rules and regulations of the department of labor and training.  (g) Employer means any person, partnership, association, trust, estate, or corporation, whether foreign or domestic, or the legal representative, trustee in bankruptcy, receiver, or trustee of a receiver, or the legal representative of a deceased person, including the state of Rhode Island and each city and town in the state, which has in its employ one or more individuals during any calendar year. For the purposes of this section, the term employer refers only to an employer with persons employed within the state of Rhode Island.  (h) Enrollee means an individual who has been enrolled in a health maintenance organization.  (i) Essential health benefits shall have the meaning set forth in section 1302(b) of the federal Affordable Care Act [42 U.S.C.  18022(b)].  (j) Evidence of coverage means any certificate, agreement, or contract issued to an enrollee setting out the coverage to which the enrollee is entitled.  (k) Grandfathered health plan means any group health plan or health insurance coverage subject to 42 U.S.C.  18011.  (l) Group health insurance coverage means, in connection with a group health plan, health insurance coverage offered in connection with such plan.  (m) Group health plan means an employee welfare benefit plan as defined in 29 U.S.C.  1002(1), to the extent that the plan provides health benefits to employees or their dependents directly or through insurance, reimbursement, or otherwise.  (n) Health benefits or covered benefits means coverage or benefits for the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body including coverage or benefits for transportation primarily for and essential thereto, and including medical services as defined in  27-19-17;  (o) Healthcare facility means an institution providing healthcare services or a healthcare setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings.  (p) Healthcare professional means a physician or other healthcare practitioner licensed, accredited or certified to perform specified healthcare services consistent with state law.  (q) Healthcare provider or provider means a healthcare professional or a healthcare facility.  (r) Healthcare services means any services included in the furnishing to any individual of medical, podiatric, or dental care, or hospitalization, or incident to the furnishing of that care or hospitalization, and the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability.  (s) Health insurance carrier means a person, firm, corporation or other entity subject to the jurisdiction of the commissioner under this chapter, and includes a health maintenance organization. Such term does not include a group health plan.  (t) Health maintenance organization means a single public or private organization which:  (1) Provides or makes available to enrolled participants healthcare services, including at least the following basic healthcare services: usual physician services, hospitalization, laboratory, x-ray, emergency, and preventive services, and out of area coverage, and the services of licensed midwives;  (2) Is compensated, except for copayments, for the provision of the basic healthcare services listed in subdivision (1) of this subsection to enrolled participants on a predetermined periodic rate basis; and  (3)(i) Provides physicians services primarily:  (A) Directly through physicians who are either employees or partners of the organization; or  (B) Through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis;  (ii) Health maintenance organization does not include prepaid plans offered by entities regulated under chapter 1, 2, 19, or 20 of this title that do not meet the criteria above and do not purport to be health maintenance organizations;  (4) Provides the services of licensed midwives primarily:  (i) Directly through licensed midwives who are either employees or partners of the organization; or  (ii) Through arrangements with individual licensed midwives or one or more groups of licensed midwives organized on a group practice or individual practice basis.  (u) Licensed midwife means any midwife licensed pursuant to  23-13-9.  (v) Material modification means only systemic changes to the information filed under  27-41-3.  (w) Net worth, for the purposes of this chapter, means the excess of total admitted assets over total liabilities.  (x) Office of the health insurance commissioner means the agency established under  42-14.5-1.  (y) Physician includes podiatrist as defined in chapter 29 of title 5.  (z) Private organization means a legal corporation with a policy making and governing body.  (aa) Provider means any physician, hospital, licensed midwife, or other person who is licensed or authorized in this state to furnish healthcare services.  (bb) Public organization means an instrumentality of government.  (cc) Rescission means a cancellation or discontinuance of coverage that has retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.  (dd) Risk based capital (RBC) instructions means the risk based capital report including risk based capital instructions adopted by the National Association of Insurance Commissioners (NAIC), as these risk based capital instructions are amended by the NAIC in accordance with the procedures adopted by the NAIC.  (ee) Total adjusted capital means the sum of:  (1) A health maintenance organizations statutory capital and surplus (i.e. net worth) as determined in accordance with the statutory accounting applicable to the annual financial statements required to be filed under  27-41-9; and  (2) Any other items, if any, that the RBC instructions provide.  (ff) Uncovered expenditures means the costs of healthcare services that are covered by a health maintenance organization, but that are not guaranteed, insured, or assumed by a person or organization other than the health maintenance organization. Expenditures to a provider that agrees not to bill enrollees under any circumstances are excluded from this definition.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1987, ch. 107,  1; P.L. 1990, ch. 168,  3; P.L. 1995, ch. 334,  1; P.L. 1999, ch. 254,  1; P.L. 2002, ch. 292,  85; P.L. 2012, ch. 256,  9; P.L. 2012, ch. 262,  9. 
 27-41-20. Administrative procedures. (a) When the director of business regulation has cause to believe that grounds for the denial of an application for a license exist, or that grounds for the suspension or revocation of a license exist, the director shall notify the health maintenance organization and the director of health, in writing, specifically stating the grounds for denial, suspension, or revocation and fixing a time for a hearing on the matter.  (b) The director of health, or his or her designated representative, shall be in attendance at the hearing and shall participate in the proceedings. The recommendation and findings of the director of health, with respect to matters relating to the quality of health care services provided by the health maintenance organization in connection with any decision regarding the denial, suspension, or revocation of a license, shall be conclusive and binding upon the director of business regulation. After the hearing, or upon the failure of the health maintenance organization to appear at the hearing, the director of business regulation shall take any action that is deemed advisable on written findings that shall be mailed to the health maintenance organization with a copy to the director of health. The action of the director of business regulation and the recommendation and findings of the director of health shall be subject to review by the superior court for the county of Providence.  (c) The provisions of chapter 35 of title 42 shall apply to proceedings under this section to the extent they are not in conflict with subsections (a) and (b) of this section.  History of Section.P.L. 1983, ch. 225,  2. 
 27-41-21. Penalties and enforcement. (a) The director of business regulation may, in lieu of the suspension or revocation of a license under  27-41-17, levy an administrative penalty in an amount not less than five hundred dollars ($500) nor more than fifty thousand dollars ($50,000), if reasonable notice in writing is given of the intent to levy the penalty and the health maintenance organization has a reasonable time in which to remedy the defect in its operations which gave rise to the penalty citation. The director of business regulation may augment this penalty by an amount equal to the sum that the director calculates to be the damages suffered by enrollees or other members of the public.  (b) Any person who violates this chapter shall be guilty of a misdemeanor and may be punished by a fine not to exceed five hundred dollars ($500) or by imprisonment for a period not exceeding one year, or both.  (c)(1) If the director of business regulation or the director of health shall for any reason have cause to believe that any violation of this chapter has occurred or is threatened, the director of business regulation or the director of health may give notice to the health maintenance organization and to their representatives, or other persons who appear to be involved in the suspected violation, to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the facts relating to the suspected violation, and, in the event it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing the violation;  (2) Proceedings under this subsection shall be governed by chapter 35 of title 42.  (d)(1) The director of business regulation may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any act or practice in violation of the provisions of this chapter;  (2) Within thirty (30) days after service of the order to cease and desist, the respondent may request a hearing on the question of whether acts or practices in violation of this chapter have occurred. Those hearings shall be conducted pursuant to  42-35-9  42-35-13, and judicial review shall be available as provided by  42-35-15 and 42-35-16.  (e) In the case of any violation of the provisions of this chapter, if the director of business regulation elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued pursuant to subsection (d) of this section, the director of business regulation may institute a proceeding to obtain injunctive relief, or seeking other appropriate relief, in the superior court for the county of Providence.  (f) Notwithstanding any other provisions of this act, if a health maintenance organization fails to comply with the net worth, risk based capital or any other requirement of this title related to the solvency of the health maintenance organization, the director is authorized to take appropriate action to assure that the continued operation of the health maintenance organization will not be hazardous to its enrollees or the public.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1989, ch. 542,  85; P.L. 2005, ch. 176,  1. 
 27-41-22. Statutory construction and relationship to other laws. (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 subscribers health care history, diagnosis, condition, treatment, or evaluation shall be considered confidential health care 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 44-17.  History of Section.P.L. 1983, ch. 225,  2; P.L. 2007, ch. 73, art. 28,  3. 
 27-41-23. Filings and reports as public documents. The provisions of chapter 2 of title 38, relating to access to public records, shall apply to all applications, filings, and reports required under this chapter. Annual and quarterly financial statements shall be treated as public documents.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1994, ch. 404,  13. 
 27-41-24. Director of healths authority to contract. The director of health, in carrying out his or her obligations under  27-41-4(a)(2), 27-41-16(b), and 27-41-17(b), may contract with qualified persons to make recommendations concerning the determinations required to be made by the director. Those recommendations may be accepted in full or in part by the director of health.  History of Section.P.L. 1983, ch. 225,  2. 
 27-41-25. Holding company systems. 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.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1998, ch. 90,  5; P.L. 2000, ch. 178,  9; P.L. 2000, ch. 200,  19; P.L. 2000, ch. 229,  19. 
 27-41-26.1. Patient responsibility  Administrative requirements. For health benefit contracts issued, renewed, or delivered in this state the following shall apply:  (1) The amount of copayments for physician office visits and hospital emergency room visits shall be printed on the subscriber identification cards issued to the insured.  (2) A schedule of all applicable copayments, by product or by group, in paper or electronic format, or both, shall be published, updated, and distributed to participating providers.  (3) On an annual basis, notification shall be provided to subscribers regarding their responsibility for copayments and deductibles.  History of Section.P.L. 2001, ch. 283,  3; P.L. 2002, ch. 292,  85. 
 27-41-26. Enrollee liability. No enrollee is liable to any provider for charges for covered health services, except for amounts due for copayments, when provided or made available to enrolled participants by a licensed health maintenance organization during a period in which premiums were paid by or on behalf of the enrollee.  History of Section.P.L. 1983, ch. 225,  2; P.L. 2003, ch. 341,  1. 
 27-41-27.1. No derogation of attorney general. 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 law.  History of Section.P.L. 1998, ch. 90,  10. 
 27-41-27.2. Health insurance rates. No insurance company organized as a stock or mutual corporation which merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or acquires control of a non-profit hospital service corporation organized under chapter 19 of this title, a non-profit medical service corporation organized under chapter 20 of this title or a health maintenance organization organized under chapter 41 of this title: (1) may file with any state agency for review or approval any proposed rate to be used by the company in the state, or (2) may charge to any party in the state any rate or premium, which takes into account or reflects in any manner the value of any contribution, distribution or allocation the company expends or incurs in establishing or funding a charitable foundation organized to maintain or account for the assets of a non-profit hospital service corporation, non-profit medical service corporation or health maintenance organization. For any rate that is to be charged to policy holders, regardless of whether this rate is subject to approval by a state agency under this or another chapter, the company shall at least thirty (30) days before implementing the rate submit under oath to the commissioner of insurance an accounting that documents the cost structure on which the rate is based and demonstrates the companys compliance with this section.  History of Section.P.L. 1999, ch. 215,  5; P.L. 1999, ch. 376,  5. 
 27-41-27. Offer of health maintenance organization alternative to employees. (a)(1) In accordance with regulations promulgated by the director of the department of business regulation: (i) each employer which during any calendar quarter employed an average number of employees of not less than twenty-five (25), and (ii) the state and each political subdivision of the state which during any calendar quarter employed an average number of employees of not less than twenty-five (25), shall include in any benefits plan, offered to their employees in the calendar year beginning after that calendar quarter, the option of membership in licensed health maintenance organizations (HMOs) which are qualified under the provisions of  42-62-9 and which are engaged in the provision of basic health services in health maintenance organization (HMO) service areas in which at least twenty-five (25) of those employees reside;  (2) If any of the employees of an employer or the state or political subdivision of the state described in subdivision (1) of this subsection are represented by a collective bargaining representative or other employee representative designated or selected under the law, the offer of a membership in a licensed health maintenance organization (HMO), required by subdivision (1) of this subsection to be made in a health benefits plan offered to those employees:  (i) Shall be first made to that collective bargaining representative or other employee representative; and  (ii) If that offer is accepted by that representative, it shall then be made to each employee.  (b) If there is more than one licensed and qualified health maintenance organization which is engaged in the provision of health services in the area in which the employees of an employer reside and if:(1) one or more of those organizations provides health services through professionals who are employed members of the staff of the organization or through an organized medical group or groups on a contractual basis; and  (2) one or more of those organizations provides those services through an individual practice association or associations; then of the licensed and qualified health maintenance organizations included in a health benefits plan of that employer pursuant to subsection (a) of this section at least one shall be an organization which provides health services as described in subdivision (1) of this subsection and at least one shall be an organization which provides health services as described in subdivision (2) of this subsection.   (c) An employer shall offer the option of membership in additional licensed and qualified health maintenance organizations if the additional licensed and qualified health maintenance organizations demonstrate that their service areas include the residence areas of employees:  (1) Who do not reside in the service area of licensed health maintenance organizations already included in the employers health benefits plans; or  (2) To whom membership in licensed and qualified health maintenance organizations already included in the health benefits plans is not available because those organizations have closed their enrollment of eligible employees of that employer.  (d) An employer is not required to include in the health benefits plan offered to eligible employees the option of membership in the specific licensed and qualified health maintenance organization which initiated the request for inclusion in the health benefits plan; provided, that the employer selects, in a manner consistent with this section, one or more other licensed and qualified health maintenance organizations that may not have made a request but are willing to be included; provided, that these latter health maintenance organizations are of the same type, i.e., the type described in subdivision (b)(1) of this section or the type described in subdivision (b)(2) of this section, and serve, or will serve at a minimum, the same area in which the employers or public entitys employees reside individually or collectively as the health maintenance organization which submitted the timely request.  (e) No employer shall be required to pay more for health benefits as a result of the application of this section than would otherwise be required by any prevailing collective bargaining agreement or legally enforceable contract for the provision of health benefits between the employer and its employees; provided, that the annual per employee absolute dollar contribution by the employer for any alternative health maintenance organization coverage shall in no event be required by this section to exceed the employers per employee absolute dollar contribution to any other health benefits plan offered by the employer. Each employer which provides payroll deductions as a means of paying employees contributions for health benefits or which provides a health benefits plan, and which is required by subsection (a) to offer his or her employees the option of membership in a licensed and qualified health maintenance organization (HMO), shall, with the consent of an employee who exercises that option, arrange for the employees contribution for that membership to be paid through payroll deductions.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1985, ch. 406,  1. 
 27-41-28. Applicability. Notwithstanding any of the provisions of this chapter, except for  27-41-5, 27-41-26, 27-41-35, and 27-41-37 which shall apply to all licensed health maintenance organizations including health maintenance organizations licensed pursuant to chapter 17 of title 23, nothing contained in this chapter shall apply to those health maintenance organizations licensed pursuant to chapter 17 of title 23 which were actively engaged in the provision of or making available to enrolled participants health care services prior to January 1, 1982; provided, that this exemption shall not under any circumstances have effect beyond July 1, 1994, and that on and after July 1, 1991,  27-41-18 shall also apply to all licensed health maintenance organizations licensed pursuant to chapter 17 of title 23. Any health maintenance organization which was actively engaged in the provision of or making available to enrolled participants health care services prior to January 1, 1982, including a health maintenance organization which experiences a change in owner or change in operator as defined in  23-17-2(5) and (4), respectively, may, at its discretion, continue to be licensed under the requirements and provisions of chapter 17 of title 23 until July 1, 1994, or under the requirements and provisions of this chapter. That health maintenance organization shall be deemed to be licensed under the requirements and the provisions of this chapter upon submission of materials required under  27-41-3(b)(1), (2), (3), (4) and (11) sufficient and satisfactory to the director. Until July 1, 1998, the directors shall waive, reduce, or alter the requirements of  27-41-4 and 27-41-13 for licensure for this defined class of health maintenance organizations unless after notice and hearing he or she finds that reasonable progress is not being made toward meeting the requirements of those sections. After July 1, 1998 the director may waive, reduce, or alter the requirements of  27-41-4 and 27-41-13 for licensure for this defined class of health maintenance organizations if the licensee demonstrates to the satisfaction of the director that it is making satisfactory progress toward compliance with the requirements of those sections.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1990, ch. 161,  1; P.L. 1991, ch. 345,  5; P.L. 1991, ch. 370,  4. 
 27-41-29.1. Uniform explanation of benefits and coverage. (a) A health maintenance organization shall provide a summary of benefits and coverage explanation and definitions to policyholders and others required by, and at the times and in the format required, by the federal regulations adopted under section 2715 of the Public Health Service Act, as amended by the federal Affordable Care Act [42 U.S.C.  300gg-15]. The forms required by this section shall be made available to the commissioner on request. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.  (b) The provisions of this section shall apply to grandfathered health plans. This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  (c) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.  History of Section.P.L. 2012, ch. 256,  10; P.L. 2012, ch. 262,  10. 
 27-41-29.2. Filing of policy forms. (a) A health maintenance organization shall file all policy forms and rates used by it in the state with the commissioner, including the forms of any rider, endorsement, application blank, and other matter generally used or incorporated by reference in its policies or contracts of insurance. No such form shall be used if disapproved by the commissioner under this section, or if the commissioners 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 actuarys 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.  History of Section.P.L. 2012, ch. 256,  10; P.L. 2012, ch. 262,  10. 
 27-41-29. Severability. If any section, term, or provision of this chapter shall be adjudged invalid for any reason, that judgment shall not affect, impair, or invalidate any other section, term, or provision of this chapter, but the remaining sections, terms, and provisions shall be and remain in full force and effect.  History of Section.P.L. 1983, ch. 225,  2. 
 27-41-3. Establishment of health maintenance organizations. (a)(1) Notwithstanding chapter 5.1 of title 7, sections 27-2-22, 27-19-4, 27-20-4, 27-20.1-2, and 27-20.2-2, or any other law of this state to the contrary, any public or private organization may apply to the director of business regulation for and obtain a license to establish and operate a health maintenance organization in compliance with this chapter. No public or private organization shall establish or operate a health maintenance organization in this state without obtaining a license under this chapter. A foreign corporation may qualify under this chapter, subject to its registration to do business in this state as a foreign corporation under  7-1.2-1401;  (2) Notwithstanding anything to the contrary in  7-6-4, a non-profit corporation may be organized for the purpose of a health maintenance organization and that corporation shall not be subject to limits in its assets except as provided in this chapter.  (b) Each application for a license shall be verified by an officer or authorized representative of the applicant, shall be in a form prescribed by the director in consultation with the director of health, and shall set forth or be accompanied by the following:  (1) A copy of the organizational documents of the applicant, such as the articles of incorporation;  (2) A copy of the bylaws, rules and regulations, or similar document, if any, regulating the conduct of the internal affairs of the applicant;  (3) A list of the names, addresses, and official positions of the persons who are to be responsible for the conduct of the affairs of the applicant, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers of the corporation;  (4) A copy of any contract made or to be made, including any revisions to the document between any providers or persons listed in subdivision (3) of this subsection and the applicant;  (5) A copy of the form of evidence of coverage to be issued to the enrollees;  (6) A copy of the form of the group contract, if any, which is to be issued to employers, unions, trustees, or other organizations;  (7) Financial statements showing the applicants assets, liabilities, and sources of financial support. If the applicants financial affairs are audited by independent certified public accountants, a copy of the applicants most recent regular certified financial statement shall be deemed to satisfy this requirement unless the director directs that additional or more recent financial information is required for the proper administration of this chapter;  (8) An examination report prepared by the insurance department of the companys state of domicile or port of entry state. This requirement shall be deemed to be satisfied if the report is less than five (5) years old and: (i) the insurance department at the time of the examination was accredited under the National Association of Insurance Commissioners financial regulations standards and accreditation program or (ii) the examination is performed under the supervision of an accredited insurance department or with the participation of one or more examiners who are employed by an accredited state insurance department and who, after a review of the examination work papers and report, state under oath that the examination was performed in a manner consistent with the standards and procedures required by their insurance department. In lieu of an examination meeting the requirements set forth in this section, an examination of the company may be performed, prior to licensure, by the Rhode Island insurance division. The examination shall be performed and the associated costs shall be borne by the company in accordance with all the provisions of chapter 13.1 of this title.  (9) A description of the proposed method of marketing the health maintenance organization, a financial plan which includes a projection of the initial operating results anticipated until the organization has had net income for at least one year, and a statement as to the sources of working capital and any other sources of funding;  (10) A power of attorney duly executed by the applicant, if not domiciled in this state, appointing the director and his or her successors in office, and duly authorized deputies, as the true and lawful attorney of the applicant in and for this state upon whom all lawful process in any legal action or proceeding against the health maintenance organization on a cause of action arising in this state may be served;  (11) A statement reasonably describing the geographic area or areas to be served;  (12) A description of the complaint procedures to be utilized as required under  27-41-11;  (13) A description of the procedures and programs to be implemented to meet the quality of health care requirements in  27-41-4(a)(2);  (14) A description of the mechanism by which enrollees will be afforded an opportunity to participate in matters of policy and operation under  27-41-6(b);  (15) A description of the provider networks to be utilized to provide health care services to enrollees;  (16) A description of the utilization management mechanisms by which enrollees access to and use of health services will be controlled; and  (17) Any other information that the director in consultation with the director of health may require to make the determinations required in  27-41-4.  (c) An applicant or a licensed health maintenance organization shall, unless otherwise provided for in this chapter, file a notice describing any material modification of the operation including, but not limited to, systematic changes in provider networks and mechanisms for the management and control of the use of covered services by enrollees, set out in the information required by subsection (b) of this section. The notice shall be filed with the director and with the director of health prior to the modification. If the director or the director of health does not disapprove within ninety (90) days of the filing, the modification shall be deemed approved.  (d) An applicant or a licensed health maintenance organization shall file all contracts of reinsurance. Any agreement between the organization and an insurer shall be subject to the laws of this state regarding reinsurance. All reinsurance agreements and any modifications to them must be filed and approved. Reinsurance agreements shall remain in full force and effect for at least ninety (90) days following written notice by registered mail of cancellation to the director by either party.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1984, ch. 380,  4; P.L. 1984, ch. 444,  1; P.L. 1994, ch. 134,  16; P.L. 1995, ch. 334,  1; P.L. 1997, ch. 55,  1; P.L. 2005, ch. 36,  21; P.L. 2005, ch. 72,  21. 
 27-41-30.1. Post-partum hospital stays. (a) Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for a forty-eight (48) hour time period in a hospital after a vaginal birth, and ninety-six (96) hours after a Cesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending health care provider in consultation with the mother. The decision shall be made in accordance with the standards for guidelines for perinatal care published by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics. The standards shall be relative to early discharge, defined as less than forty-eight (48) hours for a vaginal delivery and ninety-six (96) for a Cesarean delivery. In the case of early discharge, post-delivery care shall include home visits, parent education, assistance and training in breast or bottle feeding and the performance of any necessary and appropriate clinical tests or any other tests or services consistent with the guidelines in this subsection.  (b) For the purposes of this section, attending health care provider includes the attending obstetrician, pediatrician, family practitioner, general practitioner or certified nurse midwife attending the mother and newly born child.  (c) Any member who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.  History of Section.P.L. 1996, ch. 246,  5; P.L. 1996, ch. 260,  5; P.L. 2002, ch. 292,  85. 
 27-41-30. Mammograms and pap smears  Coverage mandated. (a) Subscribers to any health maintenance organization plan shall be afforded coverage under that 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 health maintenance organization plan shall be afforded coverage for 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.  History of Section.P.L. 1988, ch. 532,  3; P.L. 2005, ch. 405,  4. 
 27-41-31. Mammograms  Quality assurance standards. A mammogram eligible for reimbursement under  27-41-30 shall be reimbursed only if the facility in which the mammogram has been taken and processed, and the licensed physician interpreting the mammogram both meet state approved quality assurance standards for taking, processing, and interpreting mammograms. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section.  History of Section.P.L. 1989, ch. 217,  4. 
 27-41-32. Pap smears  Quality assurance standards. A pap smear eligible for reimbursement under  27-41-30 shall be reimbursed only if the laboratory in which the pap smear is processed is licensed by the department of health specifically to perform cervical cytology, or is accredited by the American Society of Cytology, or is accredited by the College of American Pathologists, or is a hospital accredited by the joint commission on accreditation of health care organizations or the American Osteopathic Association at the time the pap smear is processed.  History of Section.P.L. 1989, ch. 217,  11. 
 27-41-33. Coverage for infertility. (a) Any health maintenance organization service contract plan or policy delivered, issued for delivery, or renewed in this state, except a contract providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a health maintenance organization 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 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).  History of Section.P.L. 1989, ch. 478,  4; P.L. 2002, ch. 292,  85; P.L. 2006, ch. 246, art. 34,  4; P.L. 2007, ch. 411,  4; P.L. 2017, ch. 132,  4; P.L. 2017, ch. 150,  4. 
 27-41-34. Health maintenance organizations assessment. (a) Notwithstanding any other provisions of law, each domestic HMO shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.  (b) Each domestic HMO assessment shall be determined in accordance with the following ratio: (1) by dividing the HMO total direct premiums by the total direct premiums, including annuities, less policyholder dividends of all domestic insurance companies plus the total direct premiums of domestic companies licensed or regulated pursuant to chapters 19, 20, 20.1, 20.2, 20.3, 25, and 41 of this title, and chapter 62 of title 42; (2) and then by multiplying the resulting ratio times two hundred thousand dollars ($200,000).  (c) The minimum assessment charged shall be the greater of the sum determined by subsection (b) of this section or one thousand dollars ($1,000).  History of Section.P.L. 1990, ch. 65, art. 29,  8; P.L. 2002, ch. 292,  85. 
 27-41-35. Enrollment period in the event of insolvency. (a) In the event of an insolvency of a health maintenance organization, upon order of the director, all other carriers that participated in the enrollment process with the insolvent health maintenance organization at a groups last regular enrollment period shall offer the groups enrollees of the insolvent health maintenance organization a thirty (30) day enrollment period commencing upon the date of insolvency. Each carrier shall offer the enrollees of the insolvent health maintenance organization the same coverage and rates that it had offered to the enrollees of the group at its last regular enrollment period;  (b) If no other carrier had been offered to some groups enrolled in the insolvent health maintenance organization, or if the director determines that the other health benefit plan(s) lack(s) sufficient health care delivery resources to assure that health care services will be available and accessible to all of the group enrollees of the insolvent health maintenance organization, then the director shall allocate equitably the insolvent health maintenance organizations group contracts for the groups among all health maintenance organizations which operate within a portion of the insolvent health maintenance organizations service area, taking into consideration the health care delivery resources of each health maintenance organization. If the director determines that no health maintenance organization has sufficient resources to assure that health care services will be available and accessible to some groups enrolled in the insolvent health maintenance organization, then the director shall allocate equitably the insolvent health maintenance organizations contracts for the groups among the other carriers as he or she deems appropriate. Each health maintenance organization, or other carrier, to which a group or groups are so allocated shall offer the group or groups the health maintenance organizations or other carriers existing coverage which is most similar to each groups coverage with the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organizations or other carriers existing rating methodology;  (c) The director shall also allocate equitably the insolvent health maintenance organizations nongroup enrollees that are unable to obtain other coverage among all health maintenance organizations which operate within a portion of the insolvent health maintenance organizations service area, taking into consideration the health care delivery resources of each health maintenance organization. If the director determines that no health maintenance organization has sufficient resources to assure that health care services will be available and accessible to some nongroup enrollees of the insolvent health maintenance organization, then the director shall allocate equitably the insolvent health maintenance organizations contracts for the nongroup enrollees among the other carriers as he or she deems appropriate. Each health maintenance organization or other carrier to which nongroup enrollees are allocated shall offer the nongroup enrollees the health maintenance organizations or other carriers existing coverage for individual or conversion coverage as determined by his or her type of coverage in the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organizations or other carriers existing rating methodology. Successor health maintenance organizations or other carriers that do not offer direct nongroup enrollment may aggregate all of the allocated nongroup enrollees into one group for rating and coverage purposes.  History of Section.P.L. 1990, ch. 161,  2. 
 27-41-36. Services of midwives. Every health maintenance organization plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for the services of licensed midwives in accordance with each health maintenance organizations respective principles and mechanisms of reimbursement, credentialing, and contracting if the services are within the licensed midwives area of professional competence as defined by regulations promulgated pursuant to  23-13-9 and are currently reimbursed when rendered by any other licensed health care provider. No health maintenance organization may require supervision, signature, or referral by any other health care provider as a condition of reimbursement to a licensed midwife whose services are provided pursuant to  27-41-5(a)(6)(ii), except when the requirements are also applicable to other categories of health care providers. No health maintenance organization or patient may be required to pay for duplicate services actually rendered by both a licensed midwife and any other health care provider. Direct payment for licensed midwives will be contingent upon services rendered in a licensed health care facility and for services rendered in accordance with rules and regulations promulgated by the department of health; provided, that this provision shall not prohibit payment for services pursuant to  42-62-26 or for other services reimbursed by third party payors.  History of Section.P.L. 1990, ch. 168,  4; P.L. 2002, ch. 292,  85. 
 27-41-37. Discontinuance of coverage  Chronic disabilities. No health maintenance organization subject to the provisions of this chapter shall discontinue reimbursement for or providing services for covered health care services of chronic disabilities, unless the patient has exhausted benefits to which he or she is entitled under the basic subscriber agreement, or unless it is at the end of the open enrollment period; provided notice of the discontinuation of reimbursement for the services is sent to subscribers who have been reimbursed for or utilized those services in the past three (3) years. The notice shall be mailed at least sixty (60) days prior to the beginning of the open enrollment period. For the purposes of this section chronic disability means an impairment or illness that is likely to continue indefinitely.  History of Section.P.L. 1991, ch. 127,  4. 
 27-41-38.1. Medication synchronization. (a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days supply for the purpose of synchronizing the patients medications and the insureds or enrollees maintenance-prescription drug(s) to be synchronized meets all of the following requirements:  (1) Is covered by the policy, certificate, or contract described in this chapter;  (2) Is used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee;  (3) Except as otherwise provided in this subparagraph, is not a controlled substance included in schedules II to V;  (4) Meets all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insureds or enrollees multiple, maintenance-prescription drugs;  (5) Is of a formulation that can be effectively split over required short-fill periods to achieve synchronization; and  (6) Does not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insureds or enrollees multiple, maintenance-prescription drugs.  (b) The plan or policy described in subsection (a) shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insureds or enrollees multiple, maintenance-prescription drugs.  (c) The plan or policy described in subsection (a) shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.  (d) A synchronization shall only occur once per year per maintenance-prescription drug.  History of Section.P.L. 2016, ch. 179,  4; P.L. 2016, ch. 196,  4. 
 27-41-38.2. Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies. (a) Definitions. As used herein:  (1) Maximum-allowable cost or MAC means the maximum amount that a pharmacy benefits manager will reimburse toward the cost of a drug;  (2) Nationally available means that there is an adequate supply available from regional or national wholesalers and that the product is not obsolete or temporarily unavailable;  (3) Pharmacy-benefit manager means an entity doing business in this state that contracts to administer or manage prescription-drug benefits on behalf of any carrier that provides prescription-drug benefits to residents of this state.  (b) Upon each contract execution or renewal, a PBM shall, with respect to contracts between a PBM and a pharmacy or, alternatively, a PBM and a pharmacys 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 Administrations 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 pharmacys 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.  History of Section.P.L. 2016, ch. 166,  5; P.L. 2016, ch. 168,  5. 
 27-41-38. Drug coverage. No health maintenance organization that provides coverage for prescription drugs under a group plan master contract delivered, issued for delivery, or renewed in this state may require any person covered under the contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for the drugs.  History of Section.P.L. 1991, ch. 345,  4; P.L. 2002, ch. 292,  85. 
 27-41-39. Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists. (a) Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization in this state shall provide coverage for the services of certified registered nurse practitioners, practicing collaboratively and psychiatric and mental health nurse clinical specialists to subscribers, if those services are within the certified registered nurse practitioners or psychiatric and mental health nurse clinical specialists area of professional competence as established by education and certification, and are currently reimbursed when rendered by any other healthcare provider. No health maintenance organization may be required to pay for duplicative services actually rendered by a certified nurse practitioner and any other healthcare provider.  (b) Nothing in this chapter shall preclude the conducting of managed care reviews and medical necessity reviews by an insurer or hospital or medical service corporation or health maintenance organization.  (c) Every individual or group policy or contract delivered, issued for delivery, or renewed by a health maintenance organization 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.  History of Section.P.L. 1991, ch. 361,  4; P.L. 1994, ch. 90,  3; P.L. 2002, ch. 292,  85; P.L. 2009, ch. 351,  3; P.L. 2009, ch. 352,  3. 
 27-41-4. Issuance of license. (a)(1) Upon receipt of an application for issuance of a license, the director shall transmit copies of the application and accompanying documents to the director of health;  (2) The director of health shall determine whether the applicant for a license, with respect to health care services to be furnished:  (i) Has demonstrated that it fulfills the definition of a health maintenance organization delineated in  27-41-2(h);  (ii) Has demonstrated the willingness and potential ability to assure that health care services will be provided in a manner to assure both availability and accessibility of adequate personnel and facilities and in a manner enhancing availability, accessibility, and continuity of service;  (iii) Has arrangements, satisfactory to the director of health, for an ongoing quality of health assurance program concerning health care processes and outcomes; and  (iv) Has a procedure, satisfactory to the director of health, to develop, compile, evaluate, and report statistics relating to the cost of its operations, the pattern of utilization of its services, the availability and accessibility of its services, and any other matters that may be reasonably required by the director of health;  (3) Within a reasonable time following receipt of the application for issuance of a license, the director of health shall certify to the director that the proposed health maintenance organization meets the requirements of subdivision (2) of this section or notify the director that the health maintenance organization does not meet those requirements and specify in what respects it is deficient.  (b) The director shall issue or deny a license to any person filing an application pursuant to  27-41-3 within a reasonable time of receipt of the certification from the director of health. No license shall be issued until the certification is received from the director of health. Issuance of a license shall be granted if the director is satisfied that the following conditions are met:  (1) The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy, and possess good reputations;  (2) The director of health certifies, in accordance with subsection (a) of this section, that the health maintenance organizations proposed plan of operation meets the requirements of subdivision (a)(2) of this section;  (3) The health maintenance organization will effectively provide or arrange for the provision of basic health care services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments;  (4) The health maintenance organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees. The director shall require health maintenance organizations licensed pursuant to this chapter to maintain protection against insolvency. In making these determinations, the director may consider:  (i) The financial soundness of the health maintenance organizations arrangements for health care services and the schedule of charges used in connection with them;  (ii) The adequacy of working capital;  (iii) Any agreement with an insurance company for insuring the payment of the cost of health care services or the provision for automatic applicability of an alternative coverage in the event of discontinuance of the health maintenance organization;  (iv) Any agreement with providers for the provision of health care services; and  (v) Any deposit of securities submitted in accordance with  27-41-13 as a guarantee that the obligations will be duly performed;  (5) The enrollees will be afforded an opportunity to participate in matters of policy and operation pursuant to  27-41-6;  (6) Nothing in the proposed method of operation, as shown by the information submitted pursuant to  27-41-3 or by independent investigation, is contrary to the public interest; and  (7) Certification by the director of health that any deficiencies cited by the director of health have been or will be corrected.  (c) A license shall be denied only after compliance with the requirements of  27-41-20.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1984, ch. 91,  1. 
 27-41-40. Certified counselors in mental health and therapists in marriage and family practice. (a) Every individual or group policy or contract delivered, issued for delivery or renewed by a health maintenance organization in this state shall, when deemed medically necessary by the health maintenance organization in accordance with its standard medical management protocols as approved by the health department and within the contractual benefit limits, provide coverage for the services of counselors in mental health licensed pursuant to  5-63.2-9 and therapists in marriage and family practice licensed pursuant to  5-63.2-10.  (b) It shall remain within the sole discretion of the health maintenance organization as to which certified counselors in mental health and certified therapists in marriage and family practice it shall contract with. Nothing contained in this section shall require the health maintenance organization to provide coverage other than in conjunction with a related medical illness.  History of Section.P.L. 1994, ch. 89,  3; P.L. 2002, ch. 292,  85. 
 27-41-41.1. Repealed. History of Section.P.L. 1994, ch. 301,  4; Repealed by P.L. 2012, ch. 256,  17; P.L. 2012, ch. 262,  17, effective June 18, 2012. For comparable provisions, see  27-41-77. 
 27-41-41.2. Repealed. History of Section.P.L. 1994, ch. 301,  4; P.L. 1997, ch. 51,  4; P.L. 1997, ch. 92,  4; P.L. 1999, ch. 134,  4; Repealed by P.L. 2012, ch. 256,  17; P.L. 2012, ch. 262,  17, effective June 18, 2012. For comparable provisions, see  27-41-77. 
 27-41-41.3. Repealed. History of Section.P.L. 1994, ch. 301,  4; Repealed by P.L. 2012, ch. 256,  17; P.L. 2012, ch. 262,  17, effective June 18, 2012. For comparable provisions, see  27-41-77. 
 27-41-41. Repealed. History of Section.P.L. 1994, ch. 301,  4; P.L. 2002, ch. 292,  85; Repealed by P.L. 2012, ch. 256,  17; P.L. 2012, ch. 262,  17, effective June 18, 2012. For comparable provisions, see  27-41-77. 
 27-41-42. Repealed.
 27-41-43.1. Insurance coverage for mastectomy hospital stays. (a) The Rhode Island general assembly recognizes that breast cancer is a unique illness with both a physical and emotional impact on patients. Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for a minimum forty-eight (48) hour time period in a hospital after the surgical procedures known as a mastectomy, and a minimum twenty-four (24) hours after an axillary node dissection. Any decision to shorten this minimum coverage shall be made by the attending physician in consultation with and upon agreement by the patient. If the patient participates in an early discharge, defined as in-patient care following a mastectomy that is less than forty-eight (48) hours and in-patient care following an axillary node dissection that is less than twenty-four (24) hours, coverage shall include a minimum of one home visit conducted by a physician or registered nurse.  (b) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.  (c) Notice. All plans subject to this section shall provide notice to each enrollee:  (1) In the next mass mailing made by the plan to the employee; or  (2) As part of any informational packet sent to the enrollee.  History of Section.P.L. 1997, ch. 24,  4; P.L. 1997, ch. 25,  4; P.L. 2002, ch. 292,  85. 
 27-41-43. Mastectomy treatment. (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 patients physician, physician assistant, advance practice registered nurse, or surgeon.  (d)(1) [Deleted by P.L. 2018, ch. 114,  4 and P.L. 2018, ch. 204,  4.]  (2) 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.  (3) 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.  (4) Prohibitions. A group health plan and a health insurance carrier offering group or individual health insurance coverage may not:  (i) 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  (ii) 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.  History of Section.P.L. 1996, ch. 66,  4; P.L. 2002, ch. 292,  85; P.L. 2004, ch. 41,  4; P.L. 2004, ch. 45,  4; P.L. 2018, ch. 114,  4; P.L. 2018, ch. 204,  4. 
 27-41-44. Diabetes treatment. (a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state which provides medical coverage that includes coverage for physician services in a physicians office and every policy which provides major medical or similar comprehensive-type coverage shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes when medically appropriate and prescribed by a physician blood glucose monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to them, insulin infusion devices, oral agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation. Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this chapter shall guarantee coverage of this new diabetes equipment and supplies when medically appropriate and prescribed by a physician. These policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self-management and treatment of their diabetes, including information on the nutritional management of diabetes. This coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a significant change in the patients symptoms or conditions which necessitate changes in a patients self-management, or where reeducation or refresher training is necessary. This education, when medically necessary and prescribed by a physician, may be provided only by the physician or, upon his or her referral to an appropriately licensed and certified health care provider and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.  (b) Benefit plans offered by a health maintenance organization may impose copayment and/or deductibles for the benefits mandated by this chapter. However, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for other supplies, equipment, or physician office visits. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.  History of Section.P.L. 1996, ch. 106,  4; P.L. 2002, ch. 292,  85. 
 27-41-45.1. Hysterectomy or myomectomy treatment. 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.  History of Section.P.L. 2022, ch. 370,  4, effective June 29, 2022; P.L. 2022, ch. 371,  4, effective June 29, 2022. 
 27-41-45. Primary and preventive obstetric and gynecological care. Any insurer or nonprofit health service plan that provides obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health maintenance organization shall permit a woman to receive an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the woman to first obtain a referral from a primary care provider.  History of Section.P.L. 1997, ch. 166,  4; P.L. 1997, ch. 174,  4. 
 27-41-46. Whistleblowers protection. No health maintenance organizations pursuant to this chapter or any other insurer offering and/or insuring health services on a prepaid basis as defined in  42-62-4(7) shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state.  History of Section.P.L. 1997, ch. 167,  4. 
 27-41-47. Penalties and remedies. (a) Any person, firm, corporation, association or other legal entity who or which shall violate the provisions of  27-41-46 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one year, or by both a fine and imprisonment.  (b) In addition to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall willfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each violation, and each violation shall constitute a separate and distinct offense under this section.  History of Section.P.L. 1997, ch. 167,  4. 
 27-41-48. Additional relief and damages  Reinstatement. (a) A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.  (b) An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.  (c) The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of the provider agreement.  History of Section.P.L. 1997, ch. 167,  4. 
 27-41-49.1. Third party reimbursement for services of registered nurse first assistants. (a) Every individual or group health insurance contract, plan or policy delivered, issued or renewed by an insurer, health maintenance organization, nonprofit or for profit health service corporation which provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a registered nurse first assistant designed as such; provided, that the following conditions are met:  (1) The registered nurse first assistant provides certain health care services under the supervision of a licensed physician; is currently licensed as a registered nurse in Rhode Island; has successfully completed a course in preparing the registered nurse as a first assistant in accordance with the Association of Operating Room Nurses core curriculum guide for the registered nurse first assistant and includes a minimum of one academic year in a college or university with didactic instruction and clinical internship programs; and is certified in perioperative nursing by the Certification Board of Perioperative Nursing (minimum of two years perioperative experience);  (2) The policy or contract, currently provides benefits for identical services rendered by a provider of health care licensed by the state; and  (3) The registered nurse first assistant is not a salaried employee of the licensed hospital or facility for which the health maintenance organization has an alternative contractual relationship to fund the services of a registered nurse first assistant.  (b) It remains within the sole discretion of the health maintenance organization as to which registered nurse first assistant it contracts with. Reimbursement provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization is required to provide direct reimbursement, or pay for duplicative services actually rendered by a registered nurse first assistant and any other health care provider. Nothing contained in this section precludes the health maintenance organization from conducting managed care, medical necessity or utilization review.  History of Section.P.L. 1999, ch. 509,  4; P.L. 2002, ch. 292,  85. 
 27-41-49. Third-party reimbursement for services of certain healthcare workers. (a) Every individual or group health insurance contract, plan, or policy delivered, issued, or renewed by an insurer, health maintenance organization, nonprofit or for-profit health service corporation that provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the board of nurse registration and nursing education; provided, that the following conditions are met:  (1) The certified registered nurse anesthetist adheres to the practice of certified registered nurse anesthesia as defined by and in accordance with  5-34.2-2.  (2) The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and  (3) The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the health maintenance organization has an alternative contractual relationship to fund the services of a certified registered nurse anesthetist.  (b) It shall remain within the sole discretion of the health maintenance organization as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization may be required to pay for duplicative services actually rendered by a certified registered nurse anesthetist and any other healthcare provider. Nothing contained in this section shall preclude the health maintenance organization from conducting managed care, medical necessity, or utilization review.  (c) Providers. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that providers license or certification under applicable state law. This section shall not require that a group health plan or health insurance issuer contract with any healthcare provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures.  History of Section.P.L. 1997, ch. 345,  4; P.L. 1997, ch. 365,  4; P.L. 2002, ch. 292,  85; P.L. 2015, ch. 205,  4; P.L. 2015, ch. 223,  4. 
 27-41-5. Powers of health maintenance organizations. (a) The powers of a health maintenance organization include, but are not limited to, the following:  (1) The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and any property that may reasonably be required for its principal office or for any other purposes that may be necessary in the transaction of the business of the health maintenance organization as defined in  27-41-2(h);  (2) The making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation or corporations under its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees;  (3) The furnishing of health care services through providers that are under contract with or employed by the health maintenance organization;  (4) The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment, and administration;  (5) The contracting with an insurance company or a hospital or medical service corporation licensed in this state for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization;  (6) The offering, in addition to basic health care services, of:  (i) Additional health care services;  (ii) Indemnity benefits covering out of area or emergency services; and  (iii) Indemnity benefits, in addition to those relating to out of area and emergency services, provided through insurance companies or hospital or medical service corporations.  (b) A health maintenance organization shall file notice, with adequate supporting information, with the director of business regulation prior to the exercise of any power granted in subdivision (a)(1), (a)(2), or (a)(4) of this section. The director of business regulation shall disapprove any exercise of power only if in the directors opinion it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. The director of business regulation shall approve or disapprove any exercise of power within a reasonable time, subject to certification of approval from the director of health and to the requirements of chapter 15 of title 23, the Health Care Certificate of Need Act of Rhode Island.  (c) Investment in real estate may be made only for the purposes set forth in subdivision (a)(1) of this section, except that the health maintenance organization shall not be required to fully comply with the uses described in subdivision (a)(1) of this section until December 31 of the year following the year of purchase. Upon submission to the director of evidence demonstrating that the health maintenance organization is making satisfactory progress toward compliance with this subsection, the director may grant an extension of no more than one year beyond the time provided.  (d) The director of business regulation may promulgate rules and regulations exempting from the filing requirement of subsection (b) of this section those activities having a de minimis effect.  History of Section.P.L. 1983, ch. 225,  2; P.L. 2001, ch. 248,  1; P.L. 2001, ch. 330,  1. 
 27-41-50. Human leukocyte antigen testing. Every individual or group hospital or medical services plan contract delivered or renewed in this state shall include coverage of the cost for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B and DR antigens for utilization in bone marrow transplantation. The testing must be performed in a facility that is accredited by the American Association of Blood Banks or its successors, and is licensed under the Clinical Laboratory Improvement Act, 42 U.S.C.  263a, as it may be amended. At the time of the testing, the person being tested must complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program. The group hospital or medical services plan contract may limit each subscriber to one of these testings per lifetime.  History of Section.P.L. 1998, ch. 8,  4; P.L. 1998, ch. 9,  4; P.L. 2002, ch. 292,  85. 
 27-41-51. Drug coverage. (a) Any health maintenance organization that utilizes a formulary of medications for which coverage is provided under an individual or group plan master contract shall require any physician or other person authorized by the department of health to prescribe medication to prescribe from the formulary. A physician or other person authorized by the department of health to prescribe medication shall be allowed to prescribe medications previously on, or not on, the health maintenance organizations formulary if he or she believes that the prescription of non-formulary medication is medically necessary. A health maintenance organization shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the health maintenance organizations medical-exception criteria for the coverage of that medication.  (b) A health maintenance organizations medical-exception criteria for the coverage of non-formulary medications shall be developed in accordance with  23-17.13-3(c)(3) [repealed].  (c) Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23 [repealed].  (d) Prior to removing a prescription drug from its plans formulary or making any change in the preferred or tiered, cost-sharing status of a covered prescription drug, a health maintenance organization must provide at least thirty (30) days notice to authorized prescribers by established communication methods of policy and program updates and by updating available references on web-based publications. All adversely affected members must be provided at least thirty (30) days notice prior to the date such change becomes effective by a direct notification:  (i) The written or electronic notice must contain the following information:  (A) The name of the affected prescription drug;  (B) Whether the plan is removing the prescription drug from the formulary, or changing its preferred or tiered, cost-sharing status; and  (C) The means by which subscribers may obtain a coverage determination or medical exception, in the case of drugs that will require prior authorization or are formulary exclusions respectively.  (ii) A health maintenance organization may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the health maintenance organization or the Food and Drug Administration, or removed from the market by their manufacturer, without meeting the requirements of this section.  History of Section.P.L. 1998, ch. 290,  5; P.L. 2016, ch. 541,  5; P.L. 2017, ch. 274,  5; P.L. 2017, ch. 361,  5. 
 27-41-52. Restricted annual rate payments prohibited. (a) No corporation organized under this chapter shall compensate any provider of outpatient service by using the restricted annual rate method of payment.  (b) The restricted annual rate method of payment is defined as any method of payment that sets, as all or part of its payment scheme, a total payment limit for mental health and/or substance abuse treatment services for each person seeking treatment based on a per person per unit of time criterion that disregards the extent of treatment and/or degree of services rendered.  (c) This prohibition shall not be construed to prohibit or limit capitation or other risk sharing agreements between providers and insurers permissible by law.  History of Section.P.L. 1998, ch. 352,  4. 
 27-41-53.1. Genetic information. (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.  (b) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage excluding disability income, long term care and insurance supplemental policies which only provide coverage for specified diseases or other supplemental policies, shall:  (1) Use genetic information or request for genetic information or the results of genetic information or other genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a group or an individuals health insurance policy, contract, or plan;  (2) Request or require genetic information for the purpose of determining whether or not to issue or renew an individuals health benefits coverage, to set reimbursement/co-pay levels or determine covered benefits and services;  (3) Release the results of genetic information without the prior written authorization of the individual from whom the information was obtained, except in a format by which individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each re-disclosure. An exception shall exist for participation in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule);  (4) Request or require information as to whether an individual has genetic information, or participated in genetic information of any kind, whether for clinical or research purposes.  (c) For the purposes of this section, genetic information is information about genes, gene product, or inherited characteristics that may derive from the individual or a family member.  History of Section.P.L. 2001, ch. 38,  8; P.L. 2001, ch. 54,  8; P.L. 2002, ch. 292,  85. 
 27-41-53. Genetic testing. (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.  (b) No health maintenance organization subject to the provisions of this chapter shall:  (1) Use a genetic test or request for genetic test the results of a genetic test to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a group or an individuals health insurance policy contract, or plan;  (2) Request or require a genetic test for the purpose of determining whether or not to issue or renew an individuals health benefits coverage, to set reimbursement/co-pay levels or determine covered benefits and services;  (3) Release the results of a genetic test without the prior written authorization of the individual from whom the test was obtained, except in a format where individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each re-disclosure. An exception shall exist for participation in research settings governed by the federal policy for the protection of human research subjects (also known as The Common Rule); or  (4) Request or require information as to whether an individual has ever had a genetic test, or participated in genetic testing of any kind, whether for clinical or research purposes.  (c) For the purposes of this section, genetic testing is the analysis of an individuals DNA, RNA, chromosomes, protein and certain metabolites in order to detect heritable inheritable disease-related genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes include predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or prognosis. Prenatal, newborn and carrier screening, and testing in high risk families may be included provided there is an approved release by a parent or guardian. Tests for metabolites are covered only when they are undertaken with high probability that an excess or deficiency of the metabolite indicates the presence of heritable mutations in single genes. Genetic testing does not mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs or for HIV infections.  History of Section.P.L. 1998, ch. 380,  4; P.L. 2001, ch. 38,  7; P.L. 2001, ch. 54,  7. 
 27-41-54. Disassociation prohibited. Notwithstanding any provision of the general or public laws to the contrary, no individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state which provides medical coverage for physician services in a physicians office, and no policy which provides major medical or similar comprehensive-type coverage for specified diseases or other supplemental polices, shall prohibit a medical provider from ceasing an association with and participation in one health maintenance organization and associating and participating with another health maintenance organization doing business in this state.  History of Section.P.L. 1998, ch. 460,  1; P.L. 2002, ch. 292,  85. 
 27-41-55. Repealed.
 27-41-56. Magnetic resonance imaging  Quality assurance standards. (a) Except as otherwise provided in subsection (b) of this section, a magnetic resonance imaging examination eligible for reimbursement under the provisions of any individual or group health insurance contract, plan or policy delivered in this state shall be reimbursed only if the facility at which the examination has been conducted and processed is accredited by either the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC) or an alternate nationally recognized accrediting organization whose accreditation standards are substantially similar to and no less stringent than current or subsequent ACR or IAC standards and have been reviewed and deemed adequate by the department of health. All accreditation standards under this section, whether promulgated by the ACR, IAC, or an alternate nationally recognized accrediting organization, shall include, but shall not be limited to, provisions for establishing the qualifications of the physician, standards for quality control and routine performance monitoring by a medical physicist, qualifications of the technologist including minimum standards of supervised clinical experience, personnel and patient safety guidelines, and standards for initial and ongoing quality control using clinical image review and quantitative testing.  (b) Any facility conducting and processing magnetic resonance imaging examinations which, as of June 30, 2006 is receiving reimbursement for such services by a health insurer, health maintenance organization or health plan, but is not accredited pursuant to subsection (a), shall file its application for accreditation within eighteen (18) months of June 28, 2007. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. A facility which begins conducting and processing, of magnetic resonance imaging examinations after June 30, 2006 shall file its application for accreditation within twelve (12) months of the date of initiation of the magnetic resonance imaging examinations. Such accreditation shall be obtained not later than twelve (12) months after submission of its application. After such accreditation is obtained, a facility conducting and processing, magnetic resonance imaging examinations shall, at all times, maintain accreditation with the appropriate accrediting body. Notwithstanding anything herein to the contrary, any facility which has filed for accreditation pursuant to this subsection (b) and which has not been refused accreditation or withdrawn its application, will be deemed provisionally accredited for the twelve (12) month period dating from the application filing date. Provided, further, that notwithstanding any provisions of the general or public laws to the contrary, any facility conducting and processing magnetic resonance imaging examinations shall conform to the standards of the appropriate accrediting body at all times, including during the accreditation process and shall certify said conformance to any reimbursing health insurer, health maintenance organization or health plan.  History of Section.P.L. 1999, ch. 169,  6; P.L. 2003, ch. 376, art. 34,  5; P.L. 2005, ch. 207,  5; P.L. 2006, ch. 596,  5; P.L. 2007, ch. 140,  5; P.L. 2007, ch. 277,  5; P.L. 2008, ch. 475,  94. 
 27-41-57. Acupuncture services. (a) Every group health insurance contract, plan, or group policy delivered, issued for delivery or renewed in this state which provides medical coverage, and every group policy which provides for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition shall provide, as an optional rider, coverage for the services of a doctor of acupuncture as a provider of acupuncture services.  (b) For the purposes of this section:  (1) Doctor of acupuncture means a practitioner licensed under chapter 37.2 of title 5.  (2) Coverage for the services of a doctor of acupuncture as a provider of acupuncture services means coverage for acupuncture as defined in section 5-37.2-2(1).  (c) It remains within the sole discretion of the health maintenance organization as to which doctor of acupuncture it contracts with. Reimbursement is provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization is required to pay for duplicative services actually rendered by a doctor of acupuncture and any other health care provider. Nothing contained in this section precludes the health maintenance organization from conducting managed care, medical necessity or utilization review.  History of Section.P.L. 1999, ch. 288,  4. 
 27-41-58. Prohibition against requiring indemnification from dentists. No contract between a health maintenance organization (H.M.O.) and a dentist containing provisions for the provision of services to patients may require that the dentist indemnify or hold harmless the health maintenance organization for any expenses and liabilities, including without limitation, judgments, settlements, attorneys fees, court costs, and any associated charges, incurred in connection with any claim or action brought against the H.M.O. based on the H.M.O.s management decisions, or utilization review provisions for any patient.  History of Section.P.L. 1999, ch. 481,  5. 
 27-41-59. F.D.A. approved prescription contraceptive drugs and devices. (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 F.D.A. 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 employers 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.  History of Section.P.L. 2000, ch. 120,  4; P.L. 2000, ch. 126,  4; P.L. 2002, ch. 292,  85; P.L. 2018, ch. 230,  8; P.L. 2018, ch. 234,  8. 
 27-41-6. Governing body. (a) The governing body of any health maintenance organization may include providers, other individuals, or both.  (b) The governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms.  History of Section.P.L. 1983, ch. 225,  2. 
 27-41-60. Prostate and colorectal examinations  Coverage mandated  The Maryellen Goodwin Colorectal Cancer Screening Act.  (a) Subscribers to any health maintenance organization plan shall be afforded coverage under that plan for prostate and colorectal examinations and laboratory tests for cancer for any nonsymptomatic person covered under the policy or plan. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal.  (b) An insurer or the organization may not impose cost sharing on the coverage required by subsection (a) when the services are delivered within the health insurers provider network.  History of Section.P.L. 2000, ch. 125,  4; P.L. 2000, ch. 345,  4; P.L. 2021, ch. 7,  5, effective April 29, 2021; P.L. 2021, ch. 8,  5, effective April 29, 2021. 
 27-41-61. Eligibility for childrens benefits. (a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state which provides health benefits coverage for dependents, except for supplemental policies which only provide coverage for specified diseases and other supplemental policies, shall make coverage available for children until attainment of twenty-six (26) years of age, and an unmarried child of any age who is financially dependent upon the parent and medically determined to have a physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve (12) months.  (2) With respect to a child who has not attained twenty-six (26) years of age, a health maintenance organization shall not define dependent for purposes of eligibility for dependent coverage of children other than the terms of a relationship between a child and the plan participant, or subscriber.  (3) A health maintenance organization shall not deny or restrict coverage for a child who has not attained twenty-six (26) years of age based on the presence or absence of the childs financial dependency upon the participant, primary subscriber or any other person, residency with the participant and in the individual market the primary subscriber, or with any other person, marital status, student status, employment or any combination of those factors. A health carrier shall not deny or restrict coverage of a child based on eligibility for other coverage, except as provided in (b)(1) of this section.  (4) Nothing in this section shall be construed to require a health maintenance organization to make coverage available for the child of a child receiving dependent coverage, unless the grandparent becomes the legal guardian or adoptive parent of that grandchild.  (5) The terms of coverage in a health benefit plan offered by a health maintenance organization providing dependent coverage of children cannot vary based on age except for children who are twenty-six (26) years of age or older.  (b)(1) For plan years beginning before January 1, 2014, a group health plan providing group health insurance coverage that is a grandfathered health plan and makes available dependent coverage of children may exclude an adult child who has not attained twenty-six (26) years of age from coverage only if the adult child is eligible to enroll in an eligible employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of the federal Internal Revenue Code, other than the group health plan of a parent.  (2) For plan years, beginning on or after January 1, 2014, a group health plan providing group health insurance coverage that is a grandfathered health plan shall comply with the requirements of this section  (c) This section does not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; or (8) other limited benefit policies.  History of Section.P.L. 2000, ch. 214,  6; P.L. 2006, ch. 377,  5; P.L. 2006, ch. 469,  5; P.L. 2012, ch. 256,  9; P.L. 2012, ch. 262,  9. 
 27-41-62. Temporary credentials. Notwithstanding any requirements of any health maintenance organization accrediting body or organization to the contrary, each health maintenance organization licensed under this chapter may credential a provider on a conditional basis while the health maintenance organization reviews the application submitted by the provider for inclusion in the health maintenance organization network or networks.  History of Section.P.L. 2000, ch. 346,  1. 
 27-41-63. Hearing aids. (a)(1) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide coverage for one thousand five hundred dollars ($1,500) per individual hearing aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall provide coverage for seven hundred dollars ($700) per individual hearing aid per ear, every three (3) years for anyone of the age of nineteen (19) years and older.  (2) Every group health insurance contract or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2006, shall provide, as an optional rider, additional hearing aid coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group policies subject to the small employer health insurance availability act, chapter 50 of this title.  (b) For the purposes of this section, hearing aid means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices, including, but not limited to FM systems.  (c) It shall remain within the sole discretion of the health maintenance organizations as to the provider of hearing aids with which they choose to contract. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organizations. Nothing contained in this section precludes the health maintenance organizations from conducting managed care, medical necessity, or utilization review.  History of Section.P.L. 2000, ch. 461,  4; P.L. 2004, ch. 539,  4; P.L. 2004, ch. 550,  4; P.L. 2005, ch. 374,  4; P.L. 2005, ch. 395,  4; P.L. 2006, ch. 595,  4; P.L. 2006, ch. 614,  4. 
 27-41-64. Prompt processing of claims. (a) A health care entity or health plan operating in the state shall pay all complete claims for covered health care services submitted to the health care entity or health plan by a health care provider or by a policyholder within forty (40) calendar days following the date of receipt of a complete written claim or within thirty (30) calendar days following the date of receipt of a complete electronic claim. Each health plan shall establish a written standard defining what constitutes a complete claim and shall distribute this standard to all participating providers.  (b) If the health care entity or health plan denies or pends a claim, the health care entity or health plan shall have thirty (30) calendar days from receipt of the claim to notify in writing the health care provider or policyholder of any and all reasons for denying or pending the claim and what, if any, additional information is required to process the claim. No health care entity or health plan may limit the time period in which additional information may be submitted to complete a claim.  (c) Any claim that is resubmitted by a health care provider or policyholder shall be treated by the health care entity or health plan pursuant to the provisions of subsection (a) of this section.  (d) A health care entity or health plan which fails to reimburse the health care provider or policyholder after receipt by the health care entity or health plan of a complete claim within the required timeframes shall pay to the health care provider or the policyholder who submitted the claim, in addition to any reimbursement for health care services provided, interest which shall accrue at the rate of twelve percent (12%) per annum commencing on the thirty-first (31st) day after receipt of a complete electronic claim or on the forty-first (41st) day after receipt of a complete written claim, and ending on the date the payment is issued to the health care provider or the policyholder.  (e) Exceptions to the requirements of this section are as follows:  (1) No health care entity or health plan operating in the state shall be in violation of this section for a claim submitted by a health care provider or policyholder if:  (i) Failure to comply is caused by a directive from a court or federal or state agency;  (ii) The health care entity or health plan is in liquidation or rehabilitation or is operating in compliance with a court-ordered plan of rehabilitation; or  (iii) The health care entity or health plans compliance is rendered impossible due to matters beyond its control, which are not caused by it.  (2) No health care entity or health plan operating in the state shall be in violation of this section for any claim: (i) initially submitted more than ninety (90) days after the service is rendered, or (ii) resubmitted more than ninety (90) days after the date the health care provider received the notice provided for in  27-18-61(b); provided, this exception shall not apply in the event compliance is rendered impossible due to matters beyond the control of the health care provider and were not caused by the health care provider.  (3) No health care entity or health plan operating in the state shall be in violation of this section while the claim is pending due to a fraud investigation by a state or federal agency.  (4) No health care entity or health plan operating in the state shall be obligated under this section to pay interest to any health care provider or policyholder for any claim if the director of the department of business regulation finds that the entity or plan is in substantial compliance with this section. A health care entity or health plan seeking that finding from the director shall submit any documentation that the director shall require. A health care entity or health plan which is found to be in substantial compliance with this section shall submit any documentation the director may require on an annual basis for the director to assess ongoing compliance with this section.  (5) A health care entity or health plan may petition the director for a waiver of the provision of this section for a period not to exceed ninety (90) days in the event the health care entity or health plan is converting or substantially modifying its claims processing systems.  (f) For purposes of this section, the following definitions apply:  (1) Claim means: (i) a bill or invoice for covered services; (ii) a line item of service; or (iii) all services for one patient or subscriber within a bill or invoice.  (2) Date of receipt means the date the health care entity or health plan receives the claim whether via electronic submission or as a paper claim.  (3) Health care 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 described in  23-17.13-2(2) that operates a health plan.  (4) Health care provider means an individual clinician, either in practice independently or in a group, who provides health care services, and is referred to as a non-institutional provider.  (5) Health care services include, but are not limited to, medical, mental health, substance abuse, dental and any other services covered under the terms of the specific health plan.  (6) Health plan means a plan operated by a health care entity that provides for the delivery of health care services to persons enrolled in the plan through:  (i) Arrangements with selected providers to furnish health care services; and/or  (ii) Financial incentive for persons enrolled in the plan to use the participating providers and procedures provided for by the health plan.  (7) Policyholder means a person covered under a health plan or a representative designated by that person.  (8) Substantial compliance means that the health care entity or health plan is processing and paying ninety-five percent (95%) or more of all claims within the time frame provided for in  27-18-61(a) and (b).  (g) Any provision in a contract between a health care entity or a health plan and a health care provider which is inconsistent with this section shall be void and of no force and effect.  History of Section.P.L. 2001, ch. 119,  4; P.L. 2001, ch. 380,  4; P.L. 2002, ch. 292,  85. 
 27-41-65. Mandatory coverage for certain lyme disease treatments. Subscribers to any health maintenance organization plan shall be afforded coverage under that plan on or after January 1, 2004 for diagnostic testing and long term antibiotic treatment of chronic lyme disease when determined to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of title 5 entitled lyme disease diagnosis and treatment after making a thorough evaluation of the patients symptoms, diagnostic test results and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as unproven, experimental, or investigational in nature.  History of Section.P.L. 2003, ch. 113,  6; P.L. 2003, ch. 114,  6; P.L. 2004, ch. 34,  5; P.L. 2004, ch. 35,  5. 
 27-41-66. Dental insurance assignment of benefits. Every entity licensed under this chapter shall allow, as a provision of any evidence of coverage of dental services, any person covered by such entity to direct, in writing, that benefits from a health benefit plan, policy or contract, be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by such entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to such entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving such payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.  History of Section.P.L. 2004, ch. 268,  5; P.L. 2004, ch. 386,  5. 
 27-41-67. Determination of maximum coverage limitation for prescription drug benefits. The calculation of subscriber maximum coverage limitations for prescription drug coverage shall be based upon the actual cost incurred by the health maintenance organization for the purchase of the covered prescription drug.  History of Section.P.L. 2004, ch. 412,  1. 
 27-41-68. Coverage for early intervention services. (a) Every individual or group hospital or medical expense insurance policy or contract providing coverage for dependent children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of early intervention services which coverage shall take effect no later than January 1, 2005. Such coverage shall 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.  1471 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.  History of Section.P.L. 2004, ch. 595, art. 22,  4; P.L. 2004, ch. 598,  5; P.L. 2005, ch. 97,  4; P.L. 2005, ch. 99,  4; P.L. 2008, ch. 475,  94. 
 27-41-69. Post-payment audits. (a) Except as otherwise provided herein, any review, audit, or investigation by a health maintenance organization of a healthcare providers 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 payers 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  27-41-2, 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 which allow for different time frames than are prescribed herein.  History of Section.P.L. 2006, ch. 86,  5; P.L. 2006, ch. 97,  5; P.L. 2013, ch. 251,  4; P.L. 2013, ch. 395,  4; P.L. 2014, ch. 201,  4; P.L. 2014, ch. 214,  4; P.L. 2017, ch. 368,  4; P.L. 2017, ch. 375,  4; P.L. 2022, ch. 157,  4, effective June 27, 2022; P.L. 2022, ch. 158,  4, effective June 27, 2022. 
 27-41-7. Fiduciary responsibilities. (a) Any director, officer, or employee of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the organization shall be responsible for those funds in a fiduciary relationship to the enrollees.  (b) A health maintenance organization shall maintain in force a fidelity bond on employees or officers in an amount not less than one hundred thousand dollars ($100,000) or any greater sum that may be prescribed by the director. All fidelity bonds shall be written with at least a one year discovery period and if written with less than a three (3) year discovery period shall contain a provision that no cancellation or termination of the bond, whether by or at the request of the insured or by the underwriter, shall take effect prior to the expiration of ninety (90) days after written notice of cancellation or termination has been filed with the director unless an earlier date of cancellation or termination is approved by the director.  History of Section.P.L. 1983, ch. 225,  2. 
 27-41-70. Tobacco cessation programs. (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, which provides medical coverage that includes coverage for physician services in a physicians office, and every policy which provides major medical or similar comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided that if such medical coverage does not include prescription drug coverage, such contract, plan or policy shall not be required to include coverage 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 US 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 (12) hour evidence based smoking cessation counseling sessions provided by a qualified practitioner for each covered individual. Smoking cessation treatment may be redefined through regulation promulgated by the health insurance commissioner in accordance with the most current clinical practice guidelines sponsored by the United States department of health and human services or its component agencies.  (c) Health insurance contracts, plans, or policies to which this section applies, may impose copayments and/or deductibles for the benefits mandated by this section consistent with the contracts, plans or policies copayments and/or deductibles for physician services and medications. Nothing contained in this section shall impact the reimbursement, medical necessity or utilization review, managed care, or case management practices of these health insurance contracts, plans or policies.  (d) This section shall not apply to insurance coverage providing benefits for:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Limited benefit health;  (7) Specified disease indemnity;  (8) Sickness or bodily injury or death by accident or both; and  (9) Other limited benefit policies.  History of Section.P.L. 2006, ch. 262,  4; P.L. 2006, ch. 293,  4; P.L. 2008, ch. 475,  94; P.L. 2009, ch. 187,  4; P.L. 2009, ch. 291,  4. 
 27-41-71. Mandatory coverage for scalp hair prosthesis. (a) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2007, which provides coverage for any other prosthesis shall provide coverage for expenses for scalp hair prosthesis worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia; provided, however, that such coverage shall be subject to the same limitations and guidelines as other prosthesis, and that coverage shall not exceed an amount of three hundred fifty dollars ($350) per covered member per year, exclusive of any deductible.  (b) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 2006, ch. 538,  4. 
 27-41-72. Reimbursement for orthotic and prosthetic services. (a) As used in this section:  (1) Federal reimbursement rates means the current listed fee schedule from the Centers for Medicare and Medicaid Services, listing the current Healthcare Common Procedure Coding system (HCPCS) and the corresponding reimbursement rates.  (2) Orthosis means a custom fabricated brace or support that is designed based on medical necessity. Orthosis does not include prefabricated or direct-formed orthotic devices, as defined in this section, or any of the following assistive technology devices: commercially available knee orthoses used following injury or surgery; spastic muscle-tone inhibiting orthoses; upper extremity adaptive equipment; finger splints; hand splints; wrist gauntlets; face masks used following burns; wheelchair seating that is an integral part of the wheelchair and not worn by the patient independent of the wheelchair; fabric or elastic supports; corsets; low-temperature formed plastic splints; trusses; elastic hose; canes; crutches; cervical collars; dental appliances; and other similar devices as determined by the director of the department of health, such as those commonly carried in stock by a pharmacy, department store, corset shop, or surgical supply facility.  (3) Orthotics means the science and practice of evaluating measuring, designing, fabricating, assembling, fitting, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of, an orthosis for the support, correction, or alleviation of neuromuscular or musculoskeletal dysfunction, disease, injury or deformity. The practice of orthotics encompasses evaluation, treatment, and consultation; with basic observational gait and postural analysis, orthotists assess and design orthoses to maximize function and provide not only the support but the alignment necessary to either prevent or correct a deformity or to improve the safety and efficiency of mobility or locomotion or both. Orthotic practice includes providing continuing patient care in order to assess its effect on the patients tissues and to assure proper fit and function of the orthotic device by periodic evaluation.  (4) Prosthesis means an artificial limb that is alignable or, in lower-extremity applications capable of weight bearing. Prosthesis means an artificial medical device that is not surgically implanted and that is used to replace a missing limb, appendage, or other external human body part including an artificial limb, hand, or foot. The term does not include artificial eyes, ears, noses, dental appliances, osotmy products, or devices such as eyelashes or wigs.  (5) Prosthetics means the science and practice of evaluation, measuring, designing, fabricating, assembling, fitting, aligning, adjusting or servicing, as well as providing the initial training necessary to accomplish the fitting of, a prosthesis through the replacement of external parts of a human body lost due to amputation or congenital deformities or absences. The practice of prosthetics also includes the generation of an image, form, or mold that replicates the patients body or body segment and that requires rectification of dimensions, contours and volumes for use in the design and fabrication of a socket to accept a residual anatomic limb to, in turn, create an artificial appendage that is designed either to support body weight or to improve or restore function or cosmesis, or both. Involved in the practice of prosthetics is observational gait analysis and clinical assessment of the requirements necessary to refine and mechanically fix the relative position of various parts of the prosthesis to maximize function, stability, and safety of the patient. The practice of prosthetics includes providing and continuing patient care in order to assess the prosthetic devices effect on the patients tissues and to assure proper fit and function of the prosthetic device by periodic evaluation.  (6) Private insurance company means any insurance company, or management company hired by an insurance company, who is any of the following:  (i) Based in the state of Rhode Island; or  (ii) Provides coverage for citizens for the state of Rhode Island; or  (iii) Allows subscribing patients to seek prosthetic or orthotic services in the state of Rhode Island.  (b) Every individual or group health insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after January 1, 2008, which provides medical coverage that includes coverage for physician services in a physicians office and every policy, which provides major medical or similar comprehensive type coverage shall provide coverage for benefits for orthotic and prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C.  1395K, 1395l and 1395M and 42 CFR 414.202, 414.210, 414.228, and 410.100 as applicable to this section.  (c) A health insurance contract, plan or policy may require prior authorization for orthotic and prosthetic devices in the same manner that prior authorization is required for any other covered benefit.  (d) Covered benefits for orthotic or prosthetic devices shall be limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insureds treating physician.  (e) The repair and replacement of orthotic or prosthetic devices also shall be covered subject to co-payments and deductibles, unless necessitated by misuse or loss.  (f) An insurer may require, if coverage is provided through a managed care plan, that benefits mandated pursuant to this section be covered benefits only if the orthotic or prosthetic devices are provided by a vendor and orthotic or prosthetic services are rendered by a provider who is authorized by the state of Rhode Island to provide orthotics and prosthetics.  (g) This chapter 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 death by accident or both; and  (9) Other limited benefit policies.  History of Section.P.L. 2007, ch. 29,  1; P.L. 2007, ch. 35,  1. 
 27-41-73. Licensed ambulance service. (a) No individual or group health insurance contract, plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009 shall provide for a co-payment for ground ambulance services in excess of fifty dollars ($50.00).  (b) As used in this section, the term ground ambulance services shall mean those services provided by an ambulance service licensed to operate in Rhode Island in accordance with  23-4.1-6. The term excludes air and water ambulance services and ambulance services provided outside of Rhode Island.  (c) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.  History of Section.P.L. 2008, ch. 68,  4; P.L. 2008, ch. 70,  4. 
 27-41-74. Enteral nutrition products. (a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and that are medically necessary for the treatment of malabsorption caused by Crohns disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein and shall extend to all recipients regardless of age.  (b) Benefit plans offered by a health maintenance organization may impose a copayment and/or deductible for the benefits mandated by this section, however, in no instance shall the copayment or deductible amount be greater than the copayment of deductible amount imposed for prescription enteral formulas or nutritional aids. Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization. Reimbursement shall be provided according to the respective principles and policies of the accident and sickness insurer. Nothing contained in this section precludes the accident and sickness insurer from conducting managed care, medical necessity, or utilization review.  (c) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited-benefit policies.  History of Section.P.L. 2008, ch. 253,  4; P.L. 2014, ch. 269,  4; P.L. 2014, ch. 519,  4. 
 27-41-75. Prohibition on rescission of coverage. (a)(1) Coverage under a health plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be rescinded after the individual is covered under the plan, unless:  (A) The individual or a person seeking coverage on behalf of the individual, performs an act, practice or omission that constitutes fraud; or  (B) The individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage.  (2) For purposes of paragraph (1)(A), a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health maintenance organization.  (b) At least thirty (30) days advance written notice shall be provided to each plan enrollee or, for individual health insurance coverage, primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of, in the case of group health insurance coverage, whether the rescission applies to the entire group or only to an individual within the group.  (c) For purposes of this section, to rescind means to cancel or to discontinue coverage with retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.  (d) This section applies to grandfathered health plans.  History of Section.P.L. 2012, ch. 256,  10; P.L. 2012, ch. 262,  10. 
 27-41-76. Prohibition on annual and lifetime limits. (a) Annual limits.(1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health maintenance organization subject to the jurisdiction of the commissioner under this chapter may establish an annual limit on the dollar amount of benefits that are essential health benefits provided the restricted annual limit is not less than the following:  (A) For a plan or policy year beginning after September 22, 2011, but before September 23, 2012  one million two hundred fifty thousand dollars ($1,250,000); and  (B) For a plan or policy year beginning after September 22, 2012, but before January 1, 2014  two million dollars ($2,000,000).  (2) For plan or policy years beginning on or after January 1, 2014, a health maintenance organization shall not establish any annual limit on the dollar amount of essential health benefits for any individual, except:  (A) A health flexible spending arrangement, as defined in section 106(c)(2)(i) of the federal Internal Revenue Code, a medical savings account, as defined in section 220 of the federal Internal Revenue Code, and a health savings account, as defined in section 223 of the federal Internal Revenue Code are not subject to the requirements of subdivisions (1) and (2) of this subsection.  (B) The provisions of this subsection shall not prevent a health maintenance organization from placing annual dollar limits for any individual on specific covered benefits that are not essential health benefits to the extent that such limits are otherwise permitted under applicable federal law or the laws and regulations of this state.  (3) In determining whether an individual has received benefits that meet or exceed the allowable limits, as provided in subdivision (1) of this subsection, a health maintenance organization shall take into account only essential health benefits.   (b) Lifetime limits.(1) A health insurance carrier and health benefit plan offering group or individual health insurance coverage shall not establish a lifetime limit on the dollar value of essential health benefits for any individual.  (2) Notwithstanding subdivision (1) above, a health insurance carrier and health benefit plan is not prohibited from placing lifetime dollar limits for any individual on specific covered benefits that are not essential health benefits in accordance with federal laws and regulations.   (c)(1) The provisions of this section relating to lifetime limits apply to any health maintenance organization or health insurance carrier providing coverage under an individual or group health plan, including grandfathered health plans.  (2) The provisions of this section relating to annual limits apply to any health maintenance organization or health insurance carrier providing coverage under a group health plan, including grandfathered health plans, but the prohibition and limits on annual limits do not apply to grandfathered health plans providing individual health insurance coverage.  (d) This section shall not apply to a plan or to policy years prior to January 1, 2014, for which the Secretary of the U.S. Department of Health and Human Services issued a waiver pursuant to 45 C.F.R.  147.126(d)(3). This section also shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  (e) If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioners determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this subsection shall be construed to limit the authority of the Commissioner to regulate health insurance under existing state law.  History of Section.P.L. 2012, ch. 256,  10; P.L. 2012, ch. 262,  10. 
 27-41-77. Coverage for individual participating in approved clinical trials. (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:  (A) The study or investigation is approved or funded, which may include funding through in-kind contributions, by one or more of the following:  (i) The federal National Institutes of Health;  (ii) The federal Centers for Disease Control and Prevention;  (iii) The federal Agency for Health Care Research and Quality;  (iv) The federal Centers for Medicare & Medicaid Services;  (v) A cooperative group or center of any of the entities described in items (i) through (iv) or the U.S. Department of Defense or the U.S. Department of Veteran Affairs;  (vi) A qualified non-governmental research entity identified in the guidelines issued by the federal National Institutes of Health for center support grants; or  (vii) A study or investigation conducted by the U.S. Department of Veteran 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 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.  (B) The study or investigation is conducted under an investigational new drug application reviewed by the U.S. Food and Drug Administration; or  (C) The study or investigation is a drug trial that is exempt from having such an investigational new drug application.  (2) Participant has the meaning stated in section 3(7) of federal ERISA [29 U.S.C.  1002].  (3) 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.  (4) Qualified individual means a participant or beneficiary who meets the following conditions:  (A) 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  (B)(i) The referring healthcare professional is a participating provider and has concluded that the individuals participation in such trial would be appropriate based on the individual meeting the conditions described in subdivision (A) of this subdivision (3); or  (ii) The participant or beneficiary provides medical and scientific information establishing the individuals participation in such trial would be appropriate based on the individual meeting the conditions described in subdivision (A) of this subdivision (3).  (5) 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.  (b)(1) If a health maintenance organization offering group or individual health insurance coverage provides coverage to a qualified individual, it:  (A) Shall not deny the individual participation in an approved clinical trial.  (B) Subject to subdivision (3) of this subsection, 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  (C) Shall not discriminate against the individual on the basis of the individuals participation in the approved clinical trial.  (2)(A) Subject to subdivision (B) of this subdivision (2), 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.  (B) For purposes of subdivision (B) of this subdivision (2), routine patient costs do not include:  (i) The investigational item, device or service itself;  (ii) 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  (iii) 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 subdivision (1) of this subsection 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 subdivision (3) of this subsection, subdivision (1) of this subsection 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 coverages healthcare provider network unless out-of-network benefits are other provided under the coverage.  (6) Nothing in this section shall be construed to limit a health maintenance organizations 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.  (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.  History of Section.P.L. 2012, ch. 256,  10; P.L. 2012, ch. 262,  10. 
 27-41-78. Medical loss ratio reporting and rebates. (a) A health maintenance organization offering group or individual health insurance coverage of a health benefit plan, including a grandfathered health plan, shall comply with the provisions of Section 2718 of the Public Health Service Act as amended by the federal Affordable Care Act [42 U.S.C.  300gg-18], in accordance with regulations adopted thereunder.  (b) Health maintenance organizations required to report medical loss ratio and rebate calculations and any other medical loss ratio or rebate information to the U.S. Department of Health and Human Services shall concurrently file such information with the commissioner.  History of Section.P.L. 2012, ch. 256,  10; P.L. 2012, ch. 262,  10. 
 27-41-79. Emergency services. (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:  (A) 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  (B) 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:  (A) The exclusion of or coordination of benefits;  (B) An affiliation or waiting period permitted under part 7 of federal ERISA, part A of title XXVII of the federal PHS Act, or chapter 100 of the federal Internal Revenue Code; or  (C) 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 subdivision (1) of this subsection. A health maintenance organization complies with the requirements of this subsection if it provides benefits with respect to an emergency service in an amount equal to the greatest of the three amounts specified in subdivisions (A), (B), and (C) of this subdivision (1) (which are adjusted for in-network cost-sharing requirements).  (A) 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 subdivision (A) 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 subdivision (A) is disregarded.  (B) 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 subdivision (B) 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.  (C) 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.  History of Section.P.L. 2012, ch. 256,  10; P.L. 2012, ch. 262,  10. 
 27-41-8. Evidence of coverage and charges for health care services. (a) Every enrollee residing in this state is entitled to evidence of coverage for the payment and for the provision of health care services under a health maintenance organization. The health maintenance organization shall issue that evidence of coverage.  (b) Any evidence of coverage issued by a health maintenance organization licensed under this chapter shall comply with the minimum standards protection of  42-62-12 and regulations pursuant to that section.  (c) No schedule of charges, rates, or rating formulae for enrollee coverage for health care services, or amendment to any schedule, may be used by any health maintenance organization until a copy of that schedule, rate, or rating formula, or amendment to it, has been filed with and approved by the director under the provisions of  42-62-13.  History of Section.P.L. 1983, ch. 225,  2. 
 27-41-80. Internal and external appeal of adverse benefit determinations. (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 within the jurisdiction of the department of health pursuant to  23-17.12 et seq. (Utilization Review Act).  (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.  History of Section.P.L. 2012, ch. 256,  10; P.L. 2012, ch. 262,  10. 
 27-41-81. Prohibition on preexisting condition exclusions. (a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title and/or chapter:  (1) Shall not limit or exclude coverage for an individual under the age of nineteen (19) by imposing a preexisting condition exclusion on that individual.  (2) For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude coverage for any individual by imposing a preexisting condition exclusion on that individual.  (b) As used in this section:  (1) Preexisting condition exclusion means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition (whether physical or mental) was present before the effective date of coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, diagnosis, care or treatment was recommended or received before the effective date of coverage.  (2) Preexisting condition exclusion means any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individuals health status before the individuals effective date of coverage, or if the coverage is denied, the date of denial, under the health benefit plan, such as a condition (whether physical or mental) identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period.  (c) This section shall not apply to grandfathered health plans providing individual health insurance coverage.  (d) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  History of Section.P.L. 2012, ch. 256,  10; P.L. 2012, ch. 262,  10. 
 27-41-82. Primary care provider designation requirement. Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2013, shall require that the subscriber and each dependent designate a participating primary care provider and the insurer shall collect the designation from the insured. Designation of a primary care provider shall not be a condition of enrollment and failure to designate a primary care provider shall not constitute grounds for cancellation of coverage. For purposes of this section, primary care provider means the physician, practice or other medical provider considered by the insured to be his or her usual source of medical care.  History of Section.P.L. 2012, ch. 189,  4; P.L. 2012, ch. 202,  4. 
 27-41-83. Discretionary clauses. (a) No new or existing policy or certificate may contain any provision:  (1) Purporting to reserve sole discretion to the insurance company to determine eligibility for benefits or interpret the terms of a policy or certificate; or  (2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.  (b) Any such clause or language included in a contract, policy or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.  (c) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.  History of Section.P.L. 2013, ch. 85,  7; P.L. 2013, ch. 94,  7. 
 27-41-84. Orally administered anticancer medication  Cost-sharing requirement. (a) Every individual or group hospital or medical expense, insurance policy or individual or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued for delivery, or renewed in this state, on or after January 1, 2014, that offers both medical and prescription drug coverage, and provides coverage for intravenously administered anticancer medication, shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section. Notwithstanding the above, the requirements shall not be construed to impose any form of cap on cost-sharing.  (b) This section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.  History of Section.P.L. 2013, ch. 323,  4; P.L. 2013, ch. 405,  4. 
 27-41-85. Consumer notification. Every health maintenance organization providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a non-duplication of benefits clause: NO DUPLICATION OF BENEFITS.  History of Section.P.L. 2013, ch. 452,  5; P.L. 2013, ch. 479,  5. 
 27-41-86. Opioid antagonists. (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.  History of Section.P.L. 2016, ch. 175,  4; P.L. 2016, ch. 192,  4. 
 27-41-87. Healthcare provider credentialing. (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 providers 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 providers 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 entitys or health plans 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.  History of Section.P.L. 2017, ch. 185,  4; P.L. 2017, ch. 254,  4. 
 27-41-88. Unfair discrimination prohibited. Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services that may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37 of title 5.  History of Section.P.L. 2017, ch. 165,  4; P.L. 2017, ch. 314,  4. 
 27-41-89. Health insurance contracts  Full year coverage for contraception. 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.  History of Section.P.L. 2018, ch. 230,  7; P.L. 2018, ch. 234,  7. 
 27-41-9. Required reports. (a) Every health maintenance organization shall annually, on or before the first day of March, file a report verified by at least two (2) principal officers with the director, with a copy to the director of health, covering the preceding calendar year.  (b) The annual report shall be on forms prescribed by the director in consultation with the director of health and shall include:  (1) A financial statement of the organization, including its balance sheet and receipts and disbursements for the preceding year certified by an independent public accountant;  (2) Any material changes in the information submitted pursuant to  27-41-3(c);  (3) The number of persons enrolled during the year, the number of enrollees as of the end of the year, and the number of enrollments terminated during the year;  (4) A summary of information compiled pursuant to  27-41-4(a)(2)(iv) in the form required by the director of health; and  (5) Any other information relating to the performance of the health maintenance organization as is necessary to enable the director to carry out his or her duties under this chapter.  (c) In addition to the reports required in subsection (a), every health maintenance organization shall on a form prescribed by the director report on or before September 30 of each year a filing that shall set forth the amount of uncovered and covered expenses that are payable and are more than ninety (90) days past due. That report shall cover the period January 1 through July 31 of that year. At the time of the filing of the annual report as required in subsection (a), a report shall be filed setting forth the amount of uncovered and covered expenses that are payable and are more than ninety (90) days past due; that report shall cover the preceding period of August 1 through December 31 of that year.  (d) Every health maintenance organization shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners guidelines and procedures, and shall be available for inspection by the public.  (e) The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.  History of Section.P.L. 1983, ch. 225,  2; P.L. 1986, ch. 198,  12; P.L. 1994, ch. 404,  13; P.L. 1996, ch. 188,  16; P.L. 2002, ch. 292,  85. 
 27-41-90. Prohibition on discrimination in organ transplants.  Pursuant to chapter 95 of title 23, any health maintenance organization that provides coverage for anatomical gifts, organ transplants, or related treatment and services shall not:  (1) Deny coverage to a covered person solely on the basis of the persons disability;  (2) Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the health benefit plan, solely for the purpose of avoiding the requirements of this section;  (3) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide monetary or nonmonetary incentives to an attending provider, to induce the provider to provide care to an insured or enrollee in a manner inconsistent with this section; or  (4) Reduce or limit coverage benefits to a patient for the medical services or other services related to organ transplantation performed pursuant to this section as determined in consultation with the attending physician and patient.  History of Section.P.L. 2021, ch. 109,  6, effective June 30, 2021; P.L. 2021, ch. 133,  6, effective June 30, 2021. 
 27-41-91. Health insurance contracts  Copayments exemption for COVID-19 vaccinations. (a) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for COVID-19 related services, including, but not limited to: emergency services, inpatient services, provider office visits, and inpatient hospital stays, as long as the COVID-19 state of emergency remains in effect.  (b) Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for the administration of the COVID-19 vaccine or a COVID-19 test.  (c) The health insurance commissioner shall promulgate any rules and regulations as the commissioner deems necessary for the efficient administration and enforcement of this section.  History of Section.P.L. 2021, ch. 145,  4, effective July 3, 2021; P.L. 2021, ch. 161,  4, effective July 3, 2021. 
 27-41-92. Perinatal doulas.  (a) As used in this section, doula or perinatal doula means a trained professional providing continuous physical, emotional, and informational support to a pregnant individual, from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.  (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 July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurers respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas area of professional competence as defined by the doula certification standard developed and maintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other healthcare provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement, except when those requirements are also applicable to other categories of healthcare providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other healthcare provider.  (c) 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 that is required to cover perinatal doula services, as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023, and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.  (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.  History of Section.P.L. 2021, ch. 209,  5, effective July 1, 2022; P.L. 2021, ch. 321,  5, effective July 1, 2022. 
 27-41-93. Gender rating. [Effective January 1, 2023.] (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 physicians office, and no policy that provides major medical or similar comprehensive-type coverage, excluding disability income, long-term care, and insurance supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall vary the premium rate for a health coverage plan based on the gender of the individual policy holders, enrollees, subscribers, or members.  (b) This section shall not apply to insurance coverage providing benefits for any of the following:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Limited benefit health;  (7) Specified disease indemnity;  (8) Sickness of bodily injury or death by accident or both; and  (9) Other limited benefit policies.  History of Section.P.L. 2021, ch. 88,  4, effective January 1, 2023; P.L. 2021, ch. 89,  4, effective January 1, 2023. 
 27-41-94. Coverage for biomarker testing. (a) As used in this section:  (1) Biomarker means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Biomarkers include but are not limited to gene mutations or protein expression.  (2) Biomarker testing is the analysis of a patients tissue, blood, or other biospecimen for the presence of a biomarker. Biomarker testing includes, but is not limited to, single-analyte tests, multi-plex panel tests, and whole genome sequencing.  (3) Clinical utility means the test result provides information that is used in the formulation of a treatment or monitoring strategy that informs a patients outcome and impacts the clinical decision. The most appropriate test may include both information that is actionable and some information that cannot be immediately used in the formulation of a clinical decision.  (4) Consensus statements as used here are statements developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure and with a conflict of interest policy. These statements are aimed at specific clinical circumstances and base the statements on the best available evidence for the purpose of optimizing the outcomes of clinical care.  (5) Nationally recognized clinical practice guidelines as used here are evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy. Clinical practice guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options and include recommendations intended to optimize patient care.  (b) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2024, shall provide coverage for the services of biomarker testing in accordance with each health insurers respective principles and mechanisms of reimbursement, credentialing, and contracting. Biomarker testing must be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollees disease or condition to guide treatment decisions, when the test provides clinical utility as demonstrated by medical and scientific evidence, including, but not limited to:  (1) Labeled indications for an FDA-approved or -cleared test or indicated tests for an FDA-approved drug;  (2) Centers for Medicare Services (CMS) national coverage determinations or Medicare Administrative Contractor (MAC) local coverage determinations; or  (3) Nationally recognized clinical practice guidelines and consensus statements.  (c) Coverage as defined in subsection (b) is provided in a manner that limits disruptions in care including the need for multiple biopsies or biospecimen samples.  (d) The patient and prescribing practitioner shall have access to clear, readily accessible, and convenient processes to request an exception to a coverage policy of a health insurer, nonprofit health service plan, and health maintenance organization. The process shall be made readily accessible on the health insurers, nonprofit health service plans, or health maintenance organizations website.  History of Section.P.L. 2022, ch. 151,  4, effective June 27, 2022; P.L. 2022, ch. 152,  4, effective June 27, 2022. 
 27-41-95. Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. [Expires December 31, 2025.] (a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2023, shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobin therapy.  (b) For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall be coded as autoimmune encephalitis until the American Medical Association and the Centers for Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome.  (c) The healthcare benefits outlined in this section apply only to services delivered within the state of Rhode Island; provided, that all health insurance carriers shall be required to provide coverage for those benefits mandated by this section outside of the state of Rhode Island where it can be established through a pre-authorization process that the required services are not available in the state of Rhode Island from a provider in the health insurance carriers network.  (d) Each health insurance carrier shall collect and provide to the office of the health insurance commissioner, in a form and frequency acceptable to the commissioner, information and data reflecting the costs and the savings of adding the benefit coverage provided in this section. On or before January 1, 2025, the office of the health insurance commissioner shall report to the general assembly a cost-benefit analysis of the implementation of the benefit coverage provided in this section. The intent of this cost-benefit analysis is to determine if adding the benefit coverage provided in this section produces a net savings to health insurance carriers and to policy holders.  (e) This section shall sunset and be repealed effective December 31, 2025.  History of Section.P.L. 2022, ch. 422,  4, effective June 30, 2022; P.L. 2022, ch. 423,  4, effective June 30, 2022. 
 27-42-1. Purpose. The purpose of this chapter is to give this state jurisdiction to determine jurisdiction of providers of health care benefits; to indicate how each provider of health care benefits may show under what jurisdiction it falls; to allow for examinations by this state if the provider of health care benefits is unable to show it is subject to another jurisdiction; to make a provider of health care benefits subject to the laws of this state if it cannot show that it is subject to another jurisdiction; and to disclose to purchasers of health care benefits whether or not the plans are fully insured.  History of Section.P.L. 1984, ch. 177,  1. 
 27-42-2. Authority and jurisdiction of director of business regulation. Notwithstanding any other provision of law, and except as provided in this section and in  27-16-1.2(a)(5), any person or other entity which provides coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether that coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject to the jurisdiction of the director of business regulation, unless the person or other entity shows that while providing the services it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government.  History of Section.P.L. 1984, ch. 177,  1. 
 27-42-3. How to show jurisdiction. A person or entity may show that it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government, by providing to the director of business regulation the appropriate certificate, license, or other document issued by the other governmental agency that permits or qualifies it to provide those services.  History of Section.P.L. 1984, ch. 177,  1. 
 27-42-4. Examination. Any person or entity which is unable to show that it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government, shall submit to an examination by the director to determine the organization and solvency of the person or the entity, and to determine whether or not the person or entity complies with the applicable provisions of this title and chapter 62 of title 42.  History of Section.P.L. 1984, ch. 177,  1. 
 27-42-5. Subject to state laws. Any person or entity unable to show that it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government, shall be subject to all appropriate provisions of this title and of chapter 62 of title 42, regarding the conduct of its business.  History of Section.P.L. 1984, ch. 177,  1. 
 27-42-6. Disclosure. Any production agency or administrator including, but not limited to, any insurance producer licensed under chapter 2.4 of this title, which advertises, sells, transacts, or administers the coverage in this state described in  27-42-2 and which, under  27-42-4, is unable to show that it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government shall, if that coverage is not fully insured or fully covered by a domestic insurance company incorporated by the general assembly and subject to chapter 1 of this title, or a foreign insurance company licensed to do business in Rhode Island and subject to chapter 2 of this title, non-profit service corporation, as defined in chapters 19, 20, 20.1, or 20.2 of this title, or nonprofit health service corporation incorporated by the general assembly or a health maintenance organization licensed under chapter 41 of title 27, advise every purchaser, prospective purchaser, and covered person of the lack of insurance or other coverage. Any administrator which advertises or administers the coverage in this state described in  27-42-2 and which, under  27-42-4, is unable to show that it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government, shall advise any production agency of the elements of the coverage including the amount of stop loss insurance in effect.  History of Section.P.L. 1984, ch. 177,  1. 
 27-43-1. Definitions. As used in this chapter, unless the context requires otherwise: (1) Affiliated company means any corporation controlled by or an affiliate of a parent, an industrial insured, or a member organization by virtue of common ownership, control, operation, or management;  (2) Association means any association of individuals, corporations, partnerships, or associations that has a separate legal existence, the member organizations of which collectively:  (i) Own, control, or hold with power to vote all of the outstanding voting securities of an association captive insurance company incorporated as a stock insurance company; or  (ii) Have complete voting control over an association captive insurance company incorporated as a mutual insurance company;  (3) Association captive insurance company means any company that insures risks of the member organizations of the association, and their affiliated companies;  (4) Captive insurance company means any subsidiary captive insurance company, association captive insurance company, or industrial insured captive insurance company formed or licensed under the provisions of this chapter, including a captive insurance company that is organized as a protected cell company under the Protected Cell Companies Act, chapter 64 of this title;  (5) Commissioner means the director of the department of business regulation;  (6) Industrial insured means an insured:  (i) Who procures the insurance of any risk or risks by use of the services of a full-time employee acting as an insurance manager or buyer;  (ii) Whose aggregate annual premiums for insurance on all risks total at least twenty-five thousand dollars ($25,000); and  (iii) Who has at least twenty-five (25) full-time employees;  (7) Industrial insured captive insurance company means any company that insures risks of the industrial insured that comprise the industrial insured group, and their affiliated companies;  (8) Industrial insured group means any group that meets either of the following criteria:  (i) Any group of industrial insured that collectively: (A) own, control, or hold with power to vote all of the outstanding voting securities of an industrial insured captive insurance company incorporated as a stock insurance company, or (B) have complete voting control over an industrial insured captive insurance company incorporated as a mutual insurance company; or  (ii) Any group which is created under 15 U.S.C.  3901 et seq., as a corporation or other limited liability association;  (9) Member organization means any individual, corporation, partnership, or association that belongs to an association;  (10) Parent means a corporation, partnership, or individual that directly or indirectly owns, controls, or holds with power to vote more than fifty percent (50%) of the outstanding voting securities of a subsidiary captive insurance company;  (11) Personal lines of insurance means personal motor vehicle, homeowners insurance coverage, health insurance, life insurance, workers compensation, residential fire insurance, or any component of them; and  (12) Subsidiary captive insurance company means any company that insures risks of its parent and affiliated companies.  History of Section.P.L. 1988, ch. 76,  1; P.L. 1996, ch. 232,  1; P.L. 1996, ch. 256,  1; P.L. 1999, ch. 22,  12. 
 27-43-10. Rules and regulations. The commissioner may establish and amend the rules relating to captive insurance companies that are necessary to enable the commissioner to carry out the provisions of this chapter.  History of Section.P.L. 1988, ch. 76,  1. 
 27-43-11. Laws applicable. No provisions of this title, other than those contained in this chapter or contained in specific references contained in this chapter, shall apply to captive insurance companies. Insofar as the provisions of this chapter are inconsistent with the provisions of any other law, general, special, or local, the provisions of this chapter shall be controlling.  History of Section.P.L. 1988, ch. 76,  1. 
 27-43-12. Limitations on dividends. (a) An extraordinary dividend or distribution is defined as cash or other property, whose fair market value together with other dividends or distributions made within the preceding twelve (12) months exceeds the lesser of: (1) ten percent (10%) of the captive insurance companys surplus as of the preceding December 31st; or (2) net income, not including realized capital gains for the twelve (12) months ending the preceding December 31st, excluding pro rata distribution of any class of the captive insurance companys own securities.  (b) Each captive insurance company may carry forward the net income from the preceding two (2) years (as calculated in subsection (a) of this section for each year) less any dividends paid in the two (2) preceding years in determining whether the dividend or distribution is extraordinary.  History of Section.P.L. 1996, ch. 232,  1; P.L. 1996, ch. 256,  1. 
 27-43-13. Captive insurance regulatory and supervision fund. (a)(1) There is created a fund to be known as the captive insurance regulatory and supervision fund for the purpose of providing the financial means for the commissioner to administrate this chapter and for reasonable expenses incurred in promoting the captive insurance industry in Rhode Island. An appropriation of ten percent (10%) of the premiums taxed under  27-43-9, and all fees and assessments received by the department pursuant to the administration of this chapter with regards to the captive insurance industry shall be credited to this fund. Of this amount, not more than two percent (2%) of the premium tax under  27-43-9 may be transferred to the Rhode Island economic development corporation, with approval of the director of administration, for promotional expenses.  (2) All payments from the captive insurance regulatory and supervision fund for the maintenance of staff and associated expenses including contractual services as necessary, shall be disbursed from the state treasury only upon written request issued by the commissioner, after receipt of proper documentation regarding services rendered and expenses incurred.  (b) At the end of each fiscal year, that portion of the balance in the captive insurance regulatory and supervision fund which exceeds one hundred thousand dollars ($100,000), shall be transferred to the general fund.  (c) The commissioner may anticipate receipts for the captive insurance regulatory and supervision fund and issue a written request for payments based on it.  History of Section.P.L. 1996, ch. 232,  1; P.L. 1996, ch. 256,  1. 
 27-43-2. Incorporation of captive insurance companies in this state. (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 which 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 commissioners 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 (13) 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 subscribers advisory committee to consist of no less than one third (1/3) of the number of its members.  History of Section.P.L. 1988, ch. 76,  1; P.L. 1999, ch. 22,  12; P.L. 2002, ch. 292,  87; P.L. 2005, ch. 36,  22; P.L. 2005, ch. 72,  22. 
 27-43-3. Licensing  Authority. (a) Any captive insurance company, when permitted by its articles of association or charter, may apply to the commissioner for a license to do any and all insurance; provided, that:  (1) No subsidiary captive insurance company may insure any risks other than those of its parent and affiliated companies;  (2) No association captive insurance company may insure any risks other than those of the member organizations of its association, and their affiliated companies;  (3) No industrial insured captive insurance company may insure any risks other than those of the industrial insured that comprise the industrial insured group, and their affiliated companies;  (4) No captive insurance company may provide personal lines of insurance, or any component of personal lines insurance; and  (5) No captive insurance company may accept or cede reinsurance, except as provided in  27-43-7.  (b) No captive insurance company shall do any insurance business in this state unless:  (1) It first obtains from the commissioner a license authorizing it to do insurance business in this state;  (2) Its board of directors holds at least one meeting each year in this state;  (3) It maintains its principal place of business in this state; and  (4) It appoints a resident registered agent to accept service of process and to act on its behalf in this state. Whenever the registered agent cannot with reasonable diligence be found at the registered office of the captive insurance company, the commissioner shall be an agent of the captive insurance company upon whom any process, notice, or demand may be served.  (c)(1) Before receiving a license, a captive insurance company shall file with the commissioner a certified copy of its charter and by-laws, a statement under oath of its president and secretary showing its financial condition, and any other statements or documents required by the commissioner;  (2) In addition to the information required by subdivision (1) of this subsection each applicant captive insurance company shall file with the commissioner evidence of the following:  (i) The amount and liquidity of its assets relative to the risks to be assumed;  (ii) The adequacy of the expertise, experience, and character of the person or persons who will manage it;  (iii) The overall soundness of its plan of operation;  (iv) The adequacy of the loss prevention programs of its parent, member organizations, or industrial insured as applicable; and  (v) Any other factors deemed relevant by the commissioner in ascertaining whether the proposed captive insurance company will be able to meet its policy obligations.  (3) Information submitted pursuant to this section shall be and remain confidential, and may not be made public by the commissioner or an employee or agent of the commissioner without the written consent of the company, except that:  (i) The information may be discoverable by a party in a civil action or contested case to which the captive insurance company that submitted the information is a party, upon a showing by the party seeking to discover the information that:  (A) The information sought is relevant to and necessary for the furtherance of the action or case;  (B) The information sought is unavailable from other nonconfidential sources; and  (C) A subpoena issued by a judicial or administrative officer of competent jurisdiction has been submitted to the commissioner; provided, that the provisions of this subdivision do not apply to any industrial insured captive insurance company insuring the risks of an industrial insured group as defined in  27-43-1(8)(ii); and  (ii) The commissioner may, in his or her discretion, disclose the information to a public officer having jurisdiction over the regulation of insurance in another state, provided that:  (A) The public official agrees in writing to maintain the confidentiality of the information; and  (B) The laws of the state in which the public official serves requires the information to be and to remain confidential.  (d) The commissioner is authorized to retain legal, financial and examination services from outside the department, the reasonable cost of which may be charged to the applicant. Each captive insurance company shall pay to the commissioner a nonrefundable fee of one thousand dollars ($1,000) for examining, investigating, and processing its application for license. In addition, it shall pay a license fee for the first year of registration and an annual fee for each year after this of five hundred dollars ($500).  (e) If the commissioner is satisfied that the documents and statements that the captive insurance company has filed comply with the provisions of this chapter, the commissioner may grant a license authorizing it to do insurance business in this state in accordance with the provisions of this title.  History of Section.P.L. 1988, ch. 76,  1; P.L. 1996, ch. 232,  1; P.L. 1996, ch. 256,  1; P.L. 2000, ch. 176,  1; P.L. 2000, ch. 373,  1. 
 27-43-4. Minimum capital. (a) No subsidiary captive insurance company, association captive insurance company incorporated as a stock insurance company, or industrial insured captive insurance company incorporated as a stock insurance company shall be issued a license unless it possesses and after this maintains unimpaired paid in capital of:  (1) In the case of a subsidiary captive insurance company, not less than one hundred thousand dollars ($100,000);  (2) In the case of an association captive insurance company incorporated as a stock insurance company, not less than four hundred thousand dollars ($400,000); and  (3) In the case of an industrial insured captive insurance company incorporated as a stock insurance company, not less than two hundred thousand dollars ($200,000). The capital may be in the form of cash or an irrevocable letter of credit issued by a bank chartered by the state of Rhode Island or a member bank of the Federal Reserve System and approved by the commissioner.  (b) The commissioner may prescribe additional capital based upon the type, volume, and nature of insurance business transacted, which capital may be in the form of an irrevocable letter of credit issued by a bank chartered by the state of Rhode Island, or a member bank of the Federal Reserve System.  (c) No captive insurance company may pay a dividend out of, or other distribution with respect to, capital or surplus, in excess of the limitations set forth in  27-43-12, without the prior approval of the commissioner. Approval of an ongoing plan for the payment of dividends or other distributions shall be conditioned upon the retention, at the time of each payment, of the capital or surplus in excess of amounts specified by, or determined in accordance with formulas approved by, the commissioner.  History of Section.P.L. 1988, ch. 76,  1; P.L. 1996, ch. 232,  1; P.L. 1996, ch. 256,  1. 
 27-43-5. Minimum surplus. (a)(1) No captive insurance company shall be issued a license unless it shall possess and after this maintain free surplus of:  (i) In the case of a subsidiary captive insurance company, not less than one hundred fifty thousand dollars ($150,000);  (ii) In the case of an association captive insurance company incorporated as a stock insurance company, not less than three hundred fifty thousand dollars ($350,000);  (iii) In the case of an industrial insured captive insurance company incorporated as a stock insurance company, not less than three hundred thousand dollars ($300,000);  (iv) In the case of an association captive insurance company incorporated as a mutual insurance company, not less than seven hundred fifty thousand dollars ($750,000); and  (v) In the case of an industrial insured captive insurance company incorporated as a mutual insurance company, not less than five hundred thousand dollars ($500,000).  (2) The surplus may be in the form of cash or an irrevocable letter of credit issued by a bank chartered by the state of Rhode Island or a member bank of the Federal Reserve System and approved by the commissioner.  (b) The commissioner may prescribe additional surplus based upon the type, volume, and nature of insurance business transacted, which surplus may be in the form of a irrevocable letter of credit issued by a bank chartered by the state of Rhode Island, or a member bank of the Federal Reserve System.  (c) No captive insurance company may pay a dividend out of, or other distribution with respect to, surplus, in excess of the limitations set forth in  27-43-12, without the prior approval of the commissioner. Approval of an ongoing plan for the payment of dividends or other distributions shall be conditioned upon the retention, at the time of each payment, of the capital or surplus in excess of amounts specified by, or determined in accordance with formulas approved by, the commissioner.  History of Section.P.L. 1988, ch. 76,  1; P.L. 1996, ch. 232,  1; P.L. 1996, ch. 256,  1. 
 27-43-6. Reports, statements, examinations, and investigations. (a) Captive insurance companies shall annually file a statement of condition as provided in  27-12-1; provided, that the commissioner may by regulation modify the required filing and content of the statements of captive insurance companies. Captive insurance companies are also subject to the further provisions of chapter 12 of this title; provided, that statements filed pursuant to this section, except for those reports filed by industrial insured captive insurance companies insuring the risks of industrial insured groups as defined in  27-43-1(8)(ii), are not subject to the public inspection provisions of  27-12-1(b).  (b) The commissioner, either personally or by a committee appointed by him or her, consisting of one or more persons not directors or officers of any captive insurance company doing business in this state, may, at any time, examine the affairs of any captive insurance company incorporated by or doing business in this state. The officers of the company shall exhibit its books to the commissioner or committee, and facilitate the examination, and the commissioner or the committee may examine, under oath, the officers of the company in relation to its affairs, and the commissioner shall, if he or she deems it advisable, publish the result of the investigation in one or more newspapers published in the state. The total cost of the examinations shall be borne by the examined companies and shall be one hundred fifty percent (150%) of the total salaries paid to the examining personnel of the insurance division engaged in the examinations, less any salary reimbursements, and shall be paid to the commissioner to and for the use of the insurance division. The assessment shall be in addition to any taxes and fees payable to the state.  (c) Whenever it shall appear to the commissioner, from the statements, or from an examination of the affairs of any captive insurance company, that the company is insolvent, or is in an unsound financial condition, or that its business policies are unsound or improper, or that its condition or management is such as to render its further transaction of business hazardous to the public or its policyholders, or that the amount of its funds, net cash or contingent assets is deficient, or that its capital is impaired, or that it is conducting its business fraudulently or refuses or neglects to comply with the laws of the state relating to captive insurance companies, it shall be the duty of the commissioner, after notice and hearing, to revoke the license issued to the company and the licenses issued to all of its insurance producers, or he or she may revoke the licenses or suspend them for a period not exceeding the unexpired terms of the licenses.  History of Section.P.L. 1988, ch. 76,  1; P.L. 1991, ch. 348,  9; P.L. 2000, ch. 176,  1; P.L. 2000, ch. 373,  1. 
 27-43-7. Reinsurance. (a) Any captive insurance company may provide reinsurance on risks ceded by any other insurer, provided, that the captive insurance company and the insurer comply with the requirements established by regulations promulgated pursuant to this chapter.  (b) Any captive insurance company may reinsure its risks and take credit for reserves on risk or on portions of risk ceded to reinsurers as provided in chapter 1.1 of this title. Subsidiary captive insurance companies may take credit for reserves on risks or portions of risk ceded to reinsurers not complying with chapter 1.1 of this title only after obtaining the prior approval of the director. The director may require any other documents, financial information or other evidence that the reinsurer will be able to provide adequate security for its financial obligations. The commissioner may deny authorization or impose any limitations on the activities of a reinsurer that, in his or her judgment, are necessary and proper to provide adequate security for the ceding captive insurance company and for the protection and consequent benefit of the public at large.  (c) For the purposes of this chapter, the insurance by a captive insurance company of any workers compensation qualified self-insured plan of its parent and affiliates shall be deemed to be reinsurance.  History of Section.P.L. 1988, ch. 76,  1; P.L. 1996, ch. 232,  1; P.L. 1996, ch. 256,  1; P.L. 2001, ch. 122,  12; P.L. 2004, ch. 6,  13. 
 27-43-8. Exemption from chapter 34 of this title. No captive insurance company shall be required to join or to contribute financially to any plan, pool, association, or guaranty or insolvency fund in this state including, but not limited to, the fund established by chapter 34 of this title, nor shall any captive insurance company, or its insured, or its parent or any affiliated company, or any member organization of its association, receive any benefit from the plan, pool, association, or guaranty or insolvency funds for claims arising out of the operations of the captive insurance company.  History of Section.P.L. 1988, ch. 76,  1. 
 27-43-9. Tax on premiums collected. (a) Each captive insurance company shall pay to the division of taxation, on or before the first day of March of each year, a tax at the rate of two tenths of one percent (0.2%) on the first twenty million dollars ($20,000,000), and fifteen one hundredths of one percent (0.15%) on the next twenty million dollars ($20,000,000), and one tenth of one percent (0.1%) on the next twenty million dollars ($20,000,000), and thirty-seven and one-half thousandths of one percent (0.0375%) on each dollar thereafter on the direct premiums collected or contracted for on policies or contracts of insurance written by the captive insurance company during the year ending December 31 next preceding, after deducting from the direct premiums subject to the tax the amounts paid to policyholders as return premiums which shall include dividends on unabsorbed premiums or premium deposits returned or credited to policyholders.  (b) Each captive insurance company shall pay to the division of taxation on or before the first day of March of each year a tax at the rate of one hundred and twelve and one-half thousandths of one percent (0.1125%) on the first twenty million dollars ($20,000,000) of assumed reinsurance premium, and seventy-five thousandths of one percent (0.075%) on the next twenty million dollars ($20,000,000), and twenty-five thousandths of one percent (0.025%) on the next twenty million dollars ($20,000,000), and twelve and one-half thousandths of one percent (0.0125%) of each dollar thereafter. No reinsurance tax applies to premiums for risks or portions of risks which are subject to taxation on a direct basis pursuant to subsection (a) of this section. No reinsurance premium tax is payable in connection with the receipt of assets in exchange for the assumption of loss reserves and other liabilities of another insurer under common ownership and control if this transaction is part of a plan to discontinue the operations of the other insurer, and if the intent of the parties to this transaction is to renew or maintain this business with the captive insurance company.  (c) If the aggregate taxes to be paid by a captive insurance company calculated under subsections (a) and (b) of this section amount to less than twenty-five hundred dollars ($2,500) in any year, this captive insurance company pays a tax of twenty-five hundred dollars ($2,500) for this year.  (d) Two (2) or more captive insurance companies under common ownership and control are taxed as though they were a single captive insurance company.  (e) For the purposes of this section, common ownership and control means:  (1) In the case of stock corporations, the direct or indirect ownership of eighty percent (80%) or more of the outstanding voting stock of two (2) or more corporations by the same shareholder or shareholders; and  (2) In the case of mutual corporations, the direct or indirect ownership of eighty percent (80%) or more of the surplus and the voting power of two (2) or more corporations by the same member or members.  (f) A captive insurance company is not subject to the gross premium tax imposed under chapter 17 of title 44.  History of Section.P.L. 1988, ch. 76,  1; P.L. 1999, ch. 4,  1. 
 27-44-1. Purposes. The purposes of this chapter are: (1) To prohibit price fixing agreements and other anticompetitive behavior by insurers;  (2) To protect policy holders and the public against the adverse effects of excessive, inadequate, or unfairly discriminatory rates;  (3) To promote price competition among insurers to provide rates that are responsive to competitive market conditions;  (4) To provide regulatory assurance that price competition exists;  (5) To improve availability, fairness and reliability of insurance;  (6) To authorize essential cooperative action among insurers in the ratemaking process and to regulate that activity to prevent practices that tend to substantially lessen competition or create a monopoly;  (7) To encourage the most efficient and economic marketing practices; and  (8) To foster competitive insurance markets.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-10. Insurers and rating and advisory organizations  Prohibited activity. (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 which 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.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-11. Rating organizations  Permitted activity. 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.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-12. Rating organization  Public information. Every rating organization shall file any amendment or modification made to supplementary rate information with the director within fifteen (15) days after it is distributed to members, subscribers, or others.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-13. Records and reports. The director may adopt reasonable rules for use by companies to record and report to the director their loss and expense experience and any other information determined by the director to be necessary or appropriate for the administration of this chapter and the effectuation of its purposes. No insurer shall be required to record or report its experience on a classification basis inconsistent with its own rating system. The director may designate one or more rating or advisory organizations to assist him or her in gathering, compiling, and reporting the information.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-14. Examination. (a) The director may examine any insurer, pool, rating organization, or advisory organization as he or she deems necessary to ascertain compliance with this chapter.  (b) Every insurer, pool, rating organization, and advisory organization shall maintain reasonable records of the type and kind reasonably adapted to its method of operation containing its experience or the experience of its members including the data, statistics, or information collected or used by it in its activities. These records shall be available at all reasonable times to enable the director to determine compliance with the provisions of this chapter.  (c) The total cost of an examination made pursuant to this section shall be paid by the examined party, and shall be one hundred-fifty percent (150%) of the total salaries paid for the examining personnel of the insurance division engaged in the examinations less any salary reimbursements, and shall be paid to the director to and for the use of the state. The assessment shall be in addition to any taxes and fees otherwise payable to the state. The officers, managers, 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.  (d) In lieu of the examination the director may accept the report of an examination made by the insurance supervisory official of another state pursuant to the laws of the state.  (e) Reports on examinations  Hearing and filing. The director shall prepare a report on the examination and shall, within a reasonable time following completion of the report, furnish each rating organization with a copy of this report. The rating organization shall, within thirty (30) days after receipt of a copy of the report, request the director for a hearing on the report, which shall be held by the commissioner upon ten (10) days written notice to the rating organization. Following the hearing the director may affirm, modify, or withdraw the report. The report, or modification of it, shall then be filed in the office of the director 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.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-15. Exemptions. The director may, by his or her own initiative or upon request of any person, by rule, exempt any market from any or all of the provisions of this chapter, if and to the extent that the director finds an exemption necessary to achieve the purpose of this chapter.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-16. Assessment for review pursuant to title 42, chapter 14. The director may appoint an actuary to assist the director in the performance of his or her duties pursuant to this chapter. The actuary shall serve under the direction of the director and shall be removable at the pleasure of the director. Insurance companies doing business in this state under the provisions of this chapter shall be assessed pursuant to  42-14-10.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-17. Noncompetitive markets  Nonapplicability of chapter. Any market deemed to be a noncompetitive market, and any market described in  27-44-3, shall have rates established for it pursuant to the standards and procedures as applicable in chapters 6, 7.1, 9, 19, and 20 of this title, and the other sections of law govern the rates of different classes of insurance. Nothing contained in this section shall be construed to limit the applicability of any other relevant section of law.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-18. Penalties. (a) The director may, if he or she finds that any person or organization has violated any provision of this chapter, impose a penalty of not more than one thousand dollars ($1,000) for each violation, but if the director finds the violation to be willful, he or she may impose a penalty of not more than fifty thousand dollars ($50,000) for each violation. The penalties may be in addition to any other penalty provided by law.  (b) For the purposes of this section, any insurer using a rate for which the insurer has failed to file the rate, supplementary rate information, or supporting information, as required by this chapter or by any rules and regulations that the director may promulgate, has committed a separate violation for each day that failure continues.  (c) The director may suspend or revoke the license of any rating organization or insurer which fails to comply with an order of the director within the time limited by the order, or any extension of the order which the director may grant.  (d) The director may determine when a suspension of license shall become effective and it shall remain in effect for the period fixed by him or her, unless he or she modifies or rescinds the suspension, or until the order upon which the suspension is based is modified, rescinded, or reversed.  (e) No penalty shall be imposed and no license shall be suspended or revoked except upon a written order of the director, stating his or her findings, made after a hearing.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-19. Regulations. The director may promulgate any reasonable regulations that are necessary and proper to enforce this chapter and to require any information that the director finds necessary.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-2. Definitions. (a) Advisory organization means any person or organization other than a rating organization which assists insurers in the authorized activities enumerated in  27-44-11, except no advisory organization may make any filings on behalf of insurers.  (b) Competitive market means a market that has not been found to be noncompetitive pursuant to  27-44-4.  (c) Director means the director of department of business regulation.  (d) Market means the interaction between buyers and sellers consisting of a product market component. A product market component consists of identical or readily substitutable products including, but not limited to, consideration of coverage, policy terms, rate classifications, and underwriting. A geographic market component is a geographical area in which buyers have a reasonable degree of access to the insurance product through sales outlets and other marketing mechanisms. Determination of a geographic market component shall consider existing marketing patterns.  (e) Noncompetitive market means a market for which there is a ruling in effect pursuant to  27-44-4 that a reasonable degree of competition does not exist.  (f) Pool means a voluntary arrangement, established on an on-going basis, pursuant to which two (2) or more insurers participate in the sharing of risks on a predetermined basis. The pool may operate through an association, syndicate, or other pooling agreement.  (g) Rating organization means any entity which either has two (2) or more member insurers or is controlled either directly or indirectly by two (2) or more insurers and which assists insurers in ratemaking. Two (2) or more insurers having a common ownership or operating in this state under common management or control constitute a single insurer for the purpose of this definition.  (h) Residual market mechanism means an arrangement, either voluntary or mandated by law, involving participation by insurers in the equitable apportionment among them of insurance which may be afforded applicants who are unable to obtain insurance through ordinary methods.  (i) Supplementary rate information includes any manual or plan of rates, classification, rating schedule, minimum premium, policy fee, rating rule, and any other similar information needed to determine the applicable rate in effect or to be in effect.  (j) Supporting information means: (1) the experience and judgment of the filer and the experience or data of other insurers or organizations relied upon by the filer; (2) the interpretation of any statistical data relied upon by the filer; and (3) description of methods used in making the rates, and other similar information required by the director to be filed.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-20. Hearings. Any hearing conducted pursuant to this chapter shall be held in accordance with the Administrative Procedures Act, chapter 35 of title 42, to the extent that the APA does not conflict with any provision of law contained in this chapter.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-21. Judicial review. (a) Any order, regulation, or decision of the director made after a hearing shall be subject to judicial review in accordance with the Administrative Procedures Act, chapter 35 of title 42.  (b) Upon the request of any insurer or organization to which the director has directed an order made without a hearing, the director shall grant a hearing within thirty (30) days of the request. Within thirty (30) days after the hearing, the director shall affirm, reverse, or modify the previous action, specifying the reasons for it.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-22. Severability. 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.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-3. Scope of application. (a) This chapter applies to all kinds of insurance written on risks in this state by any insurers authorized to do business in this state, except:  (1) Life insurance;  (2) Annuities;  (3) Accident and health insurance;  (4) Ocean marine insurance;  (5) Reinsurance;  (6) Medical malpractice insurance;  (7) Workers compensation insurance; and  (8) Insurance through residual market mechanisms.  (b) The classes of insurance described in subsection (a) of this section shall be subject to all applicable provisions of law governing rates, including, but not limited to chapters 6, 7.1, 9, 19, and 20 of this title, and chapter 62 of title 42.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-4.1. Approval of policies. (a) Every insurance company and every rating/advisory organization issuing policies covering casualty, liability and fire and marine insurance provided for in this chapter shall file with the director a copy of the form of the policies proposing to use. A policy may not be issued until the director has approved the form.  (b) Any policy form, subject to this chapter and filed by an insurer or rating/advisory organization on behalf of its members or subscribers with the director, shall be deemed public information at the time of filing.  History of Section.P.L. 2002, ch. 175,  3. 
 27-44-4. Competitive market. (a) A competitive market is presumed to exist unless the director, after a hearing, determines that a reasonable degree of competition does not exist in the market and issues a ruling to that effect. The ruling shall remain in effect until the time the director deems that a competitive market exists, and issues a ruling to that effect. The director may, without a hearing, make a ruling that a competitive market exists based upon a departmental analysis of the market. Notwithstanding the foregoing, any insurer may request a hearing before the director to present evidence that competition exists in the affected market after a ruling of noncompetition has been in effect for at least one year.  (b) In determining whether a reasonable degree of competition exists, the director shall consider relevant tests of workable competition pertaining to market structure, market performance, and market conduct, and the practical opportunities available to consumers in the market to acquire pricing and other consumer information and to compare and obtain insurance from competing insurers. The tests may include, but are not limited to, the following: size and number of firms actively engaged in the market; market shares and changes in the market shares of firms; ease of entry and latent competition of insurers capable of easy entry and exit from a given market; underwriting restrictions; whether profitability for companies generally in the market is unreasonably high; availability of consumer information concerning the product and sales outlets or other sales mechanisms; existence of a degree of rate differential within a class of business; and efforts of insurers to provide consumer information. The determination of competition involves the interaction of the various tests, and the weight given to specific tests depends upon the particular situation and pattern of tests results.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-5. Rate standards. (a) Requirements. Rates shall not be excessive, inadequate, or unfairly discriminatory.  (b) Excessiveness. A rate is excessive if it is likely to produce an underwriting profit that is unreasonably high for the class of business or if expenses are unreasonably high in relation to services rendered. Evidence that a reasonable degree of competition exists with respect to the classification to which a rate is applicable shall be considered as material evidence that a rate is not excessive.  (c) Inadequacy. A rate is not inadequate unless the rate is clearly insufficient to sustain projected losses and expenses in the class of business to which it applies and the use of the rate has or, if continued, will have the effect of substantially lessening competition or the tendency to create monopoly in any market.  (d) Unfair discrimination. Unfair discrimination exists if, after allowing for practical limitations, price differentials fail to reflect equitably the differences in expected losses and expenses. Rates are not unfairly discriminatory because different premiums result for policyholders with like loss exposures but different expense factors, or like expense factors but different loss exposures, so long as the rates reflect the differences with reasonable accuracy. A rate is not unfairly discriminatory if it is averaged broadly among persons insured under a group, franchise, or blanket policy or a mass marketed plan. As used in this subsection, a mass marketed plan means a method of selling property liability insurance in which: (1) the insurance is offered to employees of particular employers or to members of particular associations or organizations, or to persons grouped in other ways, except groupings formed principally for the purpose of obtaining the insurance; and (2) the employer, association or other organization, if any, has agreed to, or affiliated itself with, the sale of the insurance to its employees or members.  (e) Rating methods. In determining whether rates comply with the rating standards, the following criteria shall apply:  (1) Basic factors in rates. Due consideration shall be given to past and prospective loss and expense experience within and outside of this state, to catastrophic hazards and contingencies, to events or trends within and outside of this state, to loadings for leveling premium rates over time or for dividends or savings to be allowed or returned by insurers to their policyholders, members or subscribers, and to all other relevant factors, including judgment;  (2) Classification. Risks may be classified in any reasonable way for the establishment of rates except that no risks may be grouped by classifications based in whole or in part on race, color, creed, or national origin of the risk. Rates may be modified for individual risks in accordance with rating plans or schedules that provide for recognition of probable variations in hazards, expenses, or both;  (3) Expenses. The expense provisions included in the rates to be used by an insurer shall reflect the operating methods of the insurer and, so far as it is credible, its own actual and anticipated expense experience;  (4) Profits. The rates may contain provision for contingencies and an allowance permitting a reasonable profit. In determining the reasonableness of the profit allowance, consideration should be given to all investment income attributable to premiums and the reserves associated with those premiums.  (f) Premiums.(1) No insurer subject to this chapter shall issue a policy of insurance with a premium developed in a manner inconsistent with the provisions of this section;  (2) No insurer may make any adjustment to the full manual premium developed for any risk without adequate justification for that adjustment. An adjustment will be presumed to be adequately justified if:  (i) It is applied in a manner consistent with the insurance companys filed rates and supplementary rate information; and  (ii) The insurance companys files contain adequate documentation of the facts supporting the adjustment;  (3) A misclassification of a risk shall be considered an adjustment without adequate justification;  (4) Each insurance company shall maintain reasonable records of the information collected or used by it in developing the premium charged for any risk so that the records will be available to enable the director to verify compliance with this section;  (5) If the director, after a hearing, finds that an insurer has violated the provisions of this subsection, he or she shall, in addition to any other penalties provided by law, impose upon the insurer a civil penalty equal to the difference between the premiums charged and those which would have been charged without the application of inadequately justified adjustments. If a finding has been made, after a hearing, that the insurer knowingly, or with such frequency as to indicate a general business practice, violated the provisions of this subsection, the director may also suspend the insurance companys authority to do business in the class in which the provisions of this subsection have been violated.   History of Section.P.L. 1988, ch. 635,  1. 
 27-44-6.1. Costs. For the purpose of determining whether the filing meets the requirements of this chapter, the director may employ staff personnel and outside consultants, including, but not limited to, those authorized pursuant to  27-9-52. The reasonable costs related to the review of rate filings, including the conduct of the hearing, shall be borne by the rating organizations or insurers making the filing.  History of Section.P.L. 2005, ch. 174,  5. 
 27-44-6. Filing of rates and other rating information. (a) Filings as to competitive markets; file and use. In a competitive market, every insurer shall file with the director all rates and supplementary rate information to be used in this state. At the time the rates are filed, the filing shall state the specific model(s) used (catastrophic risk planning), and explain the manner in which each model was used to determine the filed rate. The rates and supplementary rate information shall be filed at least thirty (30) days prior to the proposed effective date. At the end of that time, the rates may be used if no disapproval order or request for supporting information has been issued by the director. If the director finds that an insurers rates require closer review because of an insurers financial condition, or upon any other grounds as the director may consider harmful to the public interest including, but not limited to, excessiveness, inadequacy, or unfair discrimination, the director may request supporting information as needed. If the director requests the further information, the rates may not be made effective until thirty (30) days after the information has been received by the director.  (b) Filings as to noncompetitive markets. Nothing contained in this chapter shall be construed to abrogate or supersede any statute or regulation governing either classes of business identified in  27-44-3, or deemed noncompetitive pursuant to the provisions of this chapter. Those classes of business and noncompetitive markets shall have rates established pursuant to the standards and procedures applicable under chapters 6, 7.1, 9, 19, and 20 of this title, and chapter 62 of title 42.  (c) Requirement of director. Rates shall be filed in the form and manner prescribed by the director.  (d) Rating organization. Any insurer may discharge its obligation under this section by giving notice to the director that it uses rates and supplementary rate information prepared and filed by a designated rating organization of which it is a member or subscriber. The insurers rates and supplementary rate information shall be those filed by the rating organization, including any amendments, subject to modifications filed by the insurer.  (e) Consent to rate. Upon the written consent of the insured, stating the reasons for consent and filed with the director, a rate in excess of that provided by an otherwise applicable filing may be used on any specific risk. A rate greater than that applicable to the insured under a residual market mechanism may not be used unless approved by the director.  (f) Filings open to inspection. All rates, supplementary rate information, and any supporting information for rates filed under this act shall, as soon as filed, be open to public inspection at any reasonable time. Copies may be obtained by any person on request and upon payment of a reasonable charge.  History of Section.P.L. 1988, ch. 635,  1; P.L. 2007, ch. 363,  1; P.L. 2009, ch. 310,  7. 
 27-44-7. Disapproval of rates. (a) Timing of disapproval. A rate in a competitive market may be disapproved any time prior to the proposed effective date or, if supporting information is required pursuant to  27-44-6(a), at any time within thirty (30) days after receipt of the information. An existing rate may be disapproved only after a hearing to determine continued compliance with the rate standards of this chapter.  (b) Basis of disapproval. The director shall disapprove a rate for use in a competitive market if the director finds that the rate is excessive, inadequate, or unfairly discriminatory, or violates the standards of  27-44-5. The directors order shall specify in what respects the rate fails to meet the rate standards.  (c) Disapproval procedures; order. If the director determines that a reasonable degree of competition does not exist in a market in accordance with  27-44-4, he or she may review and suspend existing rates in accordance with the procedures established in the other provisions of law that govern rates, including, but not limited to, chapters 6 and 9 of this title;  (2) If the director disapproves an existing rate in a competitive market, the director shall issue an order specifying in what respects it fails to meet the rate standards and stating when, within a reasonable period after this, the rate shall be discontinued for any policy issued or renewed after a date specified in the order. The order shall be issued within thirty (30) days after the close of the hearing or within any reasonable time extension the director may fix. The order may include a provision for premium adjustment for the period after the effective date of the order for policies in effect on that date.  (d) Review of ratings. Every insurer or rating organization shall provide within this state reasonable means by which any person aggrieved by the application of its rating system may upon written request review the manner in which the rating system has been applied in connection with the insurance afforded or offered. If the insurer or rating organization fails to grant or reject the request within thirty (30) days, the applicant may proceed in the same manner as if the application had been rejected. Any party affected by the action of an insurer or rating organization on the request may, within thirty (30) days after written notice of the action, appeal to the director, who, after a hearing held upon not less than ten (10) days written notice to the appellant and to the insurer or rate service organization, may affirm, modify, or reverse the action.  History of Section.P.L. 1988, ch. 635,  1. 
 27-44-8. Licensing of rating organizations. (a) License required. No rating organization shall provide any service relating to the rates of any insurance subject to this chapter, and no insurer shall utilize the services of the organization for these purposes unless the organization has obtained a license under subsection (c) of this section.  (b) Availability of services. No rating organization shall refuse to supply any services for which it is licensed in this state to any insurer authorized to do business in this state and offering to pay the fair and usual compensation for the services.  (c) Licensing.(1) Application. A rating organization applying for a license shall include with its application:  (i) A copy of its constitution, charter, articles of organization, agreement, association, or incorporation, and a copy of its bylaws, plan of operation, and any other rules or regulations governing the conduct of its business;  (ii) A list of its members and subscribers;  (iii) The name and address of one or more residents of this state upon whom notices, process affecting it, or orders of the director may be served;  (iv) A statement showing its technical qualifications for acting in the capacity for which it seeks a license; and  (v) Any other relevant information and documents that the director may require;  (2) Change of circumstances. Every organization that has applied for a license shall notify the director of every material change in the facts or in the documents on which its application was based. Any amendment to a document filed under this section shall be filed with the director not less than thirty (30) days after it becomes effective;  (3) Granting of license; fee. If the director finds that the applicant and the natural persons through whom it acts are competent, trustworthy, and technically qualified to provide the services proposed, and that all requirements of the law are met, he or she shall issue a license specifying the authorized activity of the applicant. The fee for the license shall be three hundred dollars ($300). The director shall not issue a license if the proposed activity would tend to create a monopoly or to substantially lessen the competition in any market;  (4) Duration. Licenses issued pursuant to this section shall remain in effect for three (3) years unless sooner suspended or revoked. All in force licenses shall be transitioned into a three (3) year licensing cycle beginning June 1, 2006, to expire every three (3) years thereafter. License fees may be prorated for the initial renewal period as deemed appropriate by the director. The director may, at any time, after a hearing, revoke or suspend the license of a rating organization that does not comply with the requirements and standards of this chapter.   History of Section.P.L. 1988, ch. 635,  1; P.L. 2001, ch. 122,  13; P.L. 2005, ch. 174,  6. 
 27-44-9. Licensing of advisory organizations. (a) License required. No advisory organization shall provide any service relating to the rates of any insurer subject to this chapter, and no insurer shall utilize the services of the organization for those purposes unless the organization has become licensed under subsection (d) of this section.  (b) Authorized activities. A licensed advisory organization may perform any of the authorized activities enumerated in  27-44-11 except no advisory organization may make any filings on behalf of any insurer.  (c) Availability of services. No advisory organization shall refuse to supply any services for which it is licensed in this state to any insurer authorized to do business in this state and offering to pay the fair and usual compensation for the services.  (d) License. An advisory organization shall submit at the time of application:  (1) A copy of its constitution, articles of association or incorporation, and the bylaws, plan of operation, or other rules and regulations governing its activities;  (2) A list of its members and subscribers;  (3) The name and address of one or more residents of this state upon whom notices, process affecting it, or orders of the director may be served; and  (4) Any other relevant information and documents that the director may require.  (e) Change of circumstances. Every registered advisory organization shall promptly notify the director of every material change in the facts or in the documents upon which its registration was based.  (f) License; fee. If the director finds that the applicant and the natural persons through whom it acts are competent, trustworthy, and technically qualified to provide the services proposed, and that all requirements of law are met, he or she shall issue a license specifying the authorized activity of the applicant. The annual fee for the license shall be one hundred dollars ($100). The director shall not issue a license if the proposed activity would tend to create a monopoly or to substantially lessen competition.  (g) Duration. Licenses issued pursuant to this section shall remain in effect for three (3) years unless sooner suspended or revoked. All in force licenses shall be transitioned into a three (3) year licensing cycle beginning June 1, 2006, to expire every three (3) years thereafter, license fees may be prorated for the initial renewal period as deemed appropriate by the director. The director, after a hearing, may revoke or suspend the license of an advisory organization that does not comply with the requirements and standards of this chapter.  History of Section.P.L. 1988, ch. 635,  1; P.L. 2001, ch. 122,  13; P.L. 2008, ch. 371,  5. 
 27-45-1  27-45-5. Repealed.
 27-46-1. Purpose. 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.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-10. Purchasing group taxation. Premium taxes and taxes on premiums paid for coverage of risks resident or located in this state by a purchasing group or any members of the purchasing groups shall be:  (1) Imposed at the same rate and subject to the same interest, fines, and penalties as that applicable to premium taxes and taxes on premiums paid for similar coverage from a similar insurance source by other insured; and  (2) Paid first by the insurance source, and if not by the source by the agent or broker or producer for the purchasing group, and if not by the agent or broker or producer then by the purchasing group, and if not by the purchasing group then by each of its members.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-11. Administrative and procedural authority regarding risk retention groups and purchasing groups. 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 commissioners administrative authority to investigate, issue subpoena, 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.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-12. Duty of agents or brokers or insurance producers to obtain license. (a) Risk retention groups. No person, firm, association, or corporation shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance in this state from a risk retention group unless that person, firm, association, or corporation is licensed as an insurance agent or broker or producer in accordance with applicable provisions of law.  (b) Purchasing groups.(1) No person, firm, association, or corporation shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance in this state for a purchasing group from an authorized insurer or a risk retention group chartered in a state unless that person, firm, association, or corporation is licensed as an insurance agent or broker or producer in accordance with applicable provisions of law;  (2) No person, firm, association, or corporation shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance coverage in this state for any member of a purchasing group under a purchasing groups policy unless that person, firm, association, or corporation is licensed as an insurance agent or broker or producer in accordance with applicable provisions of law;  (3) No person, firm, association, or corporation shall act or aid in any manner in soliciting, negotiating, or procuring liability insurance from an insurer not authorized to do business in this state on behalf of a purchasing group located in this state unless that person, firm, association, or corporation is licensed as a surplus lines agent or excess line broker in accordance with applicable provisions of law.   (c) Residency. For the purposes of acting as an agent or broker or insurance producer for a risk retention group or purchasing group pursuant to subsections (a) and (b) of this section, the requirement of residence in this state shall not apply.  (d) Notice requirements. Every person, firm, association, or corporation licensed pursuant to the provisions of law relating to agents or brokers or insurance producers shall inform each prospective insured on business placed with risk retention groups or written through a purchasing group of the provisions of the notice required by  27-46-4(7) in the case of a risk retention group and  27-46-9(c) in the case of a purchasing group.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-13. Binding effect of orders issued in U.S. district court. An order issued by any district court of the United States enjoining a risk retention group from soliciting or selling insurance, or operating in any state, or in all states or in any territory or possession of the United States, upon a finding that the group is in hazardous financial or financially impaired condition, shall be enforceable in the courts of the state.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-14. Rules and regulations. The commissioner may establish and amend any rules and/or regulations relating to risk retention groups as may be necessary or desirable to carry out the provisions of this chapter.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-15. Severability. If any clause, sentence, paragraph, section, or part of this chapter or the application of this chapter to any person or circumstances shall, for any reason, be adjudged by any court of competent jurisdiction to be invalid, that judgment shall not affect, impair, or invalidate the remainder of this chapter, and the application of the chapter to other persons or circumstances, but shall be confined in its operation to the clause, sentence, paragraph, section, or part of it directly involved in the controversy in which the judgment shall have been rendered and to the person or circumstances involved.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-2. Definitions. As used in this chapter: (1) Commissioner means the director of the department of business regulation or the commissioner, director, or superintendent of insurance in any other state;  (2) Completed operations liability means liability arising out of the installation, maintenance, or repair of any product at a site which is not owned or controlled by:  (i) Any person who performs that work; or  (ii) Any person who hires an independent contractor to perform that work; but shall include liability for activities which are completed or abandoned before the date of the occurrence giving rise to the liability;  (3) Domicile, for the purposes of determining the state in which a purchasing group is domiciled, means:  (i) For a corporation, the state in which the purchasing group is incorporated; and  (ii) For an unincorporated entity, the state of its principal place of business;  (4) Hazardous financial condition means that, based on its present or reasonably anticipated financial condition, a risk retention group, although not yet financially impaired or insolvent, is unlikely to be able:  (i) To meet obligations to policyholders with respect to known claims and reasonably anticipated claims; or  (ii) To pay other obligations in the normal course of business;  (5) Insurance means primary insurance, excess insurance, reinsurance, surplus lines insurance, and any other arrangement for shifting and distributing risk, which is determined to be insurance under the laws of this state;  (6) Liability:  (i) Means legal liability for damages, including costs of defense, legal costs and fees, and other claims expenses, because of injuries to other persons, damage to their property, or other damage or loss to other persons resulting from or arising out of:  (A) Any business whether profit or nonprofit, trade, product, services including professional services, premises, or operations; or  (B) Any activity of any state or local government, or any agency or political subdivision of any state or local government; and  (ii) Does not include personal risk liability and an employers liability with respect to its employees other than legal liability under 45 U.S.C.  51 et seq.;  (7) Personal risk liability means liability for damages because of injury to any person, damage to property, or other loss or damage resulting from any personal, familial, or household responsibilities or activities, rather than from responsibilities or activities referred to in subdivision (6) of this section;  (8) Plan of operation or a feasibility study means an analysis which presents the expected activities and results of a risk retention group including, at a minimum:  (i) Information sufficient to verify that its members are engaged in businesses or activities similar or related with respect to the liability to which the members are exposed by virtue of any related, similar, or common business, trade, product, services, premises or operations;  (ii) For each state in which it intends to operate, the coverages, deductibles, coverage limits, rates, and rating classification systems for each line of insurance the group intends to offer;  (iii) Historical and expected loss experience of the proposed members and national experience of similar exposures to the extent that this experience is reasonably available;  (iv) Pro forma financial statements and projections;  (v) Appropriate opinions by a qualified, independent casualty actuary, including a determination of minimum premium or participation levels required to commence operations and to prevent a hazardous financial condition;  (vi) Identification of management, underwriting, and claims procedures, marketing methods, managerial oversight methods, investment policies, and reinsurance agreements;  (vii) Identification of each state in which the risk retention group has obtained, or sought to obtain, a charter and license, and a description of its status in each state; and  (viii) Any other matters that may be prescribed by the commissioner of the state in which the risk retention group is chartered for liability insurance companies authorized by the insurance laws of that state;  (9) Product liability means liability for damages because of any personal injury, death, emotional harm, consequential economic damage, or property damage, including damages resulting from the loss of use of property, arising out of the manufacturer, design, importation, distribution, packaging, labeling, lease, or sale of a product, but does not include the liability of any person for those damages if the product involved was in the possession of the person when the incident giving rise to the claim occurred;  (10) Purchasing group means any group which:  (i) Has as one of its purposes the purchase of liability insurance on a group basis;  (ii) Purchases the insurance only for its group members and only to cover their similar or related liability exposure, as described in subdivision (10)(iii);  (iii) Is composed of members whose business or activities are similar or related with respect to the liability to which members are exposed by virtue of any related, similar, or common business, trade, product, services, premises or operations; and  (iv) Is domiciled in any state;  (11) Risk retention group means any corporation or other limited liability association:  (i) Whose primary activity consists of assuming and spreading all, or any portion, of the liability exposure of its group members;  (ii) Which is organized for the primary purpose of conducting the activity described under paragraph (i) of this subdivision;  (iii) Which:  (A) Is chartered and licensed as a liability insurance company and authorized to engage in the business of insurance under the laws of any state; or  (B) Before January 1, 1985, was chartered or licensed and authorized to engage in the business of insurance under the laws of Bermuda or the Cayman Islands and, before that date, had certified to the insurance commissioner of at least one state that it satisfied the capitalization requirements of that state, except that the group shall be considered to be a risk retention group only if it has been engaged in business continuously since that date and only for the purpose of continuing to provide insurance to cover product liability or completed operations liability, as the terms were defined in the Product Liability Risk Retention Act of 1981 before the date of the enactment of the Liability Risk Retention Act of 1986, 15 U.S.C.  3901 et seq.;  (iv) That does not exclude any person from membership in the group solely to provide for members of the group a competitive advantage over the person;  (v) Which:  (A) Has as its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group; or  (B) Has as its sole owner an organization which has as:  (I) Its members only persons who comprise the membership of the risk retention group; and  (II) Its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group;  (vi) Whose members are engaged in businesses or activities similar or related with respect to the liability of which the members are exposed by virtue of any related, similar, or common business trade, product, services, premises or operations;  (vii) Whose activities do not include the provision of insurance other than:  (A) Liability insurance for assuming and spreading all or any portion of the liability of its group members; and  (B) Reinsurance with respect to the liability of any other risk retention group or any members of the other group which is engaged in business or activities so that the group or member meets the requirement described in subdivision (vi) from membership in the risk retention group which provides the reinsurance; and  (viii) The name of which includes the phrase risk retention group; and  (12) State means any state of the United States or the District of Columbia.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-3. Risk retention groups chartered in this state. (a) A risk retention group shall be, pursuant to the provisions of this title, chartered and licensed to write only liability insurance pursuant to this chapter and, except as provided in this chapter, must comply with all of the laws, rules, regulations, and requirements applicable to the insurers chartered and licensed in this state and with  27-46-4 to the extent those requirements are not a limitation on laws, rules, regulations, or requirements of this state.  (b) Before it may offer insurance in any state, each risk retention group shall also submit for approval to the insurance commissioner of this state a plan of operation or feasibility study. The risk retention group shall submit an appropriate revision in the event of any subsequent material change in any item of the plan of operation or feasibility study, within ten (10) days of any change. The group shall not offer any additional kinds of liability insurance, in this state or in any other state, until a revision of the plan or study is approved by the commissioner.  (c) At the time of filing its application for a charter, the risk retention group shall provide to the commissioner in summary form the following information: the identity of the initial members of the group, the identity of those individuals who organized the group or who will provide administrative services or influence or control the activities of the group, the amount and nature of initial capitalization, the coverage to be afforded, and the states in which the group intends to operate. Upon receipt of this information, the commissioner shall forward the information to the National Association of Insurance Commissioners. Providing notification to the National Association of Insurance Commissioners is in addition to and shall not be sufficient to satisfy the requirements of  27-46-4 or any other sections of this chapter.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-4. Risk retention groups not chartered in this state. Risk retention groups chartered and licensed in states other than this state and seeking to do business as a risk retention group in this state shall comply with the laws of this state as follows:  (1) Notice of operations and designation of commissioner as agent.(i) Before offering insurance in this state, a risk retention group shall submit to the commissioner:  (A) A statement identifying the state or states in which the risk retention group is chartered and licensed as a liability insurance company, charter date, its principal place of business, and any other information, including information on its membership, that the commissioner of this state may require to verify that the risk retention group is qualified under  27-46-2(11);  (B) A copy of its plan of operations or feasibility study and revisions of the plan or study submitted to the state in which the risk retention group is chartered and licensed; provided, that the provision relating to the submission of a plan of operation or feasibility study shall not apply with respect to any line or classification of liability insurance which:  (I) Was defined in  15 U.S.C. 3901 et seq. before October 27, 1986; and  (II) Was offered before that date by any risk retention group that had been chartered and operating for not less than three (3) years before that date;  (ii) The risk retention group shall submit a copy of any revision to its plan of operation or feasibility study required by  27-46-3(b) at the same time that the revisions is submitted to the commissioner of its chartering state; and  (iii) The risk retention group shall submit a statement of registration that designates the commissioner as its agent for the purpose of receiving service of legal documents or process;  (2) Financial condition. Any risk retention group doing business in this state shall submit to the commissioner:  (i) A copy of the groups financial statement submitted annually to the state in which the risk retention group is chartered and licensed which shall be certified by an independent public accountant and contain a statement of opinion on loss and loss adjustment expense reserves made by a member of the American Academy of Actuaries or a qualified loss reserve specialist, under criteria established by the National Association of Insurance Commissioners;  (ii) A copy of each examination of the risk retention group as certified by the commissioner or public official conducting the examination;  (iii) Upon request by the commissioner, a copy of any information or document pertaining to any outside audit performed with respect to the risk retention group; and  (iv) Any information that may be required to verify its continuing qualification as a risk retention group under  27-46-2(11);  (3) Taxation.(i) Each risk retention group shall be liable for the payment of premium taxes and taxes on premiums of direct business for risks resident or located within this state, and shall report to the commissioner the net premiums written for risks resident or located within this state. The risk retention group shall be subject to taxation, and any applicable fines and penalties related to taxation, on the same basis as a foreign admitted insurer;  (ii) To the extent licensed agents or brokers or insurance producers are utilized pursuant to  27-46-12, they shall report to the commissioner the premiums for direct business for risks resident or located within this state which those licensees have placed with or on behalf of a risk retention group not chartered in this state;  (iii) To the extent that insurance agents or brokers or producers are utilized pursuant to  27-46-12, the agent or broker or insurance producers shall keep a complete and separate record of all policies procured from each risk retention group, which record shall be open to examination by the commissioner. The total cost of the examinations shall be paid for in the same manner as set forth in  27-13-1. These records shall, for each policy and each kind of insurance provided under them, include the following:  (A) The limit of liability;  (B) The time period covered;  (C) The effective date;  (D) The name of the risk retention group which issued the policy;  (E) The gross premium charged; and  (F) The amount of return premiums, if any;  (4) Adherence to fair claims settlement practices. Any risk retention group, its agents, and representatives shall comply with any law or regulations regarding claims settlement practices;  (5) Deceptive, false, or fraudulent practices. Any risk retention group shall comply with and be subject to the laws of this state regarding deceptive, false, or fraudulent acts or practices;  (6) Examination regarding financial condition. Any risk retention group must submit to an examination by the commissioner to determine its financial condition if the commissioner of the jurisdiction in which the group is chartered and licensed has not initiated an examination or does not initiate an examination within sixty (60) days after a request by the commissioner of this state. Any examination shall be coordinated to avoid unjustified repetition and conducted in an expeditious matter and in accordance with the NAICs examiner handbook. The total cost of the examination shall be paid for in the same manner as set forth in  27-13-1;  (7) Notice of purchasers. Every application form for insurance from a risk retention group, and every policy, on its front and declaration pages, issued by a risk retention group, shall contain in ten (10) point type the following notice:  NOTICETHIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP.   (8) Prohibited acts regarding solicitation or sale. The following acts by a risk retention group are prohibited:  (i) The solicitation or sale of insurance by a risk retention group to any person who is not eligible for membership in the group; and  (ii) The solicitation or sale of insurance, by, or operation of, a risk retention group that is in hazardous financial condition or financially impaired;  (9) Prohibition on ownership by an insurance company. No risk retention group shall be allowed to do business in this state if an insurance company is directly or indirectly a member or owner of the risk retention group, other than in the case of a risk retention group all of whose members are insurance companies;  (10) Prohibited coverage. The terms of any insurance policy issued by any risk retention group shall not provide, or be construed to provide, coverage prohibited generally by statute of this state or declared unlawful by the highest court of this state whose law applies to the policy;  (11) Delinquency proceedings. A risk retention group not chartered in this state and doing business in this state shall comply with a lawful order issued in a voluntary dissolution proceeding or in a delinquency or liquidation proceeding commenced by the state insurance commissioner if there has been a finding of financial impairment after an examination under subdivision (6) of this section; and  (12) Penalties. A risk retention group that violates any provision of this chapter will be subject to fines and penalties including revocation of its right to do business in this state, applicable to licensed insurers generally.  History of Section.P.L. 1991, ch. 348,  1; P.L. 1993, ch. 180,  29; P.L. 1996, ch. 188,  17; P.L. 2002, ch. 292,  88. 
 27-46-5. Compulsory associations. (a) No risk retention group shall be required or permitted to join or contribute financially to any insurance insolvency fund, or similar mechanism, in this state, nor shall any risk retention group, or its insured or claimants against its insureds, receive any benefit from any such fund for claims arising under the insurance policies issued by the risk retention group.  (b) When a purchasing group obtains insurance covering its members risks from an insurer not authorized or licensed in this state or a risk retention group, none of these risks, wherever resident or located, shall be covered by an insurance insolvency fund or similar mechanism in this state.  (c) When a purchasing group obtains insurance covering its members risks from a member insurer of the Rhode Island insurance insolvency fund only those risks as are subject to the insolvency fund shall be covered by the insolvency fund.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-6. Countersignatures not required. A policy of insurance issued to a risk retention group or any member of that group shall not be required to be countersigned as otherwise provided in this title.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-7. Purchasing groups  Exemption from certain laws. A purchasing group and its insurer or insurers shall be subject to all applicable laws of this state, except that a purchasing group and its insurer or insurers shall be exempt, in regard to liability insurance for the purchasing group, from any law that would:  (1) Prohibit the establishment of a purchasing group;  (2) Make it unlawful for an insurer to provide or offer to provide insurance on a basis providing, to a purchasing group or its members, advantages based on their loss and expense experience not afforded to other persons with respect to rates, policy forms, coverage or other matters;  (3) Prohibit a purchasing group or its members from purchasing insurance on a group basis described in subdivision (2) of this section;  (4) Prohibit a purchasing group from obtaining insurance on a group basis because the group has not been in existence for a minimum period of time or because any member has not belonged to the group for a minimum period of time;  (5) Require that a purchasing group must have a minimum number of members, common ownership or affiliation, or certain legal form;  (6) Require that a certain percentage of a purchasing group must obtain insurance on a group basis;  (7) Discriminate against a purchasing group or any of its members; or  (8) Require that any insurance policy issued to a purchasing group or any of its members be countersigned by an insurance agent or broker or producer residing in this state.  History of Section.P.L. 1991, ch. 348,  1. 
 27-46-8. Notice and registration requirements of purchasing groups. (a) A purchasing group which intends to do business in this state shall, prior to doing business, furnish notice to the commissioner which shall:  (1) Identify the state in which the group is domiciled;  (2) Identify all other states in which the group intends to do business;  (3) Specify the lines and classifications of liability insurance that the purchasing group intends to purchase;  (4) Identify the insurance company or companies from which the group intends to purchase its insurance and the domicile of the company;  (5) Specify the method by which, and the person or persons, if any, through whom insurance will be offered to its members whose risks are resident or located in this state;  (6) Identify the principal place of business of the group; and  (7) Provide any other information that may be required by the commissioner to verify that the purchasing group is qualified under  27-46-2(10).  (b) A purchasing group shall, within ten (10) days, notify the commissioner of any changes in any of the items set forth in subsection (a) of this section.  (c) The purchasing group shall register with and designate the commissioner as its agent solely for the purpose of receiving service of legal documents or process, for which a filing fee shall be determined by the commissioner, except that these requirements shall not apply in the case of a purchasing group which only purchases insurance that was authorized under the federal Products Liability Risk Retention Act of 1981, 15 U.S.C.  3901 et seq., and:  (1) Which in any state of the United States:  (i) Was domiciled before April 1, 1986; and  (ii) Is domiciled on and after October 27, 1986;  (2) Which:  (i) Before October 27, 1986 purchased insurance from an insurance carrier licensed in any state; and  (ii) Since October 27, 1986 purchased its insurance from an insurance carrier licensed in any state; or  (3) Which was a purchasing group under the requirements of 15 U.S.C.  3901 et seq. before October 27, 1986.  (d) Each purchasing group that is required to give notice pursuant to subsection (a) shall also furnish the information that may be required by the commissioner to:  (1) Verify that the entity qualifies as a purchasing group;  (2) Determine where the purchasing group is located; and  (3) Determine appropriate tax treatment.  History of Section.P.L. 1991, ch. 348,  1; P.L. 2002, ch. 292,  88. 
 27-46-9. Restrictions on insurance purchased by purchasing groups. (a) A purchasing group may not purchase insurance from a risk retention group that is not chartered in a state or from an insurer not admitted in the state in which the purchasing group is located, unless the purchase is effected through a licensed agent or broker or insurance producer acting pursuant to the surplus lines laws and regulations of that state.  (b) A purchasing group which obtains liability insurance from an insurer not admitted in this state or a risk retention group shall inform each of the members of the group which have a risk resident or located in this state that the risk is not protected by an insurance insolvency guaranty fund in this state, and that the risk retention group or the insurer may not be subject to all insurance laws and regulations of this state.  (c) No purchasing group may purchase insurance providing for a deductible or self insured retention applicable to the group as a whole; coverage may provide for a deductible or self insured retention applicable to individual members.  (d) Purchases of insurance by purchasing groups are subject to the same standards regarding aggregate limits which are applicable to all purchases of group insurance.  History of Section.P.L. 1991, ch. 348,  1. 
 27-47-1. Definitions. (a) Chief executive officer is the person, irrespective of his or her title, designated by the board of directors or trustees of an insurer as the person charged with the responsibility of administering and implementing the insurers policies and procedures.  (b) Commissioner means the commissioner of insurance or the commissioners equivalent of the state of domicile of any insurer.  (c) Impaired is a financial situation in which the assets of an insurer are less than the sum of the insurers minimum required capital, minimum required surplus and all liabilities as determined in accordance with the requirements for the preparation and filing of the annual statement of an insurer under chapter 12 of this title.  (d) Insurer means any insurance company or other insurer licensed to do business in this state.  History of Section.P.L. 1991, ch. 348,  1. 
 27-47-2. Duty to notify. (a) Whenever a chief executive officer of an insurer knows or has reason to know that an insurer is impaired, he or she shall notify the commissioner, in writing, of the impairment as soon as reasonably possible, but in no event later than fifteen (15) days after the chief executive officer knows or has reason to know of the impairment, and shall also notify, in writing, all of the board of directors or trustees of the insurer within the same time period.  (b) Any officer, director, or trustee of an insurer shall notify the person serving as chief executive officer of the impairment of the insurer in the event the officer, director, or trustee knows or has reason to know that the insurer is impaired.  History of Section.P.L. 1991, ch. 348,  1. 
 27-47-3. Penalty. (a) Any person who violates  27-47-2 shall, upon conviction, be fined not more than fifty thousand dollars ($50,000) or be imprisoned for not more than one year, or both.  (b) Any person who does any of the following:  (1) Conceals any property belonging to an insurer;  (2) Transfers or conceals in contemplation of a state insolvency proceeding his own property or property belonging to an insurer;  (3) Conceals, destroys, mutilates, alters, or makes a false entry in any document which affects or related to the property of an insurer or withholds any document from a receiver, trustee, or other officer of a court entitled to its possession; or  (4) Gives, obtains, or receives a thing of value for acting or forbearing to act in any court proceedings, and that act or acts results in or contributes to an insurer becoming impaired or insolvent, then that person shall be guilty of a felony and, upon conviction, be punished by imprisonment for not more than five (5) years.  History of Section.P.L. 1991, ch. 348,  1. 
 27-48-1. Short title. This chapter may be known as the Business Transacted with Producer Controlled Insurer Act.  History of Section.P.L. 1992, ch. 445,  9. 
 27-48-2. Definitions. As used in this chapter: (1) Accredited state means a state in which the insurance department or regulatory agency has qualified as meeting the minimum financial regulatory standards promulgated and established from time to time by the National Association of Insurance Commissioners (NAIC);  (2) Control or controlled has the meaning ascribed in  27-35-1(c);  (3) Controlled insurer means a licensed insurer which is controlled, directly or indirectly, by a producer;  (4) Controlling producer means a producer who, directly or indirectly, controls an insurer;  (5) Director means the director of the department of business regulation, or his or her designee;  (6) Licensed insurer or insurer means any person, firm, association, or corporation duly licensed to transact a property or casualty insurance business in this state. The following, inter alia, are not licensed insurers for the purposes of this chapter:  (i) All risk retention groups as defined in the Risk Retention Act, 15 U.S.C.  3901 et seq., and chapter 46 of this title;  (ii) All residual market pools and joint underwriting authorities or associations; and  (iii) All captive insurers; for the purposes of this chapter, captive insurers means insurance companies which are owned by another organization whose exclusive purpose is to insure risks of the parent organization and affiliated companies or, in the case of groups and associations, insurance organizations owned by the insured whose exclusive purpose is to insure risks to member organizations and/or group members and their affiliates; and  (7) Producer means an insurance broker or brokers or any other person, firm, association, or corporation, when, for any compensation, commission, or other thing of value, that person, firm, association, or corporation acts or aids in any manner in soliciting, negotiating, or procuring the making of any insurance contract on behalf of an insured other than the person, firm, association, or corporation.  History of Section.P.L. 1992, ch. 445,  9. 
 27-48-3. Applicability. This chapter shall apply to licensed insurers as defined in  27-48-2, either domiciled in this state or domiciled in a state that is not an accredited state having in effect a substantially similar law. All provisions of chapter 35 of this title to the extent they are not superseded by this chapter shall continue to apply to all parties within holding company systems subject to this chapter.  History of Section.P.L. 1992, ch. 445,  9. 
 27-48-4. Minimum standards. (a)(1) The provisions of this section shall apply if, in any calendar year, the aggregate amount of gross written premium on business placed with a controlled insurer by a controlling producer is equal to or greater than five percent (5%) of the admitted assets of the controlled insurer, as reported in the controlled insurers quarterly statement filed as of September 30 of the prior year;  (2) Notwithstanding subdivision (1) of this subsection, the provisions of this section shall not apply if:  (i) The controlling producer:  (A) Places insurance only with the controlled insurer, or only with the controlled insurer and a member or members of the controlled insurers holding company system, or the controlled insurers parent, affiliate, or subsidiary and receives no compensation based upon the amount of premiums written in connection with the insurance; and  (B) Accepts insurance placements only from nonaffiliated subproducers, and not directly from the insured; and  (ii) The controlled insurer, except for insurance business written through a residual market facility, accepts insurance business only from a controlling producer, a producer controlled by the controlled insurer, or a producer that is a subsidiary of the controlled insurer.  (b) A controlled insurer shall not accept business from a controlling producer and a controlling producer shall not place business with a controlled insurer unless there is a written contract between the controlling producer and the insurer specifying the responsibilities of each party, which contract has been approved by the board of directors of the insurer and contains the following minimum provisions:  (1) The controlled insurer may terminate the contract for cause, upon written notice to the controlling producer. The controlled insurer shall suspend the authority of the controlling producer to write business during the pendency of any dispute regarding the cause for the termination;  (2) The controlling producer shall render accounts to the controlled insurer detailing all material transactions, including information necessary to support all commissions, charges, and other fees received by, or owing to, the controlling producer;  (3) The controlling producer shall remit all funds due under the terms of the contract to the controlled insurer on at least a monthly basis. The due date shall be fixed so that collected premiums or installments shall be remitted no later than ninety (90) days after the effective date of any policy placed with the controlled insurer under this contract;  (4) All funds collected for the controlled insurers account shall be held by the controlling producer in a fiduciary capacity, in one or more appropriately identified bank accounts in banks that are members of the Federal Reserve System, in accordance with the provisions of the insurance law as applicable. Funds of a controlling producer not required to be licensed in this state shall be maintained in compliance with the requirements of the controlling producers domiciliary jurisdiction;  (5) The controlling producer shall maintain separately identifiable records of business written for the controlled insurer;  (6) The contract shall not be assigned in whole or in part by the controlling producer;  (7) The controlled insurer shall provide the controlling producer with its underwriting standards, rules and procedures, manuals setting forth the rates to be charged, and the conditions for the acceptance or rejection of risks. The controlling producer shall adhere to the standards, rules, procedures, rates and conditions. The standards, rules, procedures, rates and conditions shall be the same as those applicable to comparable business placed with the controlled insurer by a producer other than the controlling producer;  (8) The rates and terms of the controlling producers commissions, charges, or other fees and the purposes for those charges or fees. The rates of the commissions, charges, and other fees shall be no greater than those applicable to comparable business placed with the controlled insurer by producers other than controlling producers. For the purposes of this subsection and subdivision (7) of this subsection, examples of comparable business shall include the same lines of insurance, same kinds of insurance, same kinds of risks, similar policy limits, and similar quality of business;  (9) If the contract provides that the controlling producer on insurance business placed with the insurer is to be compensated contingent upon the insurers profits on that business, then the compensation shall not be determined and paid until at least five (5) years after the premiums on liability insurance are earned and at least one year after the premiums are earned on any other insurance. In no event shall the commissions be paid until the adequacy of the controlled insurers reserves on remaining claims has been independently verified pursuant to subdivision (d)(1) of this section;  (10) There shall be a limit on the controlling producers writings in relation to the controlled insurers surplus and total writings. The insurer may establish a different limit for each line or sub-line of business. The controlled insurer shall notify the controlling producer when the applicable limit is approached and shall not accept business from the controlling producer if the limit is reached. The controlling producer shall not place business with the controlled insurer if it has been notified by the controlled insurer that the limit has been reached; and  (11) The controlling producer may negotiate but shall not bind reinsurance on behalf of the controlled insurer on business the controlling producer places with the controlled insurer, except that the controlling producer may bind facultative reinsurance contracts pursuant to obligatory facultative agreements if the contract with the controlled insurer contains underwriting guidelines including, for both reinsurance assumed and ceded, a list of reinsurers with which the automatic agreements are in effect, the coverage and amounts or percentages that may be reinsured, and commission schedules.  (c) Every controlled insurer shall have an audit committee of the board of directors composed of independent directors. The audit committee shall annually meet with management, the insurers independent certified public accountants, and an independent casualty actuary or other independent loss reserve specialist acceptable to the commissioner to review the adequacy of the insurers loss reserves.  (d)(1) In addition to any other required loss reserve certification, the controlled insurer shall annually, on April 1 of each year, file with the director an opinion of an independent casualty actuary, or any other independent loss reserve specialist acceptable to the director, reporting loss ratios for each line of business written and attesting to the adequacy of loss reserves established for losses incurred and outstanding as of year end including incurred but not reported on business placed by the producer; and  (2) The controlled insurer shall annually report to the director the amount of commissions paid to the producer, the percentage that amount represents of the net premiums written, and comparable amounts and percentage paid to noncontrolling producers for placements of the same kinds of insurance.  History of Section.P.L. 1992, ch. 445,  9; P.L. 1993, ch. 180,  28. 
 27-48-5. Disclosure. The producer, prior to the effective date of the policy, shall deliver written notice to the prospective insured disclosing the relationship between the producer and the controlled insurer; except that, if the business is placed through a subproducer who is not a controlling producer, the controlling producer shall retain in his or her records a signed commitment from the subproducer that the subproducer is aware of the relationship between the insurer and the producer and that the subproducer has notified or will notify the insured.  History of Section.P.L. 1992, ch. 445,  9. 
 27-48-6. Penalties. (a)(1) If the director believes that the controlling producer or any other person has not materially complied with this chapter, or any regulation or order promulgated pursuant to this chapter, after notice and opportunity to be heard, the director may order the controlling producer to cease placing business with the controlled insurer; and  (2) If it was found that because of the material noncompliance that the controlled insurer or any policyholder of the insurer has suffered any loss or damage, the director may maintain a civil action or intervene in an action brought by or on behalf of the insurer or policyholder for recovery of compensatory damages for the benefit of the insurer or policyholder or other appropriate relief.  (b) If an order for liquidation or rehabilitation of the controlled insurer has been entered pursuant to chapter 14.3 of this title, and the receiver appointed under that order believes that the controlling producer or any other person has not materially complied with this chapter, or any regulation or order promulgated pursuant to this chapter, and the insurer suffered any loss or damage from the noncompliance, the receiver may maintain a civil action for recovery of damages or other appropriate sanctions for the benefit of the insurer.  (c) Nothing contained in this section shall affect the right of the director to impose any other penalties provided for in the insurance law.  (d) Nothing contained in this section is intended to or shall in any manner alter or affect the rights of policyholders, claimants, creditors, or other third parties.  History of Section.P.L. 1992, ch. 445,  9. 
 27-49-1. Purpose. The purpose of this chapter is to allow for the sharing of information as to motor vehicle theft and/or motor vehicle insurance fraud between automobile insurers and certain governmental agencies. This chapter allows the governmental agencies to request and receive from the insurers information relating to motor vehicle theft or motor vehicle insurance fraud losses; provide for insurers to notify these agencies of motor vehicle theft and insurance fraud; and to provide for immunity to the insurers providing this information, and protecting the confidentiality of the information exchanged or released pursuant to this chapter.  History of Section.P.L. 1992, ch. 274,  1; P.L. 1998, ch. 441,  24. 
 27-49-2. Definitions. (a) Authorized governmental agency includes:  (1) The office of the attorney general;  (2) The state police;  (3) Any police or fire department of a municipality;  (4) The U.S. Attorneys office for the state of Rhode Island;  (5) Any duly constituted criminal investigative department or agency, including the Federal Bureau of Investigation of the United States;  (6) Any solicitor or prosecuting attorney for a municipality;  (7) The director of the insurance division;  (8) The administrator of the division of motor vehicles; and  (9) The office of automobile theft and insurance fraud established by  31-50-1.  (b) Insured means a person, corporation, or other entity for which automobile insurance coverage is provided by an insurer.  (c) Insurer means any domestic insurer or foreign insurer, licensed to provide automobile insurance coverage pursuant to the provisions of this title, or otherwise liable for any loss due to motor vehicle theft or motor vehicle insurance fraud.  (d) Relevant means having a tendency to make the existence of any fact that is of consequence to the investigation or determination of the issue more probable or less probable than it would be without the information.  History of Section.P.L. 1992, ch. 274,  1; P.L. 1993, ch. 228,  1; P.L. 1994, ch. 86,  5. 
 27-49-3.1. Disclosure of personal information obtained in connection with motor vehicle records. (a) Purpose. The purpose of this section is to implement the federal Drivers Privacy Protection Act of 1994 (DPPA), 18 U.S.C.  2721 et seq.  (b) Definitions. As defined in 18 U.S.C.  2725, the following definitions apply to this section:  (1) Motor vehicle record means any record that pertains to a motor vehicle operators permit, motor vehicle title, motor vehicle registration, or identification card issued by the department of motor vehicles;  (2) Person means an individual, organization, or entity, but does not include a state or agency of a state; and  (3) Personal information means information that identifies an individual, including an individuals photograph, social security number, driver identification number, name, address (but not the 5 digit zip code), telephone number, and medical or disability information, but does not include information on vehicular accidents, driving violations, and drivers status.  (c) Prohibition on release and use of certain personal information from state motor vehicle records.(1) In general. Except as provided in subdivision (2) of this section, the division of motor vehicles, and any officer, employee, or contractor of the division, shall not knowingly disclose or make available to any person or entity personal information about any individual obtained by the division in connection with a motor vehicle record.  (2) Permissible uses. Personal information referred to in subdivision (1) of this section shall be disclosed for use in connection with matters of motor vehicle or driver safety and theft, motor vehicle emissions, motor vehicle product alterations, recalls, or advisories, performance monitoring of motor vehicles and dealers by motor vehicle manufacturers, and removal of nonowner records from the original owner records of motor vehicles manufacturers to carry out the purposes of the Automobile Information Disclosure Act, 15 U.S.C.  1231 et seq., the Motor Vehicle Information and Cost Saving Act (see now 49 U.S.C.  32101 et seq.), the National Traffic and Motor Vehicle Safety Act of 1966 (see now 49 U.S.C.  30101 et seq.), and Anti-Car Theft Act of 1992 (see now 49 U.S.C.  32101 et seq.), and the Clean Air Act, 42 U.S.C.  7401 et seq., and may be disclosed as follows:  (i) For use by any government agency, including any court or law enforcement agency, in carrying out its functions, or any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions.  (ii) For use in connection with matters of motor vehicle or driver safety and theft; motor vehicle emissions; motor vehicle product alterations, recalls or advisories; performance monitoring of motor vehicles, motor vehicle parts and dealers; motor vehicle market research activities, including survey research; and removal of nonowner records from the original owner records of motor vehicle manufacturers.  (iii) For use in the normal course of business by a legitimate business or its agents, employees, or contractors, but only:  (A) To verify the accuracy of personal information submitted by the individual to the business of its agents, employees, or contractors, and  (B) If the information as submitted is not correct or is no longer correct, to obtain the correct information, but only for the purposes of preventing fraud by pursuing legal remedies against, or recovering on a debt or security interest against, the individual.  (iv) For use in connection with any civil, criminal, administrative, or arbitral proceeding in any federal, state, or local agency or before any self-regulatory body, including the service of process, investigation in anticipation of litigation, and the execution or enforcement of judgments and orders, or pursuant to an order of a federal, state, or local court.  (v) For use in research activities, and for use in producing statistical reports, so long as the personal information is not published, redisclosed, or used to contact the individuals.  (vi) For use by any insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or contractors in connection with claims investigation activities, anti-fraud activities, rating or underwriting.  (vii) For use in providing notice to the owners of towed or impounded vehicles.  (viii) For use by any licensed private investigative agency or licensed security service for any purpose permitted under this subsection.  (ix) For use by an employer or its agent or insurer to obtain or verify information relating to a holder of a commercial drivers license that is required under the Commercial Motor Vehicle Safety Act of 1986 (see now 49 U.S.C.  31301 et seq.).  (x) For use in connection with the operation of private toll transportation facilities.  (xi) For any other use in response to a request for individual motor vehicle records, unless that use is prohibited by the individual.  (xii) For bulk distribution for surveys, marketing or solicitations, provided that the information will be used, rented or sold solely for bulk distribution for surveys, marketing, and solicitations and that surveys, marketing, and solicitations will not be directed at those individuals who have requested in a timely fashion that they not be directed at them.  (3) Notice. The division of motor vehicles shall provide in a clear and conspicuous manner on forms for issuance or renewal of operators permits, titles, registrations or identification cards, notice that personal information collected by the division may be disclosed to any business or person and provide in a clear and conspicuous manner on the forms an opportunity to prohibit the disclosures; provided, that social security numbers and medical or disability information shall not be subject to disclosure under this chapter.   History of Section.P.L. 1997, ch. 26,  1; P.L. 2002, ch. 292,  89; P.L. 2008, ch. 475,  95; P.L. 2009, ch. 310,  8. 
 27-49-3. Disclosure of information. (a) Upon written request to an insurer by an authorized governmental agency, an insurer or agent authorized by an insurer to act on its behalf shall release to the requesting authorized governmental agency any or all relevant information, which is deemed important to the authorized governmental agency and which the insurer may possess relating to any specific motor vehicle theft or motor vehicle insurance fraud. Relevant information may include, but is not limited to:  (1) Insurance policy information relevant to the motor vehicle theft or motor vehicle insurance fraud under investigation, including any application for the policy;  (2) Policy premium payment records, which are available;  (3) History of previous claims made by the insured; and  (4) Information relating to the investigation of the motor vehicle theft or motor vehicle insurance fraud, including statements of any person, proofs of loss, and notice of loss.  (b) When an insurer knows the identity of a person, or possesses information tending to establish the identity of a person, whom it has reason to believe committed a criminal or fraudulent act relating to a motor vehicle theft or motor vehicle insurance claim, or has knowledge of a criminal or fraudulent act which is reasonably believed not to have been reported to an authorized governmental agency, then for the purpose of notification and investigation, the insurer or an agent authorized by an insurer to act on its behalf shall notify an authorized governmental agency of the knowledge or information and provide any additional information in accordance with subsection (a). For the purpose of this chapter, when an insurer provides any of the authorized governmental agencies with notice pursuant to this section it shall be deemed sufficient notice to all authorized governmental agencies. Nothing in this subsection shall abrogate or impair the rights or powers created under subsection (a) of this section.  (c) The authorized governmental agency provided with information pursuant to subsection (a) or (b) of this section may release or provide the information to any other authorized governmental agencies.  (d) Any insurer providing information to an authorized governmental agency pursuant to this section shall have the right to request and receive relevant information from the authorized governmental agency, and receive within a reasonable time, not to exceed thirty (30) days, the requested information.  History of Section.P.L. 1992, ch. 274,  1. 
 27-49-4. Evidence and confidentiality. Any information furnished pursuant to this chapter shall be privileged and not a part of any public record. Except as otherwise provided by law, any authorized governmental agency, insurer, or an agent authorized by an insurer to act on its behalf which receives any information furnished pursuant to this chapter, shall not release the information to public inspection. The evidence or information shall not be subject to subpoena duces tecum in a civil or criminal proceeding, unless, after reasonable notice to any insurer, agent authorized by an insurer to act on its behalf, and authorized governmental agency which has an interest in the information and a subsequent hearing, the court determines that the public interest and any ongoing investigation by the authorized governmental agency, insurer, or an agent authorized by an insurer to act on its behalf will not be jeopardized by compliance with the subpoena or subpoena duces tecum.  History of Section.P.L. 1992, ch. 274,  1. 
 27-49-5.1. Insurer disclosure  Qualified immunity. (a) An insurer and an agent authorized to act on its behalf, upon written request, may provide to another insurer or insurance industry related organization whose purpose it is to investigate or assist in the prosecution of motor vehicle insurance fraud any and all relevant factually accurate information which the insurer may possess as to any motor vehicle claim or other information which may relate to whether a motor vehicle theft or motor vehicle insurance fraud has occurred.  (b) No insurer, organization or agent authorized to act under subsection (a) of this section shall be subjected to any civil or criminal liability in any cause of action of any kind for releasing or receiving any relevant factually accurate information pursuant to subsection (a) of this section if it acts in good faith and with due care solely for the purpose of facilitating the discovery and prosecution of the theft or fraud.  History of Section.P.L. 1993, ch. 228,  2. 
 27-49-5. Immunity. No insurer, or agent authorized by an insurer to act on its behalf, authorized governmental agency or its respective employees shall be subject to any civil or criminal liability in a cause of action of any kind for releasing or receiving any factually accurate information pursuant to  27-49-3 or  27-49-4. Nothing in this chapter is intended to or does in any way or manner abrogate or lessen the common and statutory law, privileges and immunities of an insurer, agent authorized by an insurer to act on its behalf, or authorized governmental agency or any of their respective employees.  History of Section.P.L. 1992, ch. 274,  1. 
 27-49-6. Severability. If any clause, sentence, paragraph, section, or part of this chapter or its application to any person or circumstances, shall, for any reason, be adjudged by any court of competent jurisdiction to be invalid, that judgment shall not affect, impair, or invalidate the remainder of this chapter, and the application of this chapter to other persons or circumstances, but shall be confined in its operation to the clause, sentence, paragraph, section, or part of it directly involved in the controversy in which the judgment shall have been rendered and to the person or circumstances involved.  History of Section.P.L. 1992, ch. 274,  1. 
 27-5-1. Standard fire insurance policy. The printed form of a policy of fire insurance, as set forth in  27-5-3, shall be known and designated as the standard fire insurance policy of the state of Rhode Island.  The printed form of a policy of fire insurance, as set forth in  27-5-3, shall be known and designated as the standard fire insurance policy of the state of Rhode Island.  The printed form of a policy of fire insurance, as set forth in  27-5-3, shall be known and designated as the standard fire insurance policy of the state of Rhode Island.  History of Section.G.L. 1896, ch. 183,  4; G.L. 1909, ch. 222,  4; G.L. 1923, ch. 258,  4; G.L. 1938, ch. 154,  1; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-1. 
 27-5-10. Penalty for nonconforming policy  Validity. 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.  History of Section.G.L. 1896, ch. 183,  6; G.L. 1909, ch. 222,  6; G.L. 1923, ch. 258,  6; G.L. 1938, ch. 154,  3; G.L. 1938, ch. 154,  2; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-10. 
 27-5-11. Enforcement of standard policy requirements. The director of business regulation shall enforce the provisions of  27-5-1  27-5-10. History of Section.P.L. 1935, ch. 2250,  73; G.L. 1938, ch. 154,  4; G.L. 1938, ch. 154,  3; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-11. 
 27-5-12. Declination of premium notes by mutual companies  Provision as to liability. Every mutual fire insurance company organized under the laws of this state may decline to take premium notes in partial payment for insurance; provided, there is inserted in the body of the policy issued a provision making the assured, his or her or their executors, administrators, or assigns, liable for any assessments provided in the policy, and as shall become necessary in order to pay all losses and expenses not exceeding twenty (20) times the amount of the cash premium paid.  History of Section.G.L. 1896, ch. 181,  16; G.L. 1909, ch. 219,  16; G.L. 1923, ch. 255,  16; G.L. 1938, ch. 150,  15; P.L. 1944, ch. 1524,  1; P.L. 1953, ch. 3174,  2; G.L. 1956,  27-5-12. 
 27-5-13. Mutual membership not acquired by reinsurance. Any mutual company of this or any other state ceding reinsurance to a similar company shall not, unless the contract of reinsurance provides, become a member of the company accepting the reinsurance, or be entitled to any dividend or expiration return of premium or of unabsorbed premium deposit, or be subject to liability to assessment.  History of Section.G.L. 1938, ch. 150,  15; P.L. 1944, ch. 1524,  1; P.L. 1953, ch. 3174,  2; G.L. 1956,  27-5-13. 
 27-5-14. Reinsurance by mutual insurers  Agreements with policyholders. (a) Whenever any mutual company of this or any other state shall reinsure in a similar company the whole or any portion of a risk covered by its policy or policies of insurance, it may do so either:  (1) By existing methods of reinsurance; or  (2) By agreement with its policyholder or policyholders attached to and made a part of its policy or policies.  (b) This agreement shall contain a schedule giving:  (1) The name and location of each reinsuring company; and  (2) The portion of the risk reinsured in each company.  (c) This agreement shall also provide that the dividend or return of the premium or premium deposit to be paid or credited upon termination of the policy or policies shall be the sum of:  (1) The dividend or return of the premium or premium deposit to be paid or credited upon that portion of the premium or premium deposit retained by the company issuing the policy or policies; and  (2) The aggregate amount of the dividends or returns of the premium or premium deposit paid or credited upon all portions of the premium or premium deposit ceded to all the reinsuring companies.  History of Section.G.L. 1938, ch. 150,  15; P.L. 1953, ch. 3174,  2; G.L. 1956,  27-5-14. 
 27-5-15. Power to create guaranty surplus and special reserve funds. Any insurance company organized under the laws of this state authorized to transact a fire insurance business may create the funds provided for in  27-5-16  27-5-31, to be known and designated as the guaranty surplus fund and the special reserve fund, and may avail itself of the provisions of this section and  27-5-16  27-5-31, upon complying with the requirements of those sections.  History of Section.P.L. 1907, ch. 1438,  1; G.L. 1909, ch. 219,  26; G.L. 1923, ch. 255,  26; G.L. 1938, ch. 150,  25; G.L. 1956,  27-5-15; P.L. 2002, ch. 292,  22. 
 27-5-16. Resolution to establish surplus and reserve funds  Certification of funds. Any state fire insurance company desiring to create guaranty surplus and special reserve funds may do so upon the adoption of a resolution by its board of directors, at a regular meeting of its board of directors, to that effect, and filing with the insurance commissioner a copy declaring the intention of the company to create those funds and to do business under the provisions of this chapter. As soon after the filing of a copy of the resolution as is convenient, the insurance commissioner shall make, or cause to be made, an examination of the company, and the commissioner shall make a certificate of the result which shall particularly set forth the amount of surplus funds held by the company at the date of the examination, the whole or any part of which under the provisions of this chapter may be equally divided between and set apart to constitute guaranty surplus and special reserve funds, which certificate shall be recorded in the office of the insurance commissioner.  History of Section.P.L. 1907, ch. 1438,  2; G.L. 1909, ch. 219,  27; G.L. 1923, ch. 255,  27; G.L. 1938, ch. 150,  27; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-5-16. 
 27-5-17. Restrictions on dividends  Payments into surplus and reserve funds. After the date of filing the resolution referred to in  27-5-16 with the insurance commissioner, the company shall not make or declare or pay in any form any dividend upon its capital stock exceeding eight percent (8%) per annum and six percent (6%) per annum upon the surplus funds to be formed under this chapter until after its guaranty surplus fund and its special reserve fund shall have together accumulated to an amount equal to its capital stock. Any part of the surplus profits of the company above its annual dividend may be equally divided between and set apart to constitute the guaranty surplus fund and the special reserve fund, which funds shall be held and used as provided in this chapter and not otherwise. Any company doing business under this chapter that shall declare or pay any dividend contrary to the provisions contained in this section shall forfeit its charter and be liable to be proceeded against by the attorney general for its dissolution.  History of Section.P.L. 1907, ch. 1438,  3; G.L. 1909, ch. 219,  28; G.L. 1923, ch. 255,  28; G.L. 1938, ch. 150,  27; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-5-17. 
 27-5-18. Computation of profits. (a) In estimating the profit of any company for the purpose of making a division between its guaranty surplus fund and its special reserve fund, until those funds shall together amount to a sum equal to the capital stock of the company, there shall be deducted from the gross assets of the company, including for this purpose the amount of the special reserve fund, the sum of the following items:  (1) The amount of all outstanding claims;  (2) An amount sufficient to meet the liability of the company for the unearned premiums upon its unexpired policies, which amount shall at least equal one half (12) of the premiums received on policies having less than one year to run from the date of the policy, and a pro rata proportion of the premiums received on the policies having more than one year to run from the date of the policy, and shall be known as the reinsurance liability;  (3) The amount of its guaranty surplus fund and of its special reserve fund;  (4) The amount of the capital of the company; and  (5) Interest at the rate of eight percent (8%) per annum upon the amount of the capital and six percent (6%) per annum upon the amount of the funds for whatever time shall have elapsed since the last preceding cash dividend.  (b) The balance shall constitute the net surplus of the company, any portion of which is subject to an equal division between the funds as provided in this section.  History of Section.P.L. 1907, ch. 1438,  7; G.L. 1909, ch. 219,  32; G.L. 1923, ch. 255,  32; G.L. 1938, ch. 150,  31; P.L. 1939, ch. 659,  2; G.L. 1956,  27-5-18. 
 27-5-19. Certification that funds equal capital stock  Subsequent additions. Whenever any company notifies the insurance commissioner that it has fulfilled the requirements already expressed in this chapter, and that its guaranty surplus fund and its special reserve fund taken together equal its capital stock, the commissioner shall make an examination of the company and make a certificate of the result and file the certificate in his or her office. If the commissioner finds that the combined funds equal the capital stock of the company, after this the company may continue, out of any subsequent profits of its business, to add to those funds; provided, that whenever any addition is made to the special reserve fund, an equal sum shall be carried to the guaranty surplus fund.  History of Section.P.L. 1907, ch. 1438,  4; G.L. 1909, ch. 219,  29; G.L. 1923, ch. 255,  29; G.L. 1938, ch. 150,  28; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-5-19. 
 27-5-2.1. Repealed.
 27-5-2. Compliance with standard policy required. Except as provided in  27-5-9.1 and  27-65-1(e), no policy or contract of fire insurance shall be made, issued, or delivered by any insurer or by any insurance producer or representative of an insurance producer on any property in this state, unless it shall conform, as to all provisions, stipulations, agreements, and conditions, with the standard form of policy.  History of Section.G.L. 1896, ch. 183,  4; G.L. 1909, ch. 222,  4; G.L. 1923, ch. 258,  4; G.L. 1938, ch. 154,  1; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-2; 1979, ch. 48,  1; P.L. 2004, ch. 91,  2; P.L. 2004, ch. 320,  2; P.L. 2011, ch. 18,  2; P.L. 2011, ch. 25,  2. 
 27-5-20. Investment of guaranty surplus fund  Liability to payment of losses. The guaranty surplus fund shall be held and be invested by a state fire insurance company in the same manner as its capital stock and surplus accumulation may be held and be invested, and shall be liable and applicable in the same manner as the capital stock is to the payment generally of the losses of the company.  History of Section.P.L. 1907, ch. 1438,  5; G.L. 1909, ch. 219,  30; G.L. 1923, ch. 255,  30; G.L. 1938, ch. 150,  29; G.L. 1956,  27-5-20. 
 27-5-21. Deposit of special reserve fund. The special reserve fund shall be invested according to existing laws relating to investments of capital by fire insurance companies, and shall be deposited as the fund shall accumulate and be invested, with the insurance commissioner of the state, who shall permit the company depositing the fund to change deposits by substituting for those withdrawn others of equal amount and value, and to collect and receive the interest or dividends upon those securities as the interest or dividends may accrue. The fund shall not be regarded as any part of the assets in possession of the company, so as to be or render the company liable for any claim for loss by fire or except as provided in this chapter.  History of Section.P.L. 1907, ch. 1438,  6; G.L. 1909, ch. 219,  31; G.L. 1923, ch. 255,  31; G.L. 1938, ch. 150,  30; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-5-21. 
 27-5-22. Application of special reserve fund to protection of policyholders. Whenever the claims upon a fire insurance company shall exceed the amount of its capital stock and of the guaranty surplus fund provided for by this chapter, the company shall notify the insurance commissioner of the fact, who shall then make or cause to be made an examination of the company, and shall issue his or her certificate of the result, showing the amounts of capital, of guaranty surplus fund, of special reserve fund, of reinsurance liability, and of other assets. Upon the issuing of that certificate in duplicate, one copy to be given to the company and one to be recorded in the office of the insurance commissioner, the special reserve fund shall be immediately held to protect all policyholders of the company other than those that are claimants upon it at the date of the certificate, and the special reserve fund together with other assets, certified by the insurance commissioner as equal in value to the amount of the unearned premiums of the company, to be ascertained as provided in this chapter, shall constitute the capital and assets of the company for the protection of policyholders other than the claimants and for the further conduct of its business, and any official certificate of the insurance commissioner shall be binding and conclusive upon all parties interested in the company, whether as stockholders, creditors, or policyholders. Upon the payment to the claimants, who are claimants at the date of the certificate, of the full sum of the capital of the company and of its guaranty surplus fund and of its assets at that date, excepting only the special reserve fund and an amount of its assets equal to the liability of the company for unearned premiums, as certified in this manner by the insurance commissioner, the company shall be forever discharged from any and all further liability to the claimants and to each of them, and the insurance commissioner shall, after issuing his or her certificate, upon the demand of the company, transfer to it all securities that have been deposited with the commissioner by the company as the special reserve fund, and if the amount of the special reserve fund is less than fifty percent (50%) of the full amount of the capital of the company, a requisition shall be issued by the insurance commissioner upon the stockholders to make up the capital to that proportion of its full amount; provided, that any capital impaired in this manner shall be made up at least to the sum of two hundred thousand dollars ($200,000), and in case the company, after the requisition, shall fail to make up its capital at least to the sum of two hundred thousand dollars ($200,000), the special reserve fund shall still be held as security and liable for any and all losses occurring upon policies of the company.  History of Section.P.L. 1907, ch. 1438,  8; G.L. 1909, ch. 219,  33; G.L. 1923, ch. 255,  33; G.L. 1938, ch. 150,  32; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-5-22. 
 27-5-23. Annual statement of amounts of funds. A fire insurance company shall, in its annual statement to the insurance commissioner, set forth the amount of its special reserve fund and of its guaranty surplus fund.  History of Section.P.L. 1907, ch. 1438,  8; G.L. 1909, ch. 219,  33; G.L. 1923, ch. 255,  33; G.L. 1938, ch. 150,  32; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-5-23. 
 27-5-24. Maintenance of surplus fund equal to reserve fund. If, in consequence of the payment of losses by fires, or of the expenses of the business, or of the interest or dividends payable under the provisions of this chapter to stockholders, or from any cause, the guaranty surplus fund shall be reduced in amount below the amount of the special reserve fund, the directors of the corporation shall make no additions to the special reserve fund until the guaranty surplus fund is equal to the special reserve fund.  History of Section.P.L. 1907, ch. 1438,  8; G.L. 1909, ch. 219,  33; G.L. 1923, ch. 255,  33; G.L. 1938, ch. 150,  32; G.L. 1956,  27-5-24. 
 27-5-25. Use of special reserve fund to replace capital stock. If any amount greater than a sum equal to one half (12) of its capital stock shall have been deposited with the commissioner by a fire insurance company under the provisions of this chapter, the commissioner shall retain of those securities an amount equal to one half (12) of what amount he or she shall hold in excess of a sum equal to one half (12) of the capital stock, and the commissioner shall transfer the balance to the company, and the amount transferred to the company shall from the time of the transfer, provided the amount shall not be less than two hundred thousand dollars ($200,000), constitute the capital stock of the company for the further conduct of its business, and the retained securities shall be regarded as the special reserve fund of the company, to which additions may be made, and shall be held in the same manner, and for the same purpose, and under the same conditions as the original special reserve fund of the company was held.  History of Section.P.L. 1907, ch. 1438,  8; G.L. 1909, ch. 219,  33; G.L. 1923, ch. 255,  33; G.L. 1938, ch. 150,  32; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-5-25. 
 27-5-26. Physical assets for protection of policyholders. The policy registers, insurance maps, books of record, and other books in use by a fire insurance company in its business, and its policy and other blanks, office furniture, fixtures, and supplies, are not to be considered as assets, but shall be held by the company for its use in the protection of its policyholders.  History of Section.P.L. 1907, ch. 1438,  8; G.L. 1909, ch. 219,  33; G.L. 1923, ch. 255,  33; G.L. 1938, ch. 150,  32; G.L. 1956,  27-5-26. 
 27-5-27. Making up of impairments of capital. If, at any time after a special reserve fund has been accumulated by any company, the directors of the company shall present evidence satisfactory to the insurance commissioner that the capital of the company has become impaired, the commissioner shall order the directors to call upon the stockholders to make up that impairment, and the board of directors may then require the necessary payment by the stockholders to make good the whole of that impairment, or they may apply for that purpose the whole or any part of the special reserve fund and require of the stockholders payment of any amount as may be necessary to make up the balance of that impairment not made up out of the special reserve fund. The stock of every stockholder shall be pledged and liable for the amount assessed upon the stockholder to make up that impairment either in whole or in part, and in case any stockholder refuses to pay that assessment the stock standing in his or her name may be sold at public auction after thirty (30) days notice in any manner as the directors may provide. If the board of directors elects to make good that impairment or any part of the impairment out of the special reserve fund, the insurance commissioner shall, upon request of the board, transfer to the company so much of the special reserve fund as is necessary for the purpose.  History of Section.P.L. 1907, ch. 1438,  9; G.L. 1909, ch. 219,  34; P.L. 1919, ch. 1783,  1; G.L. 1923, ch. 255,  34; G.L. 1938, ch. 150,  33; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-5-27. 
 27-5-28. Maximum single risk insured. 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.  History of Section.P.L. 1907, ch. 1438,  9; G.L. 1909, ch. 219,  34; P.L. 1919, ch. 1783,  1; G.L. 1923, ch. 255,  34; G.L. 1938, ch. 150,  33; G.L. 1956,  27-5-28. 
 27-5-29. Statement on policy as to surplus and reserve funds. Every policy issued by a company which has constituted and set apart a guaranty surplus and special reserve fund under  27-5-15  27-5-31, or any prior law of this state, shall have printed on the policy by the company a statement that the policy is issued under and in pursuance of the laws of the state of Rhode Island relating to guaranty surplus and special reserve funds, and every policy shall be deemed to have been issued and received subject to the provisions of this chapter.  History of Section.P.L. 1907, ch. 1438,  10; G.L. 1909, ch. 219,  35; G.L. 1923, ch. 255,  35; G.L. 1938, ch. 150,  34; G.L. 1956,  27-5-29. 
 27-5-3.1. Exclusion  Nuclear damage. Insurers issuing the standard fire insurance policy of the state of Rhode Island pursuant to  27-5-3 are authorized to affix to the policy or include in it a written statement that the policy does not cover loss or damage caused by nuclear reaction or nuclear radiation or radioactive contamination resulting from an insured peril under the policy; provided, that nothing contained in this section shall be construed to prohibit the attachment to any policy of an endorsement or endorsements specifically assuming coverage for loss or damage caused by nuclear reaction or nuclear radiation or radioactive contamination.  History of Section.P.L. 1961, ch. 23,  1. 
 27-5-3.2. Property insurance. (a) No lending institution, as defined in  19-9-1, doing business in this state, its affiliates or subsidiaries, or a bank holding company, as defined in 12 U.S.C.  1841, its affiliates or subsidiaries, shall, as a condition of the mortgage or as a term of the mortgage deed, require that the mortgagor carry property insurance on the property which is the subject of the mortgage in excess of the replacement cost of any buildings or appurtenances subject to the mortgage; provided, when in the course of selling, transferring, conveying or assigning a mortgage, the servicing rights of the mortgage are similarly transferred, conveyed or assigned, then and in that event it shall be the responsibility of the holder of the mortgage to notify the insurance producer issuing the property insurance policy and the insurer in writing of that sale, transfer, conveyance, or assignment. This notice shall be made in writing and shall be sent to the insurance producer and the insurer within thirty (30) days of the sale, transfer, conveyance, or assignment by mail. In the event that the holder of a mortgage shall fail to notify the insurance producer and the insurer who issued the property insurance policy that is in force, in writing, of that sale, transfer, conveyance, or assignment within thirty (30) days, the holder shall indemnify and hold the insurance producer harmless.  (b) Notwithstanding any provision in this title to the contrary, no such holder of a mortgage shall be entitled to payment of a claim under a property insurance policy for a loss to a covered building which equals less than three thousand five hundred dollars ($3,500), and for which such holder of a mortgage is otherwise entitled to payment, unless no liability exists as to the mortgagor.  History of Section.P.L. 1986, ch. 166,  1; P.L. 1988, ch. 63,  1; P.L. 2002, ch. 112,  1; P.L. 2003, ch. 102,  1; P.L. 2003, ch. 105,  1. 
 27-5-3.3. Resident agent  Banks. All banks and lending institutions doing business in this state, whether acting under state or federal authority, which include, but are not limited to: (1) a bank, savings bank, or trust company, as defined in this title, its affiliates or subsidiaries, (2) a bank holding company, as defined in 12 U.S.C.  1841, its affiliates or subsidiaries, (3) mortgage companies, and (4) any other individual, corporation, partnership, or association authorized to take deposits and/or to make loans of money under the provisions of title 19, shall maintain a resident agent in this state who shall have authority to endorse insurance claim checks on behalf of those banks and lending institutions.  History of Section.P.L. 1988, ch. 74,  1. 
 27-5-3.4. Cancellation or nonrenewal of standard fire insurance policy. (a) A company issuing any policy of insurance which is subject to cancellation or nonrenewal by the company shall effect cancellation or nonrenewal by serving the notice of it provided by the policy. That notice shall be delivered in hand to the named insured, or be left at his or her last address as shown by the companys records, or, if its records contain no last address, at his or her last business, residence, or other address known to the company, or be forwarded to that address by first class mail and maintain proof of mailing of the notice to the insured by United States Postal Service certificate of mailing in the ordinary course of the insurers business, and this proof of mailing shall be sufficient proof of notice.  (b) If a policy is made payable to a mortgagee or any person other than the named insured, notice shall be given as provided in subsection (a) of this section to the payee and to the named insured.  (c) Policies subject to cancellation by the named insured upon giving notice to the company may be cancelled by serving notice in the manner provided in subsection (a) of this section upon the company or upon its insurance producer who issued the policy.  History of Section.P.L. 1989, ch. 483,  1; P.L. 1996, ch. 188,  4; P.L. 2001, ch. 122,  4; P.L. 2002, ch. 292,  22; P.L. 2003, ch. 101,  1; P.L. 2003, ch. 104,  1. 
 27-5-3.5. Earthquake coverage endorsement for property insurance. Notwithstanding any general or special law to the contrary, all insurance companies authorized to provide condominium unit owners, tenants, or homeowners insurance on owner-occupied, one to four (4) unit dwellings in this state shall, in connection with that insurance, make available to any insured purchasing a policy, at the insureds option, earthquake coverage. The premium amount and deductible amount for the earthquake coverage shall be shown separately on the declarations page of the policy.  History of Section.P.L. 1990, ch. 126,  1. 
 27-5-3.6. Notice concerning flood insurance. Upon issuance and each renewal of insurance policies covering standard fire insurance as defined in  27-5-3 and 27-5-9.1, insurers shall provide written notice advising the policy holder that the insurance policy may not cover damages resulting from the flood, that flood insurance may be available through the Federal Emergency Management Agency (FEMA) National Flood Insurance Program, and to contact their insurer or producer for assistance. The notice shall be clear and conspicuous to the policyholder.  History of Section.P.L. 2005, ch. 172,  1. 
 27-5-3.7. Repealed. History of Section.P.L. 2007, ch. 169,  1; P.L. 2007, ch. 262,  1; P.L. 2008, ch. 475,  5, 76; P.L. 2009, ch. 15,  1; P.L. 2009, ch. 42,  1; Repealed by P.L. 2012, ch. 64,  1, effective May 14, 2012; P.L. 2012, ch. 83,  1, effective May 21, 2012. For comparable provisions, see  27-76-2. 
 27-5-3.8. Rhode Island commission on hurricane loss projection methodology. (a) Legislative findings and intent.(1) Reliable projections of hurricane losses are necessary in order to assure that rates for residential property insurance meet the statutory requirement that rates be neither excessive nor inadequate.  (2) The general assembly recognizes the need for expert evaluation of computer models and other recently developed or improved actuarial methodologies for projecting hurricane losses, in order to resolve conflicts among actuarial professionals, and in order to provide both immediate and continuing improvement in the sophistication of actuarial methods used to set rates charged to consumers.  (3) It is the intent of the general assembly to create the Rhode Island commission on hurricane loss projection methodology as a panel of experts to provide the most actuarially sophisticated guidelines and standards for projection of hurricane losses possible, given the current state of actuarial science.   (b) Commission created.(1) There is created the Rhode Island commission on hurricane loss projection methodology. For the purposes of this section, the term commission means the Rhode Island commission on hurricane loss projection methodology. The commission shall be administratively housed within the department of administration, but it shall independently exercise the powers and duties specified in this section.  (2) The commission shall consist of the following eight (8) members:  (i) The director of business regulation, acting as the administrator of insurance, or designee;  (ii) The director of the Rhode Island emergency management agency;  (iii) A member of the board of directors of the Rhode Island Joint Reinsurance Association appointed by the governor;  (iv) Five (5) members directly appointed by the governor, as follows:  (A) An actuary who is employed full-time by a property and casualty insurer that was responsible for at least one percent of the aggregate statewide direct written premium for homeowners insurance in the calendar year preceding the members appointment to the commission;  (B) An expert in insurance finance who has a background in actuarial science;  (C) An expert in statistics who has a background in insurance;  (D) An expert in computer system design.  (E) An expert in meteorology who specializes in hurricanes.  (3) Members designated under subparagraphs (b)(2)(i)-(iii) shall serve on the commission as long as they maintain the respective offices designated in subparagraphs (b)(2)(i)-(iii). Members under subparagraph (b)(2)(iv)(A)-(E) shall serve for a term of three (3) years, and may be reappointed to the commission. All members may be removed by the governor prior to the expiration of their term for cause. Vacancies on the commission shall be filled in the same manner as the original appointment.  (4) The governor shall annually appoint one of the members of the commission to serve as chair.  (5) Members of the commission shall serve without compensation but shall be reimbursed for per diem and travel expenses.  (6) There shall be no liability on the part of, and no cause of action of any nature shall arise against, any member of the commission for any action taken in the performance of their duties under this section. In addition, the commission may, in writing, waive any potential cause of action for negligence of a consultant, contractor, or contract employee engaged to assist the commission.   (c) Adoption and effect of standards and guidelines.(1) The commission shall consider any actuarial methods, principles, standards, models, or output ranges that have the potential for improving the accuracy of or reliability of the hurricane loss projections used in residential property insurance rate filings. The commission shall, from time to time, adopt findings as to the accuracy or reliability of particular methods, principles, standards, models, or output ranges.  (2) The commission shall adopt revisions to previously adopted actuarial methods, principles, standards, models, or output ranges at least annually.  (3)(i) A trade secret that is used in designing and constructing a hurricane loss model and that is provided pursuant to this section, by a private company, to the commission, is confidential and shall not be deemed a public record pursuant to the provisions of chapter 2 of title 38.  (ii) That portion of a meeting of the commission or of a rate proceeding on an insurers rate filing at which a trade secret made confidential and exempt by this paragraph is discussed shall be deemed confidential and not open to disclosure pursuant to the open meetings act, but may be discussed at a closed meeting as provided for in chapter 46 of title 42.   (d) The Rhode Island commission is hereby authorized to form a multi-state commission with the states of Massachusetts, Connecticut, and any other interested state in furtherance of the goals of this act.  History of Section.P.L. 2007, ch. 131,  1; P.L. 2008, ch. 475,  76; P.L. 2015, ch. 52,  3; P.L. 2015, ch. 53,  3. 
 27-5-3.9. Vacant property. 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.  History of Section.P.L. 2018, ch. 78,  1; P.L. 2018, ch. 100,  1. 
 27-5-3. Form of standard policy. The form of the standard fire insurance policy of the state of Rhode Island, with permission to substitute for the word company or companies a more accurate descriptive term for the type of insurer, shall be as follows:  NoSpace for insertion of name of company or companies issuing the policy and other matter permitted to be stated at the head of the policy.  Space for listing amounts of insurance, rates, and premiums for the basic coverages insured under the standard form of policy and for additional coverages or perils insured under endorsements attached.  In consideration of the provisions and stipulations herein or added hereto and of ............... dollars premium this company, for the term of .............           from the ...... day of ............. , 20 ....      to the ...... day of ............. , 20 ....      at 12:01 a.m. standard time at     location of property involved,    to an amount not exceeding ..................... dollars, does insure, .......................... and legal representatives, to the extent of the actual cash value of the property at the time of loss, but not exceeding the amount which it would cost to repair or replace the property with material of like kind and quality within a reasonable time after a loss, without allowance for any increased cost of repair or reconstruction by reason of any ordinance or law regulating construction or repair, and without compensation for loss resulting from interruption of business or manufacture, nor in any event for more than the interest of the insured, against all direct loss by fire and lightning, and by removal from the premises endangered by the perils insured against in this policy, except as hereinafter provided, to the property described hereinafter while located or contained as described in this policy, or pro rata for five (5) days at each proper place to which any of the property shall necessarily be removed for preservation from the perils insured against in this policy, but not elsewhere.  Assignment of this policy shall not be valid except with the written consent of this company.  This policy is made and accepted subject to the foregoing provisions and stipulations and those hereinafter stated, which are hereby made a part of this policy, together with such other provisions, stipulations, and agreements as may be added hereto, as provided in this policy.  IN WITNESS WHEREOF, this company has executed and attested these presents; at .........................................          .......................................     .......................................    Secretary   President     In the event the domicile state of the company issuing the policy requires a Rhode Island company to have a countersignature affixed by a licensed resident agent to a policy issued in that state then in accordance with the provisions of  27-2-17, the form of the standard fire insurance policy shall in lieu of the foregoing execution and attestation clause contain the following execution and attestation clause: IN WITNESS WHEREOF, this company has executed and attested these presents; but this policy shall not be valid unless countersigned by the duly authorized agent of this company at ......................................... .........................................         .......................................     .......................................    Secretary   President     Countersigned this ..... day of .......... 20 ....             .......................................        Agent          1 Concealment, This entire policy shall be void if, whether   2 fraud. before or after a loss, the insured will-   3   fully concealed or misrepresented any material   4 fact or circumstance concerning this insurance or the subject   5 thereof, or the interest of the insured therein, or in the case of   6 any fraud or false swearing by the insured relating thereto.   7 Uninsurable This policy shall not cover accounts, bills,   8 and excepted currency, deeds, evidences of debt, money, or   9 property. securities; nor, unless specifically named here-   10   on in writing, bullion or manuscripts.   11 Perils not This company shall not be liable for loss by   12 included. fire or other perils insured against in this   13   policy caused, directly or indirectly, by: (a)   14 enemy attack by armed forces, including action taken by mili-   15 tary, naval, or air forces in resisting an actual or an immedi-     ately   16 impending enemy attack; (b) invasion; (c) insurrection; (d)   17 rebellion; (e) revolution; (f) civil war; (g) usurped power; (h)   18 order of any civil authority except acts of destruction at the time   19 of and for the purpose of preventing the spread of fire, provided   20 that this fire did not originate from any of the perils excluded   21 by this policy; (i) neglect of the insured to use all reasonable   22 means to save and preserve the property at and after a loss, or   23 when the property is endangered by fire in neighboring prem-   24 ises; (j) loss by theft.   25 Other Insurance. Other insurance may be prohibited or the    26   amount of insurance may be limited by an   27 endorsement attached hereto.   28 Conditions suspending or restricting insurance. Unless    29 otherwise provided in writing and added hereto this company      or companies shall not   30 be liable for loss occurring:   31 (a) While the hazard is increased by any means within the con-   32 trol or knowledge of the insured; or   33 (b) While a described building, whether intended for occupancy   34 by owner or tenant, is vacant or unoccupied beyond a period      of   35 sixty (60) consecutive days or   35A thirty (30) consecutive days subsequent to the date on which an   35B order is issued by the local building inspector pursuant to      23-27.3-124.2,   35C whichever first occurs; or   36 (c) As a result of explosion or riot, unless fire ensues, and in   37 that event for loss by fire only.   38 Other perils Any other peril to be insured against or sub-    39 or subjects. ject of insurance to be covered in this policy   40   shall be by endorsement in writing hereon or   41 added hereto.   42 Added provisions. The extent of the application of insurance    43   under this policy and of the contribution to   44 be made by this company in case of loss, and any other pro-   45 vision or agreement not inconsistent with the provisions of this   46 policy, may be provided for in writing and added hereto, but no   47 provision may be waived except such as by the terms of this   48 policy is subject to change.   49 Waiver No permission affecting this insurance shall   50 provisions. exist, or waiver of any provision is valid,   51   unless granted herein or expressed in writing   52 and added hereto. No provision, stipulation, or forfeiture shall   53 be held to be waived by any requirement or proceeding on the   54 part of this company relating to appraisal or to any examina-   55 tion provided for herein.   56 Cancellation This policy shall be cancelled at any time    57 of policy. at the request of the insured, in which case   58   this company shall, upon demand and sur-   59 render of this policy, refund the excess of the paid premium      above   60 the customary short rates for the expired time. This pol-   61 icy may be cancelled at any time by this company by giving   62 to the insured a thirty (30) days written notice of cancellation   except that when cancellation is for nonpayment of premium, a ten (10)   days written notice shall be required with   63 or without tender of the excess of the paid premium above the     pro   64 rata premium for the expired time.   65 Notice of cancellation shall   66 state that the excess premium (if not tendered) will be promptly   67 re-funded.   68 Mortgagee If loss hereunder is made payable, in whole   69 interests and or in part, to a designated mortgagee not    70 obligations. named herein as the insured, that interest in   71   this policy may be cancelled by giving to that   72   mortgagee a ten (10) days written notice of   73 cancellation.   74 If the insured fails to render proof of loss the mortgagee, upon   75 notice, shall render proof of loss in the form herein specified   76 within sixty (60) days thereafter and shall be subject to the pro-   77 visions hereof relating to appraisal and time of payment and of   78 bringing suit. If this company shall claim that no liability ex-   79 isted as to the mortgagor or owner, it shall, to the extent of the   pay-     80 ment of loss to the mortgagee, be subrogated to all the mort-   81 gagees rights of recovery, but without impairing the mort-     gagees   82 right to sue; or it may pay off the mortgage debt and require   83 an assignment thereof and of the mortgage. Other provisions   84 relating to the interests and obligations of the mortgagee may   85 be added hereto by agreement in writing.   86 Pro rata liability. This company shall not be liable for a    87   greater proportion of any loss than the   88 amount hereby insured shall bear to the whole insurance cover-   89 ing the property against the peril involved, whether collectible     or not.   90 Requirements in The insured shall give immediate written    91 case loss occurs. notice to this company of any loss, protect    92   the property from further damage, forth       with   93 separate the damaged and undamaged personal property, put   94 it in the best possible order, furnish a complete inventory of   95 the destroyed, damaged, and undamaged property, showing in   96 detail quantities, costs, actual cash value and amount of loss   97 claimed; and within sixty (60) days after the loss, unless such   98 time is extended in writing by this company, the insured shall   99 render to this company a proof of loss, signed and sworn to by   100 the insured, stating the knowledge and belief of the insured as     to   101 the following: the time and origin of the loss, the interest of the   102 insured and of all others in the property, the actual cash value     of   103 each item thereof and the amount of loss thereto, all encum-   104 brances thereon, all other contracts of insurance, whether valid   105 or not, covering any of the property, any changes in the title,   106 use, occupation, location, possession, or exposures of the prop-   107 erty since the issuing of this policy, and by whom and for what   108 purpose any building herein described and the several parts   109 thereof were occupied at the time of loss and whether or not it   110 then stood on leased ground, and shall furnish a copy of all the   111 descriptions and schedules in all policies and, if required, veri-   112 fied plans and specifications of any building, fixtures, or     machin-   113 ery destroyed or damaged. The insured, as often as may be   114 reasonably required, shall exhibit to any person designated by   115 this company all that remains of any property herein described,   116 and submit to examinations under oath by any person named by   117 this company, and subscribe the same; and, as often as may be   118 reasonably required, shall produce for examination all books of   119 account, bills, invoices, and other vouchers, or certified copies   120 thereof if the originals are lost, at such reasonable time and     place as   121 may be designated by this company or its representative, and   122 shall permit extracts and copies thereof to be made.   123 Appraisal. In case the insured and this company shall   124   fail to agree as to the actual cash value or   125 the amount of loss, then, on the written demand of either, each   126 shall select a competent and disinterested appraiser and notify   127 the other of the appraiser selected within twenty (20) days of   128 that demand. The appraisers shall first select a competent and   129 disinterested umpire; and failing for fifteen (15) days to agree   130 upon the umpire, then, on request of the insured or this com-   131 pany, the umpire shall be selected by a judge of a court of   132 record in the state in which the property covered is located. The   133 appraisers shall then appraise the loss, stating separately ac-     tual   134 cash value and loss to each item; and, failing to agree, shall   135 submit their differences, only, to the umpire. An award in writ-   136 ing, so itemized, of any two (2) when filed with this company     shall   137 determine the amount of actual cash value and loss. Each   138 appraiser shall be paid by the party selecting him or her and   139 the expenses of appraisal and the umpire shall be paid by   140 the parties equally.   141 Companys It shall be optional with this company to   142 options. take all, or any part, of the property at the   143   agreed or appraised value, and also to re-   144 pair, rebuild, or replace the property destroyed or damaged with   145 another of like kind and quality within a reasonable time, on   146 giving notice of its intention so to do within thirty (30) days   147 after the receipt of the proof of the loss herein required.   148 Abandonment. There can be no abandonment to this com-    149   pany of any property.   150 When loss The amount of loss for which this company   151 payable may be liable shall be payable sixty (60)   152   days after proof of loss, as herein provided,   153 is received by this company and ascertainment of the loss is   154 made either by agreement between the insured and this com-   155 pany expressed in writing or by the filing with this company   156 of an award as herein provided.   157 Suit. No suit or action on this policy for the recov-   158   ery of any claim shall be sustainable in any   159 court of law or equity unless all the requirements of this policy   160 shall have been complied with, and unless commenced within   161 twenty-four (24) months next after inception of the loss.   162 Subrogation. This company may require from the insured    163   an assignment of all rights of recovery.   164 against any party for loss to the extent that payment therefor   165 is made by this company.    Standard Fire Insurance Policy of the State ofExpires ......................................... Property ......................................... Assured ......................................... No. ....................................... (COMPANY)     It is important that the written portions of all   policies covering the same property read exactly   alike. If they do not, they should be made uniform   at once.     History of Section.G.L. 1896, ch. 183,  5; G.L. 1909, ch. 222,  5; G.L. 1923, ch. 258,  5; P.L. 1929, ch. 1359,  2; P.L. 1938, ch. 2631,  1; G.L. 1938, ch. 154,  1, 2; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-3; P.L. 1978, ch. 331,  1; P.L. 1979, ch. 47,  1; P.L. 1994, ch. 53,  1; P.L. 2004, ch. 138,  1; P.L. 2004, ch. 140,  1. 
 27-5-30. Funds established under prior law. The action of any company organized under the laws of this state authorized to do a fire insurance business in constituting and setting apart guaranty surplus and special reserve funds under the provisions of  26 to 33 of chapter 181 of the General Laws of 1896, or of chapter 307 of the Public Laws of 1896, or under any prior act of the general assembly, is hereby confirmed and approved and those companies may continue to hold and maintain the funds so constituted and set apart, subject to the terms and provisions of  27-5-15  27-5-31; and provided, that as to all policies issued prior to July 1, 1907, and which by their terms are made subject to  26 to 33 of chapter 181 of the General Laws of 1896 and chapter 307 of the Public Laws of 1896, those sections and acts shall remain in full force and effect.  History of Section.P.L. 1907, ch. 1438,  11; G.L. 1909, ch. 219,  36; G.L. 1923, ch. 255,  36; G.L. 1938, ch. 150,  35; G.L. 1956,  27-5-30. 
 27-5-31. Termination of surplus and reserve fund method  Return of special reserve fund. Any company which has established a guaranty surplus fund and special reserve fund may, at a regular meeting of its board of directors, or at a special meeting called for that purpose, adopt a resolution declaring its desire and intention to discontinue those funds and to cease to do business under and in pursuance of the provisions of law relating to those funds, and file a certified copy of that resolution with the insurance commissioner. Upon the adoption and filing of that resolution, all rights of the company to withhold a special reserve fund from its general creditors shall be terminated and the company shall discontinue printing upon its policies or renewals the notice provided for in  27-5-29, and after this the provisions of this chapter so far as they relate to those funds shall cease to apply to the company; provided, that the special reserve fund of the company shall continue at the amount prescribed by the provisions of this chapter at the date of the making and filing of the resolution and the guaranty surplus fund may continue at a like amount, but those funds need not be increased on account of any increase in capital of the company or otherwise after the adoption and filing of the resolution and shall be held and invested as provided in  27-5-15  27-5-31, but only for the purpose of assuring to the holders of policies at the time the resolution is filed with the insurance commissioner any rights and privileges as may inure to them under  27-5-15  27-5-31. At the expiration of five (5) years after the adoption and filing of the resolution by the company, the special reserve fund shall be reduced to an amount equal to the unearned premium upon and all losses incurred and unpaid under any remaining policies which were outstanding at the time of the adoption and filing of the resolution. The excess of the special reserve fund above that amount shall be returned by the insurance commissioner to the company, and when all policies which were outstanding at the time of the adoption and filing of the resolution shall have terminated by expiration or by cancellation, the entire balance of the special reserve fund shall be returned to the company.  History of Section.G.L. 1909, cn. 219,  34; P.L. 1919, ch. 1783,  1; G.L. 1923, ch. 255,  34; G.L. 1938, ch. 150,  33; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-5-31. 
 27-5-4. Items shown at head of policy. There shall be printed at the head of a fire insurance policy the name of the insurer or insurers issuing the policy, the location of the home office of the insurer or insurers, and a statement whether the insurer or insurers are stock or mutual corporations; and there may be added to the policy any device or devices that the insurer or insurers issuing the policy shall desire; provided, that any company organized under special charter provisions may indicate this upon its policy and may add a statement of the plan under which it operates in this state.  History of Section.G.L. 1896, ch. 183,  4; G.L. 1909, ch. 222,  4; G.L. 1923, ch. 258,  4; G.L. 1938, ch. 154,  1; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-4. 
 27-5-5. Inclusion of regulations of mutual insurer. If the policy is issued by a mutual insurer having special regulations with respect to the payment by the policyholder of assessments, those regulations shall be printed upon the policy, and any mutual insurer may print upon the policy any regulations that may be appropriate to or required by its form of organization.  History of Section.G.L. 1938, ch. 154,  1; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-5. 
 27-5-6.1. Notice concerning single interest hazard insurance. No bank or lending institution doing business in this state, whether acting under state or federal authority, which includes, but is not limited to: (1) a bank, savings bank, or trust company, as defined in title 19, its affiliates or subsidiaries, (2) a bank holding company, as defined in 12 U.S.C.  1841, its affiliates or subsidiaries, (3) mortgage companies and mortgage services, and (4) any other individual, corporation, partnership, or association authorized to take deposits and/or to make loans of money under the provisions of title 19, shall, in connection with a loan secured by residential property situated in the state of Rhode Island of four (4) or fewer units and occupied or to be occupied in whole or in part by the mortgagor, obtain a single interest hazard insurance policy for the property and impose the cost on the mortgagor unless the bank or lending institution shall give the mortgagor written notice of its intent to obtain that coverage and ten (10) days shall have elapsed after the date on which notice is given; provided, that nothing in this section shall require the giving of notice or preclude the bank or lending institution from obtaining that coverage and imposing the cost on the mortgagor where the bank or lending institution has received notice of the nonrenewal or cancellation of the hazard insurance on the property.  History of Section.P.L. 1987, ch. 167,  1. 
 27-5-6.2. Escrow accounts for insurance premiums. All banks and lending institutions doing business in this state, whether acting under state or federal authority, which include, but are not limited to: (1) a bank, savings bank, or trust company, as defined in title 19, its affiliates or subsidiaries, (2) a bank holding company, as defined in 12 U.S.C.  1841, its affiliates or subsidiaries, (3) mortgage companies and mortgage services, and (4) any other individual, corporation, partnership, or association authorized to take deposits and/or to makes loans of money under the provisions of title 19, that in connection with a loan secured by residential property situated in the state of Rhode Island of four (4) or fewer units and occupied or to be occupied in whole or in part by the mortgagor, require the mortgagor to escrow for hazard insurance premiums, shall pay the annual premium to the insurance company on or before the last to occur of the following dates: (A) ten (10) days after receipt of the annual insurance premium bill, approved in writing by the mortgagor if required by the bank or lending institution provided the bank or lending institution has notified the mortgagor in writing that the mortgagors approval is required, or (B) seven (7) days before the effective date of the hazard insurance policy; provided, that no payment shall be required unless the mortgagor has sufficient funds escrowed for payment of the annual premium.  History of Section.P.L. 1987, ch. 167,  1. 
 27-5-6. Binders and temporary insurance. Binders or other contracts for temporary insurance may be made, orally or in writing, for a period which shall not exceed thirty (30) days, and shall be deemed to include all of the terms of the standard fire insurance policy and all applicable endorsements, approved by the director of business regulation, as may be designated in the contract of temporary insurance; except that the cancellation clause of the standard fire insurance policy, and the clause specifying the hour of the day at which the insurance shall commence, may be superseded by the express terms of the contract of temporary insurance; provided, that all banks and lending institutions doing business in this state, whether acting under state or federal authority, which include, but are not limited to: (1) a bank, savings bank, or trust company, as defined in this title, its affiliates or subsidiaries, (2) a bank holding company as defined in 12 U.S.C.  1841, its affiliates or subsidiaries, (3) mortgage companies, and (4), any other individual, corporation, partnership, or association authorized to take deposits and/or to make loans of money under the provisions of title 19, shall be required to accept an insurance binder as evidence of insurance from any duly licensed insurance producer or insurance company; provided, that the binders are in writing and in a form acceptable to the mortgagee and indicating that the mortgagee will be listed as a loss payee on the binder or temporary contract and that the mortgagee will be notified by registered or certified mail in the event the binder or temporary insurance is cancelled. If a binder is utilized, a policy shall, at the request of the mortgagee, be produced within thirty (30) days after the real estate closing has been consummated. Any subsequent holder of the mortgage, as a result of the sale, transfer, conveyance, or assignment of the mortgage, shall have its interest automatically protected and covered in accordance with the notice requirements in  27-5-3.2.  History of Section.G.L. 1938, ch. 154,  1; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-6; P.L. 1985, ch. 295,  1; P.L. 1989, ch. 340,  1. 
 27-5-7. Combination standard form. Two (2) or more insurers authorized to do the business of fire insurance in this state may, with the approval of the director of business regulation, issue a combination standard form of fire insurance policy which shall contain the following provisions:  (1) A provision substantially to the effect that the insurers executing the policy shall be severally liable for the full amount of any loss or damage, according to the terms of the policy, or for specified percentages or amounts of loss or damage, aggregating the full amount of the insurance under the policy; and  (2) A provision substantially to the effect that service of process, or of any notice or proof of loss required by the policy, upon any of the insurers executing the policy, shall be deemed to be service upon all of the insurers.  History of Section.G.L. 1923, ch. 258,  4; P.L. 1929, ch. 1359,  1; G.L. 1938, ch. 154,  1; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-7. 
 27-5-8. Supplemental contract forms. Appropriate forms of supplemental contracts or extended coverage endorsements where the interest in the property described in a fire insurance policy shall be insured against one or more of the perils which the insurer is empowered to assume, in addition to the peril covered by the standard fire insurance policy, may be approved by the director of business regulation, and their use in connection with a standard fire insurance policy may be authorized by him or her. The first page of the policy may, in a form approved by the director of business regulation, be rearranged to provide space for the listing of amounts of insurance, rates, and premiums for the basic coverages insured under the standard form of policy, and for additional coverages or perils insured under endorsements attached, and any other data that may be conveniently included for duplication on daily reports for office records.  History of Section.G.L. 1923, ch. 258,  4; P.L. 1934, ch. 2112,  1; G.L. 1938, ch. 154,  1; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-8. 
 27-5-9.1. Simplified comprehensive policies of insurance. Simplified policies of insurance providing broad coverage of all or various combinations of risks may be approved by the director of business regulation and issued by insurers notwithstanding those provisions of any other law which specify the contents of insurance policies; provided, that those policies contain provisions assuring to policyholders and claimants protection not less favorable than they would be entitled to under  27-5-3 or a substantially similar policy which is not subject to this section.  History of Section.P.L. 1979, ch. 48,  2. 
 27-5-9. Standard form not required for reinsurance. The standard fire insurance policy provided for in this chapter need not be used for effecting reinsurance between insurers.  History of Section.G.L. 1938, ch. 154,  1; P.L. 1945, ch. 1623,  1; G.L. 1956,  27-5-9. 
 27-50-1. Short title. This chapter shall be known and may be cited as the Small Employer Health Insurance Availability Act.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10. 
 27-50-10.1. Basic benefit health plan. [Expires December 31, 2010.] (a) Small employer carriers are hereby authorized to actively market and sell basic benefit health plans developed pursuant to this section on and after July 1, 2007. Basic benefit health plans authorized under this section shall be exempt from any law requiring the coverage of a health care service or benefit or requiring the reimbursement, utilization, or inclusion of a specific category of licensed health care practitioner; provided, however, coverage for the medical treatment of mental illness and substance abuse shall be provided in accordance with chapter 38.2 of this title;  (b) Basic benefits health plans shall provide affordable health care coverage through flexible products that provide access to basic health services. Basic benefits health plans shall provide limited, flexible coverage for the following services:  (i) Inpatient hospitalization;  (ii) Outpatient surgery and diagnostics;  (iii) Outpatient physician coverage, including preventative office visits;  (iv) Accidental injury and emergency coverage;  (v) Prescription drug coverage.  (c) Small employer carriers may utilize cost containment mechanisms to control the cost of such services including, but not limited to, the following;  (i) Primary care gatekeepers;  (ii) Preadmission certification;  (iii) Mandatory second opinion prior to elective surgery;  (iv) Preauthorization for specified services;  (v) Concurrent utilization review and management;  (vi) Discharge planning for hospital care;  (vii) Deductibles and copayments;  (viii) Less costly alternatives to inpatient care;  (ix) Annual limits or maximums for each category of service; and  (x) Restricted networks with limited coverage for out-of-network services.  (d) The annual deductible shall not exceed two thousand dollars ($2,000) per individual and four thousand dollars ($4,000) per family.  (e) Basic benefit health plans shall be available only to uninsured small employers, provided, however, that once a small employer enrolls in a basic benefit health plan such small employer shall be guaranteed renewability of such basic benefit health plan coverage.  (f) The average annualized individual premium rate for a basic benefit health plan shall be less than seven and one-half percent (7.5%) of the average annual statewide wage, as reported by the Rhode Island department of labor and training, in their report entitled Quarterly Census of Rhode Island Employment and Wages. In the event that this report is no longer available or the office of the health insurance commissioner (OHIC) determines that it is no longer appropriate for the determination of maximum annualized premium, an alternative method shall be adopted in regulation by the OHIC. The maximum annualized individual premium rate shall be determined no later than August 1st of each year, to be applied to the subsequent calendar year premium rates.  (g) The health insurance commissioner shall issue a report to the general assembly as to the status and market impact of the basic benefit health plan program and shall make recommendation to the general assembly regarding the expansion, continuation or termination of the program on or before March 1, 2010.  (h) The authority provided to small employer carriers to sell basic benefit health plans pursuant to this section shall take effect on July 1, 2007.  History of Section.P.L. 2007, ch. 221,  2. 
 27-50-10. Wellness health benefit plan. (a) No provision contained in this chapter prohibits the sale of health benefit plans which differ from the wellness health benefit plans provided for in this section.  (b) The wellness health benefit plan shall be determined by regulations promulgated by the office of health insurance commissioner (OHIC). The OHIC shall develop the criteria for the wellness health benefit plan, including, but not limited to, benefit levels, cost-sharing levels, exclusions, and limitations, in accordance with the following:  (1)(i) The OHIC shall form an advisory committee to include representatives of employers, health insurance brokers, local chambers of commerce, and consumers who pay directly for individual health insurance coverage.  (ii) The advisory committee shall make recommendations to the OHIC concerning the following:  (A) The wellness health benefit plan requirements document. This document shall be disseminated to all Rhode Island small group and individual market health plans for responses, and shall include, at a minimum, the benefit limitations and maximum cost sharing levels for the wellness health benefit plan. If the wellness health benefit product requirements document is not created by November 1, 2006, it will be determined by regulations promulgated by the OHIC.  (B) The wellness health benefit plan design. The health plans shall bring proposed wellness health plan designs to the advisory committee for review on or before January 1, 2007. The advisory committee shall review these proposed designs and provide recommendations to the health plans and the commissioner regarding the final wellness plan design to be approved by the commissioner in accordance with subsection 27-50-5(h)(4), and as specified in regulations promulgated by the commissioner on or before March 1, 2007.  (2) Set a target for the average annualized individual premium rate for the wellness health benefit plan to be less than ten percent (10%) of the average annual statewide wage, as reported by the Rhode Island department of labor and training, in their report entitled Quarterly Census of Rhode Island Employment and Wages. In the event that this report is no longer available, or the OHIC determines that it is no longer appropriate for the determination of maximum annualized premium, an alternative method shall be adopted in regulation by the OHIC. The maximum annualized individual premium rate shall be determined no later than August 1st of each year, to be applied to the subsequent calendar year premium rates.  (3) Ensure that the wellness health benefit plan creates appropriate incentives for employers, providers, health plans and consumers to, among other things:  (i) Focus on primary care, prevention and wellness;  (ii) Actively manage the chronically ill population;  (iii) Use the least cost, most appropriate setting; and  (iv) Use evidence based, quality care.  (4) To the extent possible, the health plans may be permitted to utilize existing products to meet the objectives of this section.  (5) The plan shall be made available in accordance with title 27, chapter 50 as required by regulation on or before May 1, 2007.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10; P.L. 2003, ch. 120,  1; P.L. 2003, ch. 286,  1; P.L. 2006, ch. 258,  2; P.L. 2006, ch. 296,  2. 
 27-50-11. Administrative procedures. The director shall issue regulations in accordance with chapter 35 of this title for the implementation and administration of the Small Employer Health Insurance Availability Act.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10. 
 27-50-12.1. Renewal rating. To ensure ease of understanding of renewal rate calculation and related information, the health insurance commissioner may, by regulation, prescribe the presentation formats for delivery of renewal rates to small employers.  History of Section.P.L. 2006, ch. 258,  3; P.L. 2006, ch. 296,  3. 
 27-50-12. Standards to assure fair marketing. (a) Each small employer carrier shall actively market and offer all health benefit plans sold by the carrier to eligible small employers in the state.  (b)(1) Except as provided in subdivision (2) of this subsection, no small employer carrier or producer shall, directly or indirectly, engage in the following activities:  (i) Encouraging or directing small employers to refrain from filing an application for coverage with the small employer carrier because of any health status-related factor, age, gender, industry, occupation, or geographic location of the small employer; or  (ii) Encouraging or directing small employers to seek coverage from another carrier because of any health status-related factor, age, gender, industry, occupation, or geographic location of the small employer.  (2) The provisions of subdivision (1) of this subsection do not apply with respect to information provided by a small employer carrier or producer to a small employer regarding the established geographic service area or a restricted network provision of a small employer carrier.  (c)(1) Except as provided in subdivision (2) of this subsection, no small employer carrier shall, directly or indirectly, enter into any contract, agreement or arrangement with a producer that provides for or results in the compensation paid to a producer for the sale of a health benefit plan to be varied because of any initial or renewal, industry, occupation, or geographic location of the small employer.  (2) Subdivision (1) of this subsection does not apply with respect to a compensation arrangement that provides compensation to a producer on the basis of percentage of premium, provided that the percentage shall not vary because of any health status-related factor, industry, occupation, or geographic area of the small employer.  (d) A small employer carrier shall provide reasonable compensation, as provided under the plan of operation of the program, to a producer, if any, for the sale of any health benefit plan subject to  27-50-10.  (e) No small employer carrier may terminate, fail to renew, or limit its contract or agreement of representation with a producer for any reason related to health status-related factor, occupation, or geographic location of the small employers placed by the producer with the small employer carrier.  (f) No small employer carrier or producer shall induce or encourage a small employer to separate or exclude an employee or dependent from health coverage or benefits provided in connection with the employees employment.  (g) Denial by a small employer carrier of an application for coverage from a small employer shall be in writing and shall state the reason or reasons for the denial.  (h) The director may establish regulations setting forth additional standards to provide for the fair marketing and broad availability of health benefit plans to small employers in this state.  (i)(1) A violation of this section by a small employer carrier or a producer is an unfair trade practice under chapter 13 of title 6.  (2) If a small employer carrier enters into a contract, agreement, or other arrangement with a third-party administrator to provide administrative, marketing, or other services related to the offering of health benefit plans to small employers in this state, the third-party administrator is subject to this section as if it were a small employer carrier.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10. 
 27-50-13. Repealed.
 27-50-14. Severability. If any provision of this chapter or the application of any provision to any person or circumstances is for any reason held invalid, the remainder of the chapter and the application of its provisions to other persons or circumstances shall not be affected by that invalidity.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10. 
 27-50-15. Restoration of terminated coverage. 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.  History of Section.P.L. 1992, ch. 437,  1. 
 27-50-16. Risk adjustment mechanism. The director may establish a payment mechanism to adjust for the amount of risk covered by each small employer carrier. The director may appoint an advisory committee composed of individuals that have risk adjustment and actuarial expertise to help establish the risk adjusters.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10. 
 27-50-17. Affordable health plan reinsurance program for small businesses. (a) The commissioner shall allocate funds from the affordable health plan reinsurance fund for the affordable health reinsurance program.  (b) The affordable health reinsurance program for small businesses shall only be available to low wage firms, as defined in  27-50-3, who pay a minimum of fifty percent (50%), as defined in  27-50-3, of single coverage premiums for their eligible employees, and who purchase the wellness health benefit plan pursuant to  27-50-10. Eligibility shall be determined based on state and federal corporate tax filings. All eligible employees, as defined in  27-50-3, employed by low wage firms as defined in  27-50-3-(oo) shall be eligible for the reinsurance program if at least one low wage eligible employee as defined in regulation is enrolled in the employers wellness health benefit plan.  (c) The affordable health plan reinsurance shall be in the firms of a carrier cost-sharing arrangement, which encourages carriers to offer a discounted premium rate to participating individuals, and whereby the reinsurance fund subsidizes the carriers losses within a prescribed corridor of risk as determined by regulation.  (d) The specific structure of the reinsurance arrangement shall be defined by regulations promulgated by the commissioner.  (e) All carriers who participate in the Rhode Island RIte Care program as defined in  42-12.3-4 and the procurement process for the Rhode Island state employee account, as described in chapter 36-12, must participate in the affordable health plan reinsurance program.  (f) The commissioner shall determine total eligible enrollment under qualifying small group health insurance contracts by dividing the funds available for distribution from the reinsurance fund by the estimated per member annual cost of claims reimbursement from the reinsurance fund.  (g) The commissioner shall suspend the enrollment of new employers under qualifying small group health insurance contracts if the director determines that the total enrollment reported under such contracts is projected to exceed the total eligible enrollment, thereby resulting in anticipated annual expenditures from the reinsurance fund in excess of ninety-five percent (95%) of the total funds available for distribution from the fund.  (h) In the event the available funds in the affordable health reinsurance fund as created in  42-14.5-3 are insufficient to satisfy all claims submitted to the fund in any calendar year, those claims in excess of the available funds shall be due and payable in the succeeding calendar year, or when sufficient funds become available whichever shall first occur. Unpaid claims from any prior year shall take precedence over new claims submitted in any one year.  (i) The commissioner shall provide the health maintenance organization, health insurers and health plans with notification of any enrollment suspensions as soon as practicable after receipt of all enrollment data. However, the suspension of issuance of qualifying small group health insurance contracts shall not preclude the addition of new employees of an employer already covered under such a contract or new dependents of employees already covered under such contracts.  (j) The premiums of qualifying small group health insurance contracts must be no more than ninety percent (90%) of the actuarially-determined and commissioner approved premium for this health plan without the reinsurance program assistance.  (k) The commissioner shall prepare periodic public reports in order to facilitate evaluation and ensure orderly operation of the funds, including, but not limited to, an annual report of the affairs and operations of the fund, containing an accounting of the administrative expenses charged to the fund. Such reports shall be delivered to the co-chairs of the joint legislative committee on health care oversight by March 1st of each year.  History of Section.P.L. 2006, ch. 273,  6; P.L. 2006, ch. 297,  6; P.L. 2008, ch. 475,  96. 
 27-50-18. Special enrollment  Pregnancy. [Effective January 1, 2023.] (a) In general.  A carrier shall establish a special enrollment period that allows for the enrollment of a pregnant individual at any time after the commencement of the pregnancy. Coverage shall be effective as of the first of the month in which the pregnant individual applies for coverage. This special enrollment period shall be applicable to all health benefit plans subject to this chapter.  (b) Non-interference with federal and state law.  Nothing in subsection (a) shall be construed to conflict with or preempt any other applicable requirements for enrollment in health insurance coverage under federal and state law. The special enrollment period described in subsection (a) is in addition to any other special enrollment periods that are required under federal and state law.  History of Section.P.L. 2022, ch. 145,  3, effective January 1, 2023; P.L. 2022, ch. 146,  3, effective January 1, 2023. 
 27-50-2. Purpose. (a) The purpose and intent of this chapter are to enhance the availability of health insurance coverage to small employers regardless of their health status or claims experience, to prevent abusive rating practices, to prevent segmentation of the health insurance market based upon health risk, to spread health insurance risk more broadly, to require disclosure of rating practices to purchasers, to establish rules regarding renewability of coverage, to limit the use of preexisting condition exclusions, to provide for development of economy, standard and basic health benefit plans to be offered to all small employers, and to improve the overall fairness and efficiency of the small group health insurance market.  (b) This chapter is not intended to provide a comprehensive solution to the problem of affordability of health care or health insurance.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10. 
 27-50-3. Definitions. (a) Actuarial certification means a written statement signed by a member of the American Academy of Actuaries or other individual acceptable to the director that a small employer carrier is in compliance with the provisions of  27-50-5, based upon the persons examination and including a review of the appropriate records and the actuarial assumptions and methods used by the small employer carrier in establishing premium rates for applicable health benefit plans.  (b) Adjusted community rating means a method used to develop a carriers premium which spreads financial risk across the carriers entire small group population in accordance with the requirements in  27-50-5.  (c) Affiliate or affiliated means any entity or person who directly or indirectly through one or more intermediaries controls or is controlled by, or is under common control with, a specified entity or person.  (d) Affiliation period means a period of time that must expire before health insurance coverage provided by a carrier becomes effective, and during which the carrier is not required to provide benefits.  (e) Bona fide association means, with respect to health benefit plans offered in this state, an association which:  (1) Has been actively in existence for at least five (5) years;  (2) Has been formed and maintained in good faith for purposes other than obtaining insurance;  (3) Does not condition membership in the association on any health-status related factor relating to an individual (including an employee of an employer or a dependent of an employee);  (4) Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to those members (or individuals eligible for coverage through a member);  (5) Does not make health insurance coverage offered through the association available other than in connection with a member of the association;  (6) Is composed of persons having a common interest or calling;  (7) Has a constitution and bylaws; and  (8) Meets any additional requirements that the director may prescribe by regulation.  (f) Carrier or small employer carrier means all entities licensed, or required to be licensed, in this state that offer health benefit plans covering eligible employees of one or more small employers pursuant to this chapter. For the purposes of this chapter, carrier includes an insurance company, a nonprofit hospital or medical service corporation, a fraternal benefit society, a health maintenance organization as defined in chapter 41 of this title or as defined in chapter 62 of title 42, or any other entity subject to state insurance regulation that provides medical care as defined in subsection (y) that is paid or financed for a small employer by such entity on the basis of a periodic premium, paid directly or through an association, trust, or other intermediary, and issued, renewed, or delivered within or without Rhode Island to a small employer pursuant to the laws of this or any other jurisdiction, including a certificate issued to an eligible employee which evidences coverage under a policy or contract issued to a trust or association.  (g) Church plan has the meaning given this term under  3(33) of the Employee Retirement Income Security Act of 1974 [29 U.S.C.  1002(33)].  (h) Control is defined in the same manner as in chapter 35 of this title.  (i)(1) Creditable coverage means, with respect to an individual, health benefits or coverage provided under any of the following:  (i) A group health plan;  (ii) A health benefit plan;  (iii) Part A or part B of Title XVIII of the Social Security Act, 42 U.S.C.  1395c et seq., or 42 U.S.C.  1395j et seq., (Medicare);  (iv) Title XIX of the Social Security Act, 42 U.S.C.  1396 et seq., (Medicaid), other than coverage consisting solely of benefits under 42 U.S.C.  1396s (the program for distribution of pediatric vaccines);  (v) 10 U.S.C.  1071 et seq., (medical and dental care for members and certain former members of the uniformed services, and for their dependents) (Civilian Health and Medical Program of the Uniformed Services) (CHAMPUS). For purposes of 10 U.S.C.  1071 et seq., uniformed services means the armed forces and the commissioned corps of the National Oceanic and Atmospheric Administration and of the Public Health Service;  (vi) A medical care program of the Indian Health Service or of a tribal organization;  (vii) A state health benefits risk pool;  (viii) A health plan offered under 5 U.S.C.  8901 et seq., (Federal Employees Health Benefits Program (FEHBP));  (ix) A public health plan, which for purposes of this chapter, means a plan established or maintained by a state, county, or other political subdivision of a state that provides health insurance coverage to individuals enrolled in the plan; or  (x) A health benefit plan under  5(e) of the Peace Corps Act (22 U.S.C.  2504(e)).  (2) A period of creditable coverage shall not be counted, with respect to enrollment of an individual under a group health plan, if, after the period and before the enrollment date, the individual experiences a significant break in coverage.  (j) Dependent means a spouse, child under the age twenty-six (26) years, and an unmarried child of any age who is financially dependent upon, the parent and is medically determined to have a physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve (12) months.  (k) Director means the director of the department of business regulation.  (l) [Deleted by P.L. 2006, ch. 258,  2, and P.L. 2006, ch. 296,  2.]  (m) Eligible employee means an employee who works on a full-time basis with a normal work week of thirty (30) or more hours, except that at the employers sole discretion, the term shall also include an employee who works on a full-time basis with a normal work week of anywhere between at least seventeen and one-half (17.5) and thirty (30) hours, so long as this eligibility criterion is applied uniformly among all of the employers employees and without regard to any health status-related factor. The term includes a self-employed individual, a sole proprietor, a partner of a partnership, and may include an independent contractor, if the self-employed individual, sole proprietor, partner, or independent contractor is included as an employee under a health benefit plan of a small employer, but does not include an employee who works on a temporary or substitute basis or who works less than seventeen and one-half (17.5) hours per week. Any retiree under contract with any independently incorporated fire district is also included in the definition of eligible employee, as well as any former employee of an employer who retired before normal retirement age, as defined by 42 U.S.C. 18002(a)(2)(c) while the employer participates in the early retiree reinsurance program defined by that chapter. Persons covered under a health benefit plan pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1986 shall not be considered eligible employees for purposes of minimum participation requirements pursuant to  27-50-7(d)(9).  (n) Enrollment date means the first day of coverage or, if there is a waiting period, the first day of the waiting period, whichever is earlier.  (o) Established geographic service area means a geographic area, as approved by the director and based on the carriers certificate of authority to transact insurance in this state, within which the carrier is authorized to provide coverage.  (p) Family composition means:  (1) Enrollee;  (2) Enrollee, spouse and children;  (3) Enrollee and spouse; or  (4) Enrollee and children.  (q) Genetic information means information about genes, gene products, and inherited characteristics that may derive from the individual or a family member. This includes information regarding carrier status and information derived from laboratory tests that identify mutations in specific genes or chromosomes, physical medical examinations, family histories, and direct analysis of genes or chromosomes.  (r) Governmental plan has the meaning given the term under  3(32) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(32), and any federal governmental plan.  (s)(1) Group health plan means an employee welfare benefit plan as defined in  3(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(1), to the extent that the plan provides medical care, as defined in subsection (y) of this section, and including items and services paid for as medical care to employees or their dependents as defined under the terms of the plan directly or through insurance, reimbursement, or otherwise.  (2) For purposes of this chapter:  (i) Any plan, fund, or program that would not be, but for PHSA Section 2721(e), 42 U.S.C.  300gg(e), as added by P.L. 104-191, an employee welfare benefit plan and that is established or maintained by a partnership, to the extent that the plan, fund or program provides medical care, including items and services paid for as medical care, to present or former partners in the partnership, or to their dependents, as defined under the terms of the plan, fund or program, directly or through insurance, reimbursement or otherwise, shall be treated, subject to paragraph (ii) of this subdivision, as an employee welfare benefit plan that is a group health plan;  (ii) In the case of a group health plan, the term employer also includes the partnership in relation to any partner; and  (iii) In the case of a group health plan, the term participant also includes an individual who is, or may become, eligible to receive a benefit under the plan, or the individuals beneficiary who is, or may become, eligible to receive a benefit under the plan, if:  (A) In connection with a group health plan maintained by a partnership, the individual is a partner in relation to the partnership; or  (B) In connection with a group health plan maintained by a self-employed individual, under which one or more employees are participants, the individual is the self-employed individual.  (t)(1) Health benefit plan means any hospital or medical policy or certificate, major medical expense insurance, hospital or medical service corporation subscriber contract, or health maintenance organization subscriber contract. Health benefit plan includes short-term and catastrophic health insurance policies, and a policy that pays on a cost-incurred basis, except as otherwise specifically exempted in this definition.  (2) Health benefit plan does not include one or more, or any combination of, the following:  (i) Coverage only for accident or disability income insurance, or any combination of those;  (ii) Coverage issued as a supplement to liability insurance;  (iii) Liability insurance, including general liability insurance and automobile liability insurance;  (iv) Workers compensation or similar insurance;  (v) Automobile medical payment insurance;  (vi) Credit-only insurance;  (vii) Coverage for on-site medical clinics; and  (viii) Other similar insurance coverage, specified in federal regulations issued pursuant to Pub. L. No. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits.  (3) Health benefit plan does not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan:  (i) Limited scope dental or vision benefits;  (ii) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of those; or  (iii) Other similar, limited benefits specified in federal regulations issued pursuant to Pub. L. No. 104-191.  (4) Health benefit plan does not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor:  (i) Coverage only for a specified disease or illness; or  (ii) Hospital indemnity or other fixed indemnity insurance.  (5) Health benefit plan does not include the following if offered as a separate policy, certificate, or contract of insurance:  (i) Medicare supplemental health insurance as defined under  1882(g)(1) of the Social Security Act, 42 U.S.C.  1395ss(g)(1);  (ii) Coverage supplemental to the coverage provided under 10 U.S.C.  1071 et seq.; or  (iii) Similar supplemental coverage provided to coverage under a group health plan.  (6) A carrier offering policies or certificates of specified disease, hospital confinement indemnity, or limited benefit health insurance shall comply with the following:  (i) The carrier files on or before March 1 of each year a certification with the director that contains the statement and information described in paragraph (ii) of this subdivision;  (ii) The certification required in paragraph (i) of this subdivision shall contain the following:  (A) A statement from the carrier certifying that policies or certificates described in this paragraph are being offered and marketed as supplemental health insurance and not as a substitute for hospital or medical expense insurance or major medical expense insurance; and  (B) A summary description of each policy or certificate described in this paragraph, including the average annual premium rates (or range of premium rates in cases where premiums vary by age or other factors) charged for those policies and certificates in this state; and  (iii) In the case of a policy or certificate that is described in this paragraph and that is offered for the first time in this state on or after July 13, 2000, the carrier shall file with the director the information and statement required in paragraph (ii) of this subdivision at least thirty (30) days prior to the date the policy or certificate is issued or delivered in this state.  (u) Health maintenance organization or HMO means a health maintenance organization licensed under chapter 41 of this title.  (v) Health status-related factor means any of the following factors:  (1) Health status;  (2) Medical condition, including both physical and mental illnesses;  (3) Claims experience;  (4) Receipt of health care;  (5) Medical history;  (6) Genetic information;  (7) Evidence of insurability, including conditions arising out of acts of domestic violence; or  (8) Disability.  (w)(1) Late enrollee means an eligible employee or dependent who requests enrollment in a health benefit plan of a small employer following the initial enrollment period during which the individual is entitled to enroll under the terms of the health benefit plan, provided that the initial enrollment period is a period of at least thirty (30) days.  (2) Late enrollee does not mean an eligible employee or dependent:  (i) Who meets each of the following provisions:  (A) The individual was covered under creditable coverage at the time of the initial enrollment;  (B) The individual lost creditable coverage as a result of cessation of employer contribution, termination of employment or eligibility, reduction in the number of hours of employment, involuntary termination of creditable coverage, or death of a spouse, divorce or legal separation, or the individual and/or dependents are determined to be eligible for RIteCare under chapter 5.1 of title 40 or chapter 12.3 of title 42 or for RIteShare under chapter 8.4 of title 40; and  (C) The individual requests enrollment within thirty (30) days after termination of the creditable coverage or the change in conditions that gave rise to the termination of coverage;  (ii) If, where provided for in contract or where otherwise provided in state law, the individual enrolls during the specified bona fide open enrollment period;  (iii) If the individual is employed by an employer which offers multiple health benefit plans and the individual elects a different plan during an open enrollment period;  (iv) If a court has ordered coverage be provided for a spouse or minor or dependent child under a covered employees health benefit plan and a request for enrollment is made within thirty (30) days after issuance of the court order;  (v) If the individual changes status from not being an eligible employee to becoming an eligible employee and requests enrollment within thirty (30) days after the change in status;  (vi) If the individual had coverage under a COBRA continuation provision and the coverage under that provision has been exhausted; or  (vii) Who meets the requirements for special enrollment pursuant to  27-50-7 or 27-50-8.  (x) Limited benefit health insurance means that form of coverage that pays stated predetermined amounts for specific services or treatments or pays a stated predetermined amount per day or confinement for one or more named conditions, named diseases or accidental injury.  (y) Medical care means amounts paid for:  (1) The diagnosis, care, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body;  (2) Transportation primarily for and essential to medical care referred to in subdivision (1); and  (3) Insurance covering medical care referred to in subdivisions (1) and (2) of this subsection.  (z) Network plan means a health benefit plan issued by a carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the carrier.  (aa) Person means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination of the foregoing.  (bb) Plan sponsor has the meaning given this term under  3(16)(B) of the Employee Retirement Income Security Act of 1974, 29 U.S.C.  1002(16)(B).  (cc)(1) Preexisting condition means a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received during the six (6) months immediately preceding the enrollment date of the coverage.  (2) Preexisting condition does not mean a condition for which medical advice, diagnosis, care, or treatment was recommended or received for the first time while the covered person held creditable coverage and that was a covered benefit under the health benefit plan, provided that the prior creditable coverage was continuous to a date not more than ninety (90) days prior to the enrollment date of the new coverage.  (3) Genetic information shall not be treated as a condition under subdivision (1) of this subsection for which a preexisting condition exclusion may be imposed in the absence of a diagnosis of the condition related to the information.  (dd) Premium means all moneys paid by a small employer and eligible employees as a condition of receiving coverage from a small employer carrier, including any fees or other contributions associated with the health benefit plan.  (ee) Producer means any insurance producer licensed under chapter 2.4 of this title.  (ff) Rating period means the calendar period for which premium rates established by a small employer carrier are assumed to be in effect.  (gg) Restricted network provision means any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of healthcare providers that have entered into a contractual arrangement with the carrier pursuant to provide healthcare services to covered individuals.  (hh) Risk adjustment mechanism means the mechanism established pursuant to  27-50-16.  (ii) Self-employed individual means an individual or sole proprietor who derives a substantial portion of his or her income from a trade or business through which the individual or sole proprietor has attempted to earn taxable income and for which he or she has filed the appropriate Internal Revenue Service Form 1040, Schedule C or F, for the previous taxable year.  (jj) Significant break in coverage means a period of ninety (90) consecutive days during all of which the individual does not have any creditable coverage, except that neither a waiting period nor an affiliation period is taken into account in determining a significant break in coverage.  (kk) Small employer means, except for its use in  27-50-7, any person, firm, corporation, partnership, association, political subdivision, or self-employed individual that is actively engaged in business including, but not limited to, a business or a corporation organized under the Rhode Island Non-Profit Corporation Act, chapter 6 of title 7, or a similar act of another state that, on at least fifty percent (50%) of its working days during the preceding calendar quarter, employed no more than fifty (50) eligible employees, with a normal work week of thirty (30) or more hours, the majority of whom were employed within this state, and is not formed primarily for purposes of buying health insurance and in which a bona fide employer-employee relationship exists. In determining the number of eligible employees, companies that are affiliated companies, or that are eligible to file a combined tax return for purposes of taxation by this state, shall be considered one employer. Subsequent to the issuance of a health benefit plan to a small employer and for the purpose of determining continued eligibility, the size of a small employer shall be determined annually. Except as otherwise specifically provided, provisions of this chapter that apply to a small employer shall continue to apply at least until the plan anniversary following the date the small employer no longer meets the requirements of this definition. The term small employer includes a self-employed individual.  (ll) Waiting period means, with respect to a group health plan and an individual who is a potential enrollee in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. For purposes of calculating periods of creditable coverage pursuant to subsection (j)(2) of this section, a waiting period shall not be considered a gap in coverage.  (mm) Wellness health benefit plan means a plan developed pursuant to  27-50-10.  (nn) Health insurance commissioner or commissioner means that individual appointed pursuant to  42-14.5-1 and afforded those powers and duties as set forth in  42-14.5-2 and 42-14.5-3 of title 42.  (oo) Low-wage firm means those with average wages that fall within the bottom quartile of all Rhode Island employers.  (pp) Wellness health benefit plan means the health benefit plan offered by each small employer carrier pursuant to  27-50-7.  (qq) Commissioner means the health insurance commissioner.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10; P.L. 2002, ch. 292,  90; P.L. 2003, ch. 119,  1; P.L. 2003, ch. 120,  1; P.L. 2003, ch. 286,  1; P.L. 2003, ch. 375,  1; P.L. 2004, ch. 269,  1; P.L. 2006, ch. 258,  2; P.L. 2006, ch. 273,  5; P.L. 2006, ch. 296,  2; P.L. 2006, ch. 297,  5; P.L. 2006, ch. 377,  6; P.L. 2006, ch. 469,  6; P.L. 2007, ch. 164,  1; P.L. 2007, ch. 221,  1; P.L. 2011, ch. 131,  1; P.L. 2011, ch. 146,  1; P.L. 2012, ch. 256,  11; P.L. 2012, ch. 262,  11. 
 27-50-4. Applicability and scope. (a) This chapter applies to any health benefit plan that provides coverage to the employees of a small employer in this state, whether issued directly by a carrier or through a trust, association, or other intermediary, and regardless of issuance or delivery of the policy, if any of the following conditions are met:  (1) Any portion of the premium or benefits is paid by or on behalf of the small employer;  (2) An eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the small employer for any portion of the premium;  (3) The health benefit plan is treated by the employer or any of the eligible employees or dependents as part of a plan or program for the purposes of Section 162, Section 125, or Section 106 of the United States Internal Revenue Code, 26 U.S.C.  162, 125, or 106; or  (4) The health benefit plan is marketed to individual employees through an employer.  (b)(1) Except as provided in subdivision (2) of this subsection, for the purposes of this chapter, carriers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one carrier and any restrictions or limitations imposed by this chapter shall apply as if all health benefit plans delivered or issued for delivery to small employers in this state by the affiliated carriers were issued by one carrier.  (2) An affiliated carrier that is a health maintenance organization having a license under chapter 41 of this title or a health maintenance organization as defined in chapter 62 of title 42 may be considered to be a separate carrier for the purposes of this chapter.  (3) Unless otherwise authorized by the director, a small employer carrier shall not enter into one or more ceding arrangements with respect to health benefit plans delivered or issued for delivery to small employers in this state if those arrangements would result in less than fifty percent (50%) of the insurance obligation or risk for the health benefit plans being retained by the ceding carrier. The department of business regulations statutory provisions under this title shall apply if a small employer carrier cedes or assumes all of the insurance obligation or risk with respect to one or more health benefit plans delivered or issued for delivery to small employers in this state.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10; P.L. 2007, ch. 164,  1. 
 27-50-5. Restrictions relating to premium rates. [Effective until January 1, 2023.] (a) Premium rates for health benefit plans subject to this chapter are subject to the following provisions:  (1) Subject to subdivision (2) of this subsection, a small employer carrier shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate for:  (i) Age;  (ii) Gender; and  (iii) Family composition;  (2) The adjustment for age in paragraph (1)(i) of this subsection may not use age brackets smaller than five (5) year increments and these shall begin with age thirty (30) and end with age sixty-five (65).  (3) The small employer carriers are permitted to develop separate rates for individuals age sixty-five (65) or older for coverage for which Medicare is the primary payer and coverage for which Medicare is not the primary payer. Both rates are subject to the requirements of this subsection.  (4) For each health benefit plan offered by a carrier, the highest premium rate for each family composition type shall not exceed four (4) times the premium rate that could be charged to a small employer with the lowest premium rate for that family composition.  (5) Premium rates for bona fide associations except for the Rhode Island Builders Association whose membership is limited to those who are actively involved in supporting the construction industry in Rhode Island shall comply with the requirements of this section.  (6) For a small employer group renewing its health insurance with the same small employer carrier which provided it small employer health insurance in the prior year, the combined adjustment factor for age and gender for that small employer group will not exceed one hundred twenty percent (120%) of the combined adjustment factor for age and gender for that small employer group in the prior rate year.  (b) The premium charged for a health benefit plan may not be adjusted more frequently than annually except that the rates may be changed to reflect:  (1) Changes to the enrollment of the small employer;  (2) Changes to the family composition of the employee; or  (3) Changes to the health benefit plan requested by the small employer.  (c) Premium rates for health benefit plans shall comply with the requirements of this section.  (d) Small employer carriers shall apply rating factors consistently with respect to all small employers. Rating factors shall produce premiums for identical groups that differ only by the amounts attributable to plan design and do not reflect differences due to the nature of the groups assumed to select particular health benefit plans. Two groups that are otherwise identical, but which have different prior year rate factors may, however, have rating factors that produce premiums that differ because of the requirements of subdivision (a)(6) of this section. Nothing in this section shall be construed to prevent a group health plan and a health insurance carrier offering health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention, including those included in affordable health benefit plans, provided that the resulting rates comply with the other requirements of this section, including subdivision (a)(5) of this section.  The calculation of premium discounts, rebates, or modifications to otherwise applicable copayments or deductibles for affordable health benefit plans shall be made in a manner consistent with accepted actuarial standards and based on actual or reasonably anticipated small employer claims experience. As used in the preceding sentence, accepted actuarial standards includes actuarially appropriate use of relevant data from outside the claims experience of small employers covered by affordable health plans, including, but not limited to, experience derived from the large group market, as this term is defined in  27-18.6-2(19).  (e) For the purposes of this section, a health benefit plan that contains a restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restriction of benefits to network providers results in substantial differences in claim costs.  (f) The health insurance commissioner may establish regulations to implement the provisions of this section and to assure that rating practices used by small employer carriers are consistent with the purposes of this chapter, including regulations that assure that differences in rates charged for health benefit plans by small employer carriers are reasonable and reflect objective differences in plan design or coverage (not including differences due to the nature of the groups assumed to select particular health benefit plans or separate claim experience for individual health benefit plans) and to ensure that small employer groups with one eligible subscriber are notified of rates for health benefit plans in the individual market.  (g) In connection with the offering for sale of any health benefit plan to a small employer, a small employer carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all of the following:  (1) The provisions of the health benefit plan concerning the small employer carriers right to change premium rates and the factors, other than claim experience, that affect changes in premium rates;  (2) The provisions relating to renewability of policies and contracts;  (3) The provisions relating to any preexisting condition provision; and  (4) A listing of and descriptive information, including benefits and premiums, about all benefit plans for which the small employer is qualified.  (h)(1) Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.  (2) Each small employer carrier shall file with the commissioner annually on or before March 15 an actuarial certification certifying that the carrier is in compliance with this chapter and that the rating methods of the small employer carrier are actuarially sound. The certification shall be in a form and manner, and shall contain the information, specified by the commissioner. A copy of the certification shall be retained by the small employer carrier at its principal place of business.  (3) A small employer carrier shall make the information and documentation described in subdivision (1) of this subsection available to the commissioner upon request. Except in cases of violations of this chapter, the information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the director to persons outside of the department except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction.  (4) For the wellness health benefit plan described in  27-50-10, the rates proposed to be charged and the plan design to be offered by any carrier shall be filed by the carrier at the office of the commissioner no less than thirty (30) days prior to their proposed date of use. The carrier shall be required to establish that the rates proposed to be charged and the plan design to be offered are consistent with the proper conduct of its business and with the interest of the public. The commissioner may approve, disapprove, or modify the rates and/or approve or disapprove the plan design proposed to be offered by the carrier. Any disapproval by the commissioner of a plan design proposed to be offered shall be based upon a determination that the plan design is not consistent with the criteria established pursuant to  27-50-10(b).  (i) The requirements of this section apply to all health benefit plans issued or renewed on or after October 1, 2000.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch 229,  10; P.L. 2002, ch. 41,  1; P.L. 2002, ch. 124,  1; P.L. 2002, ch. 292,  90; P.L. 2002, ch. 306,  1; P.L. 2002, ch. 366,  1; P.L. 2003, ch. 119,  1; P.L. 2003, ch. 120,  1; P.L. 2003, ch. 286,  1; P.L. 2003, ch. 375,  1; P.L. 2004, ch. 406,  2; P.L. 2004, ch. 502,  2; P.L. 2006, ch. 258,  2; P.L. 2006, ch. 296,  2; P.L. 2008, ch. 95,  1; P.L. 2008, ch. 290,  1; P.L. 2008, ch. 475,  96; P.L. 2009, ch. 48,  1; P.L. 2009, ch. 77,  1.   27-50-5. Restrictions relating to premium rates. [Effective January 1, 2023.] (a) Premium rates for health benefit plans subject to this chapter are subject to the following provisions:  (1) Subject to subsection (a)(2) of this section, a small employer carrier shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate for:  (i) Age; and  (ii) [Deleted by P.L. 2021, ch. 88,   5 and P.L. 2021, ch. 89,   5.]  (iii) Family composition.  (2) The adjustment for age in subsection (a)(1)(i) of this section may not use age brackets smaller than five-year (5) increments and these shall begin with age thirty (30) and end with age sixty-five (65).  (3) The small employer carriers are permitted to develop separate rates for individuals age sixty-five (65) or older for coverage for which Medicare is the primary payer and coverage for which Medicare is not the primary payer. Both rates are subject to the requirements of this subsection.  (4) For each health benefit plan offered by a carrier, the highest premium rate for each family composition type shall not exceed four (4) times the premium rate that could be charged to a small employer with the lowest premium rate for that family composition.  (5) Premium rates for bona fide associations except for the Rhode Island Builders Association whose membership is limited to those who are actively involved in supporting the construction industry in Rhode Island shall comply with the requirements of this section.  (6) For a small employer group renewing its health insurance with the same small employer carrier that provided it small employer health insurance in the prior year, the adjustment factor for age for that small employer group will not exceed one hundred twenty percent (120%) of the adjustment factor for age for that small employer group in the prior rate year.  (b) The premium charged for a health benefit plan may not be adjusted more frequently than annually except that the rates may be changed to reflect:  (1) Changes to the enrollment of the small employer;  (2) Changes to the family composition of the employee; or  (3) Changes to the health benefit plan requested by the small employer.  (c) Premium rates for health benefit plans shall comply with the requirements of this section.  (d) Small employer carriers shall apply rating factors consistently with respect to all small employers. Rating factors shall produce premiums for identical groups that differ only by the amounts attributable to plan design and do not reflect differences due to the nature of the groups assumed to select particular health benefit plans. Two groups that are otherwise identical, but which have different prior year rate factors may, however, have rating factors that produce premiums that differ because of the requirements of subsection (a)(6) of this section. Nothing in this section shall be construed to prevent a group health plan and a health insurance carrier offering health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention, including those included in affordable health benefit plans, provided that the resulting rates comply with the other requirements of this section, including subsection (a)(4) of this section.  The calculation of premium discounts, rebates, or modifications to otherwise applicable copayments or deductibles for affordable health benefit plans shall be made in a manner consistent with accepted actuarial standards and based on actual or reasonably anticipated small employer claims experience. As used in the preceding sentence, accepted actuarial standards includes actuarially appropriate use of relevant data from outside the claims experience of small employers covered by affordable health plans, including, but not limited to, experience derived from the large group market, as this term is defined in  27-18.6-2.  (e) For the purposes of this section, a health benefit plan that contains a restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restriction of benefits to network providers results in substantial differences in claim costs.  (f) The health insurance commissioner may establish regulations to implement the provisions of this section and to ensure that rating practices used by small employer carriers are consistent with the purposes of this chapter, including regulations that ensure that differences in rates charged for health benefit plans by small employer carriers are reasonable and reflect objective differences in plan design or coverage (not including differences due to the nature of the groups assumed to select particular health benefit plans or separate claim experience for individual health benefit plans) and to ensure that small employer groups with one eligible subscriber are notified of rates for health benefit plans in the individual market.  (g) In connection with the offering for sale of any health benefit plan to a small employer, a small employer carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all of the following:  (1) The provisions of the health benefit plan concerning the small employer carriers right to change premium rates and the factors, other than claim experience, that affect changes in premium rates;  (2) The provisions relating to renewability of policies and contracts;  (3) The provisions relating to any preexisting condition provision; and  (4) A listing of and descriptive information, including benefits and premiums, about all benefit plans for which the small employer is qualified.  (h)(1) Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.  (2) Each small employer carrier shall file with the commissioner annually on or before March 15 an actuarial certification certifying that the carrier is in compliance with this chapter and that the rating methods of the small employer carrier are actuarially sound. The certification shall be in a form and manner, and shall contain the information, specified by the commissioner. A copy of the certification shall be retained by the small employer carrier at its principal place of business.  (3) A small employer carrier shall make the information and documentation described in subsection (h)(1) of this section available to the commissioner upon request. Except in cases of violations of this chapter, the information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the director to persons outside of the department except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction.  (4) For the wellness health benefit plan described in  27-50-10, the rates proposed to be charged and the plan design to be offered by any carrier shall be filed by the carrier at the office of the commissioner no less than thirty (30) days prior to their proposed date of use. The carrier shall be required to establish that the rates proposed to be charged and the plan design to be offered are consistent with the proper conduct of its business and with the interest of the public. The commissioner may approve, disapprove, or modify the rates and/or approve or disapprove the plan design proposed to be offered by the carrier. Any disapproval by the commissioner of a plan design proposed to be offered shall be based upon a determination that the plan design is not consistent with the criteria established pursuant to  27-50-10(b).  (i) The requirements of this section apply to all health benefit plans issued or renewed on or after October 1, 2000.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch 229,  10; P.L. 2002, ch. 41,  1; P.L. 2002, ch. 124,  1; P.L. 2002, ch. 292,  90; P.L. 2002, ch. 306,  1; P.L. 2002, ch. 366,  1; P.L. 2003, ch. 119,  1; P.L. 2003, ch. 120,  1; P.L. 2003, ch. 286,  1; P.L. 2003, ch. 375,  1; P.L. 2004, ch. 406,  2; P.L. 2004, ch. 502,  2; P.L. 2006, ch. 258,  2; P.L. 2006, ch. 296,  2; P.L. 2008, ch. 95,  1; P.L. 2008, ch. 290,  1; P.L. 2008, ch. 475,  96; P.L. 2009, ch. 48,  1; P.L. 2009, ch. 77,  1; P.L. 2021, ch. 88,  5, effective January 1, 2023; P.L. 2021, ch. 89,  5, effective January 1, 2023. 
 27-50-6. Renewability of coverage. (a) A health benefit plan subject to this chapter is renewable with respect to all eligible employees or dependents, at the option of the small employer, except in any of the following cases:  (1) The plan sponsor has failed to pay premiums or contributions in accordance with the terms of the health benefit plan or the carrier has not received timely premium payments;  (2) The plan sponsor or, with respect to coverage of individual insured under the health benefit plan, the insured or the insureds representative has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of coverage;  (3) Noncompliance with the carriers minimum participation requirements;  (4) Noncompliance with the carriers employer contribution requirements;  (5) The small employer carrier elects to discontinue offering all of its health benefit plans delivered or issued for delivery to small employers in this state if the carrier:  (i) Provides advance notice of its decision under this paragraph to the commissioner in each state in which it is licensed; and  (ii) Provides notice of the decision to:  (A) All affected small employers and enrollees and their dependents; and  (B) The insurance commissioner in each state in which an affected insured individual is known to reside at least one hundred and eighty (180) days prior to the nonrenewal of any health benefit plans by the carrier, provided the notice to the commissioner under this subparagraph is sent at least three (3) working days prior to the date the notice is sent to the affected small employers and enrollees and their dependents;  (6) The director:  (i) Finds that the continuation of the coverage would not be in the best interests of the policyholders or certificate holders or would impair the carriers ability to meet its contractual obligations; and  (ii) Assists affected small employers in finding replacement coverage;  (7) The small employer carrier decides to discontinue offering a particular type of health benefit plan in the states small employer market if the carrier:  (i) Provides notice of the decision not to renew coverage at least ninety (90) days prior to the nonrenewal of any health benefit plans to all affected small employers and enrollees and their dependents;  (ii) Offers to each small employer issued a particular type of health benefit plan the option to purchase all other health benefit plans currently being offered by the carrier to small employers in the state; and  (iii) In exercising this option to discontinue a particular type of health benefit plan and in offering the option of coverage pursuant to paragraph (7)(ii) of this subsection acts uniformly without regard to the claims experience of those small employers or any health status-related factor relating to any enrollee or dependent of an enrollee or enrollees and their dependents covered or new enrollees and their dependents who may become eligible for coverage;  (8) In the case of health benefit plans that are made available in the small group market through a network plan, there is no longer an employee of the small employer living, working or residing within the carriers established geographic service area and the carrier would deny enrollment in the plan pursuant to  27-50-7(e)(1)(ii); or  (9) In the case of a health benefit plan that is made available in the small employer market only through one or more bona fide associations, the membership of an employer in the bona fide association, on the basis of which the coverage is provided, ceases, but only if the coverage is terminated under this paragraph uniformly without regard to any health status-related factor relating to any covered individual.  (b)(1) A small employer carrier that elects not to renew health benefit plan coverage pursuant to subdivision (a)(2) of this section because of the small employers fraud or intentional misrepresentation of material fact under the terms of coverage may choose not to issue a health benefit plan to that small employer for one year after the date of nonrenewal.  (2) This subsection shall not be construed to affect the requirements of  27-50-7 as to the obligations of other small employer carriers to issue any health benefit plan to the small employer.  (c)(1) A small employer carrier that elects to discontinue offering health benefit plans under subdivision (a)(5) of this section is prohibited from writing new business in the small employer market in this state for a period of five (5) years beginning on the date the carrier ceased offering new coverage in this state.  (2) In the case of a small employer carrier that ceases offering new coverage in this state pursuant to subdivision (a)(5) of this section, the small employer carrier, as determined by the director, may renew its existing business in the small employer market in the state or may be required to nonrenew all of its existing business in the small employer market in the state.  (d) A small employer carrier offering coverage through a network plan is not required to offer coverage or accept applications pursuant to subsection (a) or (b) of this section in the case of the following:  (1) To an eligible person who no longer resides, lives, or works in the service area, or in an area for which the carrier is authorized to do business, but only if coverage is terminated under this subdivision uniformly without regard to any health status-related factor of covered individuals; or  (2) To a small employer that no longer has any enrollee in connection with the plan who lives, resides, or works in the service area of the carrier, or the area for which the carrier is authorized to do business.  (e) At the time of coverage renewal, a small employer carrier may modify the health insurance coverage for a product offered to a group health plan if, for coverage that is available in the small group market other than only through one or more bona fide associations, such modification is consistent with otherwise applicable law and effective on a uniform basis among group health plans with that product.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10; P.L. 2003, ch. 119,  1; P.L. 2003, ch. 120,  1; P.L. 2003, ch. 286,  1; P.L. 2003, ch. 375,  1. 
 27-50-7. Availability of coverage. (a) Until October 1, 2004, for purposes of this section, small employer includes any person, firm, corporation, partnership, association, or political subdivision that is actively engaged in business that on at least fifty percent (50%) of its working days during the preceding calendar quarter, employed a combination of no more than fifty (50) and no less than two (2) eligible employees and part-time employees, the majority of whom were employed within this state, and is not formed primarily for purposes of buying health insurance and in which a bona fide employer-employee relationship exists. After October 1, 2004, for the purposes of this section, small employer has the meaning used in  27-50-3(kk).  (b)(1) Every small employer carrier shall, as a condition of transacting business in this state with small employers, actively offer to small employers all health benefit plans it actively markets to small employers in this state including a wellness health benefit plan. A small employer carrier shall be considered to be actively marketing a health benefit plan if it offers that plan to any small employer not currently receiving a health benefit plan from the small employer carrier.  (2) Subject to subdivision (1) of this subsection, a small employer carrier shall issue any health benefit plan to any eligible small employer that applies for that plan and agrees to make the required premium payments and to satisfy the other reasonable provisions of the health benefit plan not inconsistent with this chapter. However, no carrier is required to issue a health benefit plan to any self-employed individual who is covered by, or is eligible for coverage under, a health benefit plan offered by an employer.  (c)(1) A small employer carrier shall file with the director, in a format and manner prescribed by the director, the health benefit plans to be used by the carrier. A health benefit plan filed pursuant to this subdivision may be used by a small employer carrier beginning thirty (30) days after it is filed unless the director disapproves its use.  (2) The director may at any time may, after providing notice and an opportunity for a hearing to the small employer carrier, disapprove the continued use by a small employer carrier of a health benefit plan on the grounds that the plan does not meet the requirements of this chapter.  (d) Health benefit plans covering small employers shall comply with the following provisions:  (1) A health benefit plan shall not deny, exclude, or limit benefits for a covered individual for losses incurred more than six (6) months following the enrollment date of the individuals coverage due to a preexisting condition, or the first date of the waiting period for enrollment if that date is earlier than the enrollment date. A health benefit plan shall not define a preexisting condition more restrictively than as defined in  27-50-3.  (2)(i) Except as provided in subdivision (3) of this subsection, a small employer carrier shall reduce the period of any preexisting condition exclusion by the aggregate of the periods of creditable coverage without regard to the specific benefits covered during the period of creditable coverage, provided that the last period of creditable coverage ended on a date not more than ninety (90) days prior to the enrollment date of new coverage.  (ii) The aggregate period of creditable coverage does not include any waiting period or affiliation period for the effective date of the new coverage applied by the employer or the carrier, or for the normal application and enrollment process following employment or other triggering event for eligibility.  (iii) A carrier that does not use preexisting condition limitations in any of its health benefit plans may impose an affiliation period that:  (A) Does not exceed sixty (60) days for new entrants and not to exceed ninety (90) days for late enrollees;  (B) During which the carrier charges no premiums and the coverage issued is not effective; and  (C) Is applied uniformly, without regard to any health status-related factor.  (iv) This section does not preclude application of any waiting period applicable to all new enrollees under the health benefit plan, provided that any carrier-imposed waiting period is no longer than sixty (60) days.  (3)(i) Instead of as provided in paragraph (2)(i) of this subsection, a small employer carrier may elect to reduce the period of any preexisting condition exclusion based on coverage of benefits within each of several classes or categories of benefits specified in federal regulations.  (ii) A small employer electing to reduce the period of any preexisting condition exclusion using the alternative method described in paragraph (i) of this subdivision shall:  (A) Make the election on a uniform basis for all enrollees; and  (B) Count a period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within the class or category.  (iii) A small employer carrier electing to reduce the period of any preexisting condition exclusion using the alternative method described under paragraph (i) of this subdivision shall:  (A) Prominently state that the election has been made in any disclosure statements concerning coverage under the health benefit plan to each enrollee at the time of enrollment under the plan and to each small employer at the time of the offer or sale of the coverage; and  (B) Include in the disclosure statements the effect of the election.  (4)(i) A health benefit plan shall accept late enrollees, but may exclude coverage for late enrollees for preexisting conditions for a period not to exceed twelve (12) months.  (ii) A small employer carrier shall reduce the period of any preexisting condition exclusion pursuant to subdivision (2) or (3) of this subsection.  (5) A small employer carrier shall not impose a preexisting condition exclusion:  (i) Relating to pregnancy as a preexisting condition; or  (ii) With regard to a child who is covered under any creditable coverage within thirty (30) days of birth, adoption, or placement for adoption, provided that the child does not experience a significant break in coverage, and provided that the child was adopted or placed for adoption before attaining eighteen (18) years of age.  (6) A small employer carrier shall not impose a preexisting condition exclusion in the case of a condition for which medical advice, diagnosis, care or treatment was recommended or received for the first time while the covered person held creditable coverage, and the medical advice, diagnosis, care or treatment was a covered benefit under the plan, provided that the creditable coverage was continuous to a date not more than ninety (90) days prior to the enrollment date of the new coverage.  (7)(i) A small employer carrier shall permit an employee or a dependent of the employee, who is eligible, but not enrolled, to enroll for coverage under the terms of the group health plan of the small employer during a special enrollment period if:  (A) The employee or dependent was covered under a group health plan or had coverage under a health benefit plan at the time coverage was previously offered to the employee or dependent;  (B) The employee stated in writing at the time coverage was previously offered that coverage under a group health plan or other health benefit plan was the reason for declining enrollment, but only if the plan sponsor or carrier, if applicable, required that statement at the time coverage was previously offered and provided notice to the employee of the requirement and the consequences of the requirement at that time;  (C) The employees or dependents coverage described under subparagraph (A) of this paragraph:  (I) Was under a COBRA continuation provision and the coverage under this provision has been exhausted; or  (II) Was not under a COBRA continuation provision and that other coverage has been terminated as a result of loss of eligibility for coverage, including as a result of a legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment or employer contributions towards that other coverage have been terminated; and  (D) Under terms of the group health plan, the employee requests enrollment not later than thirty (30) days after the date of exhaustion of coverage described in item (C)(I) of this paragraph or termination of coverage or employer contribution described in item (C)(II) of this paragraph.  (ii) If an employee requests enrollment pursuant to subparagraph (i)(D) of this subdivision, the enrollment is effective not later than the first day of the first calendar month beginning after the date the completed request for enrollment is received.  (8)(i) A small employer carrier that makes coverage available under a group health plan with respect to a dependent of an individual shall provide for a dependent special enrollment period described in paragraph (ii) of this subdivision during which the person or, if not enrolled, the individual may be enrolled under the group health plan as a dependent of the individual and, in the case of the birth or adoption of a child, the spouse of the individual may be enrolled as a dependent of the individual if the spouse is eligible for coverage if:  (A) The individual is a participant under the health benefit plan or has met any waiting period applicable to becoming a participant under the plan and is eligible to be enrolled under the plan, but for a failure to enroll during a previous enrollment period; and  (B) A person becomes a dependent of the individual through marriage, birth, or adoption or placement for adoption.  (ii) The special enrollment period for individuals that meet the provisions of paragraph (i) of this subdivision is a period of not less than thirty (30) days and begins on the later of:  (A) The date dependent coverage is made available; or  (B) The date of the marriage, birth, or adoption or placement for adoption described in subparagraph (i)(B) of this subdivision.  (iii) If an individual seeks to enroll a dependent during the first thirty (30) days of the dependent special enrollment period described under paragraph (ii) of this subdivision, the coverage of the dependent is effective:  (A) In the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received;  (B) In the case of a dependents birth, as of the date of birth; and  (C) In the case of a dependents adoption or placement for adoption, the date of the adoption or placement for adoption.  (9)(i) Except as provided in this subdivision, requirements used by a small employer carrier in determining whether to provide coverage to a small employer, including requirements for minimum participation of eligible employees and minimum employer contributions, shall be applied uniformly among all small employers applying for coverage or receiving coverage from the small employer carrier.  (ii) For health benefit plans issued or renewed on or after October 1, 2000, a small employer carrier shall not require a minimum participation level greater than seventy-five percent (75%) of eligible employees.  (iii) In applying minimum participation requirements with respect to a small employer, a small employer carrier shall not consider employees or dependents who have creditable coverage in determining whether the applicable percentage of participation is met.  (iv) A small employer carrier shall not increase any requirement for minimum employee participation or modify any requirement for minimum employer contribution applicable to a small employer at any time after the small employer has been accepted for coverage.  (10)(i) If a small employer carrier offers coverage to a small employer, the small employer carrier shall offer coverage to all of the eligible employees of a small employer and their dependents who apply for enrollment during the period in which the employee first becomes eligible to enroll under the terms of the plan. A small employer carrier shall not offer coverage to only certain individuals or dependents in a small employer group or to only part of the group.  (ii) A small employer carrier shall not place any restriction in regard to any health status-related factor on an eligible employee or dependent with respect to enrollment or plan participation.  (iii) Except as permitted under subdivisions (1) and (4) of this subsection, a small employer carrier shall not modify a health benefit plan with respect to a small employer or any eligible employee or dependent, through riders, endorsements, or otherwise, to restrict or exclude coverage or benefits for specific diseases, medical conditions, or services covered by the plan.  (e)(1) Subject to subdivision (3) of this subsection, a small employer carrier is not required to offer coverage or accept applications pursuant to subsection (b) of this section in the case of the following:  (i) To a small employer, where the small employer does not have eligible individuals who live, work, or reside in the established geographic service area for the network plan;  (ii) To an employee, when the employee does not live, work, or reside within the carriers established geographic service area; or  (iii) Within an area where the small employer carrier reasonably anticipates, and demonstrates to the satisfaction of the director, that it will not have the capacity within its established geographic service area to deliver services adequately to enrollees of any additional groups because of its obligations to existing group policyholders and enrollees.  (2) A small employer carrier that cannot offer coverage pursuant to paragraph (1)(iii) of this subsection may not offer coverage in the applicable area to new cases of employer groups until the later of one hundred and eighty (180) days following each refusal or the date on which the carrier notifies the director that it has regained capacity to deliver services to new employer groups.  (3) A small employer carrier shall apply the provisions of this subsection uniformly to all small employers without regard to the claims experience of a small employer and its employees and their dependents or any health status-related factor relating to the employees and their dependents.  (f)(1) A small employer carrier is not required to provide coverage to small employers pursuant to subsection (b) of this section if:  (i) For any period of time the director determines the small employer carrier does not have the financial reserves necessary to underwrite additional coverage; and  (ii) The small employer carrier is applying this subsection uniformly to all small employers in the small group market in this state consistent with applicable state law and without regard to the claims experience of a small employer and its employees and their dependents or any health status-related factor relating to the employees and their dependents.  (2) A small employer carrier that denies coverage in accordance with subdivision (1) of this subsection may not offer coverage in the small group market for the later of:  (i) A period of one hundred and eighty (180) days after the date the coverage is denied; or  (ii) Until the small employer has demonstrated to the director that it has sufficient financial reserves to underwrite additional coverage.  (g)(1) A small employer carrier is not required to provide coverage to small employers pursuant to subsection (b) of this section if the small employer carrier elects not to offer new coverage to small employers in this state.  (2) A small employer carrier that elects not to offer new coverage to small employers under this subsection may be allowed, as determined by the director, to maintain its existing policies in this state.  (3) A small employer carrier that elects not to offer new coverage to small employers under subdivision (g)(1) shall provide at least one hundred and twenty (120) days notice of its election to the director and is prohibited from writing new business in the small employer market in this state for a period of five (5) years beginning on the date the carrier ceased offering new coverage in this state.  (h) No small group carrier may impose a pre-existing condition exclusion pursuant to the provisions of subdivisions (d)(1), (d)(2), (d)(3), (d)(4), (d)(5), and (d)(6) of this section with regard to an individual that is less than nineteen (19) years of age. With respect to health benefit plans issued on and after January 1, 2014, a small employer carrier shall offer and issue coverage to small employers and eligible individuals notwithstanding any pre-existing condition of an employee, member, or individual, or their dependents.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10; P.L. 2002, ch. 41,  1; P.L. 2002, ch. 292,  90; P.L. 2002, ch. 366,  1; P.L. 2003, ch. 120,  1; P.L. 2003, ch. 286,  1; P.L. 2004, ch. 406,  2; P.L. 2004, ch. 502,  2; P.L. 2006, ch. 258,  2; P.L. 2006, ch. 296,  2; P.L. 2012, ch. 256,  11; P.L. 2012, ch. 262,  11. 
 27-50-8. Certification of creditable coverage. (a) Small employer carriers shall provide written certification of creditable coverage to individuals in accordance with subsection (b) of this section.  (b) The certification of creditable coverage shall be provided:  (1) At the time an individual ceases to be covered under the health benefit plan or otherwise becomes covered under a COBRA continuation provision;  (2) In the case of an individual who becomes covered under a COBRA continuation provision, at the time the individual ceases to be covered under that provision; and  (3) At the time a request is made on behalf of an individual if the request is made not later than twenty-four (24) months after the date of cessation of coverage described in subdivision (1) or (2) of this subsection, whichever is later.  (c) Small employer carriers may provide the certification of creditable coverage required under subdivision (b)(1) of this section at a time consistent with notices required under any applicable COBRA continuation provision.  (d) The certificate of creditable coverage required to be provided pursuant to subsection (a) shall contain:  (1) Written certification of the period of creditable coverage of the individual under the health benefit plan and the coverage, if any, under the applicable COBRA continuation provision; and  (2) The waiting period, if any, and, if applicable, affiliation period imposed with respect to the individual for any coverage under the health benefit plan.  (e) To the extent medical care under a group health plan consists of group health insurance coverage, the plan is deemed to have satisfied the certification requirement under subsection (a) of this section if the carrier offering the coverage provides for certification in accordance with subsection (b) of this section.  (f)(1) If an individual enrolls in a group health plan that uses the alternative method of counting creditable coverage pursuant to  27-50-7(c)(3) of this act and the individual provides a certificate of coverage that was provided to the individual pursuant to subsection (b) of this section, on request of the group health plan, the entity that issued the certification to the individual promptly shall disclose to the group health plan information on the classes and categories of health benefits available under the entitys health benefit plan.  (2) The entity providing the information pursuant to subdivision (1) of this subsection may charge the requesting group health plan the reasonable cost of disclosing the information.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10. 
 27-50-9. Periodic market evaluation. Within three (3) months after March 31, 2002, and every thirty-six (36) months after this, the director shall obtain an independent actuarial study and report. The director shall assess a fee to the health plans to commission the report. The report shall analyze the effectiveness of the chapter in promoting rate stability, product availability, and coverage affordability. The report may contain recommendations for actions to improve the overall effectiveness, efficiency, and fairness of the small group health insurance marketplace. The report shall address whether carriers and producers are fairly actively marketing or issuing health benefit plans to small employers in fulfillment of the purposes of the chapter. The report may contain recommendations for market conduct or other regulatory standards or action.  History of Section.P.L. 2000, ch. 200,  9; P.L. 2000, ch. 229,  10; P.L. 2003, ch. 120,  1; P.L. 2003, ch. 286,  1. 
 27-51-1. Short title. This chapter may be known as the Managing General Agents Act. History of Section.P.L. 1992, ch. 445,  1; P.L. 1996, ch. 188,  19; P.L. 2002, ch. 292,  91. 
 27-51-2. Definitions. 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 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, 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 paragraph (i) of this subdivision, 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 which, 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; and  (5) Underwrite means the authority to accept or reject risk on behalf of the insurer.  History of Section.P.L. 1992, ch. 445,  1. 
 27-51-3. Licensure. (a) No person, firm, association, or corporation shall act in the capacity of an MGA with respect to risks located in this state for an insurer licensed in this state unless that person is a licensed producer in this state.  (b) No person, firm, association, or corporation shall act in the capacity of an MGA representing an insurer domiciled in this state with respect to risks located outside this state unless that person is licensed as a producer in this state. The license may be a nonresident license pursuant to the provisions of this chapter.  (c) The commissioner may require a bond in an amount acceptable to him or her for the protection of the insurer.  (d) The commissioner may require the MGA to maintain an errors and omissions policy.  History of Section.P.L. 1992, ch. 445,  1. 
 27-51-4. Required contract provisions. No person, firm, association, or corporation acting in the capacity of an MGA shall place business with an insurer unless there is in force a written contract between the parties which sets forth the responsibilities of each party and where both parties share responsibility for a particular function, specifies the division of the responsibilities, and which contains the following minimum provisions:  (1) The insurer may terminate the contract for cause upon written notice to the MGA. The insurer may suspend the underwriting authority of the MGA during the pendency of any dispute regarding the cause for termination;  (2) The MGA will render accounts to the insurer detailing all transactions and remit all funds due under the contract to the insurer on not less than a monthly basis;  (3) All funds collected for the account of an insurer will be held by the MGA in a fiduciary capacity in a bank that is a member of the Federal Reserve System. This account shall be used for all payments on behalf of the insurer. The MGA may retain no more than three (3) months estimated claims payments and allocated loss adjustment expenses;  (4) Separate records of business written by the MGA will be maintained. The insurer shall have access and the right to copy all accounts and records related to its business in a form usable by the insurer, and the commissioner shall have access to all books, bank accounts, and records of the MGA in a form usable to the commissioner;  (5) The contract may not be assigned in whole or part by the MGA;  (6)(i) Appropriate underwriting guidelines including:  (A) The maximum annual premium volume;  (B) The basis of the rates to be charged;  (C) The types of risks which may be written;  (D) Maximum limits of liability;  (E) Applicable exclusions;  (F) Territorial limitations;  (G) Policy cancellation provisions; and  (H) The maximum policy period;  (ii) The insurer shall have the right to cancel or not to renew any policy of insurance subject to the applicable laws and regulations concerning the cancellation and nonrenewal of insurance policies.  (7) If the contract permits the MGA to settle claims on behalf of the insurer:  (i) All claims must be reported to the company in a timely manner;  (ii) A copy of the claim file will be sent to the insurer at its request or as soon as it becomes known that the claim:  (A) Has the potential to exceed an amount determined by the commissioner or exceeds the limit set by the company, whichever is less;  (B) Involves a coverage dispute;  (C) May exceed the MGAs claims settlement authority;  (D) Is open for more than six (6) months; or  (E) Is closed by payment of an amount set by the commissioner or an amount set by the company, whichever is less;  (iii) All claim files will be the joint property of the insurer and MGA. Upon an order of liquidation of the insurer the files shall become the sole property of the insurer or its estate; the MGA shall have reasonable access to and the right to copy the files on a timely basis;  (iv) Any settlement authority granted to the MGA may be terminated for cause upon the insurers written notice to the MGA or upon the termination of the contract. The insurer may suspend the settlement authority during the pendency of any dispute regarding the cause for termination.  (8) Where electronic claims files are in existence, the contract must address the timely transmission of the data;  (9) If the contract provides for a sharing of interim profits by the MGA, and the MGA has the authority to determine the amount of the interim profits by establishing loss reserves or controlling claim payments, or in any other manner, interim profits will not be paid to the MGA until one year after they are earned for property insurance business and five (5) years after they are earned on casualty business and not until the profits have been verified pursuant to  27-51-5; and  (10) The MGA shall not:  (i) Bind reinsurance or retrocessions on behalf of the insurer, except that the MGA may bind facultative reinsurance contracts pursuant to obligatory facultative agreements if the contract with the insurer contains reinsurance underwriting guidelines including, for both reinsurance assumed and ceded, a list of reinsurers with which the automatic agreements are in effect, the coverage and amounts or percentages that may be reinsured, and commission schedules;  (ii) Commit the insurer to participate in insurance or reinsurance syndicates;  (iii) Appoint any producer without assuring that the producer is lawfully licensed to transact the type of insurance for which he or she is appointed;  (iv) Without prior approval of the insurer, pay or commit the insurer to pay a claim over a specified amount net of reinsurance, which shall not exceed one percent (1%) of the insurers policyholders surplus as of December 31 of the last completed calendar year;  (v) Collect any payment from a reinsurer or commit the insurer to any claim settlement with a reinsurer, without prior approval of the insurer. If prior approval is given, a report must be promptly forwarded to the insurer;  (vi) Permit its subproducer to serve on the insurers board of directors;  (vii) Jointly employ an individual who is employed with the insurer; or  (viii) Appoint a sub-MGA.  History of Section.P.L. 1992, ch. 445,  1. 
 27-51-5. Duties of insurers. (a) The insurer shall have on file an independent financial examination, in a form acceptable to the commissioner, of each MGA with which it has done business.  (b) If an MGA establishes loss reserves, the insurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the MGA. This is in addition to any other required loss reserve certification.  (c) The insurer shall periodically, at least semiannually, conduct an onsite review of the underwriting and claims processing operations of the MGA.  (d) Binding authority for all reinsurance contracts or participation in insurance or reinsurance syndicates shall rest with an officer of the insurer, who shall not be affiliated with the MGA.  (e) Within thirty (30) days of entering into or termination of a contract with an MGA, the insurer shall provide written notification of the appointment or termination to the commissioner. Notices of appointment of an MGA shall include a statement of duties which the applicant is expected to perform on behalf of the insurer, the lines of insurance for which the applicant is to be authorized to act, and any other information the commissioner may request.  (f) An insurer shall review its books and records each quarter to determine if any producer has become an MGA by virtue of the provisions of this chapter. If the insurer determines that a producer has become a MGA pursuant to the provisions of this chapter, the insurer shall promptly notify the producer and the commissioner of the determination and the insurer and producer must fully comply with the provisions of this chapter within thirty (30) days.  (g) An insurer shall not appoint to its board of directors an officer, director, employee, subproducer, or controlling shareholder of its MGAs. This subsection shall not apply to relationships governed by chapter 35 of this title, or, if applicable, the Broker Controlled Insurer Act.  History of Section.P.L. 1992, ch. 445,  1. 
 27-51-6. Examination authority. The acts of the MGA are considered to be the acts of the insurer on whose behalf it is acting. An MGA may be examined as if it was the insurer and cost of examination will be borne by the insurer pursuant to  27-13-1.  History of Section.P.L. 1992, ch. 445,  1. 
 27-51-7. Penalties and liabilities. (a) If the commissioner finds after a hearing conducted in accordance with the Administrative Procedures Act, chapter 35 of title 42, that any person has violated any provision(s) of this chapter, the commissioner may order:  (1) For each separate violation, a penalty in an amount not exceeding one thousand dollars ($1,000);  (2) Revocation or suspension of the producers license. If it was found that because of material noncompliance the insurer has suffered any loss or damage, the commissioner may maintain a civil action brought by or on behalf of the insurer and its policyholders and creditors for recovery of compensatory damages for the benefit of the insurer and its policyholders and creditors or other appropriate relief.  (b) If an order of rehabilitation or liquidation of the insurer has been entered pursuant to applicable Rhode Island law and the receiver appointed under that order determines that the MGA or any other person has not materially complied with this chapter, or any regulation or order promulgated pursuant to this chapter, and the insurer suffered any loss or damage from the noncompliance, the receiver may maintain a civil action for recovery of damages or other appropriate sanctions for the benefit of the insurer.  (c) Nothing contained in this section shall affect the right of the commissioner to impose any other penalties provided for in the insurance law.  (d) Nothing contained in this chapter is intended to or shall in any manner limit or restrict the rights of policyholders, claimants, and auditors.  History of Section.P.L. 1992, ch. 445,  1; P.L. 1996, ch. 188,  19. 
 27-51-8. Rules and regulations. The commissioner of insurance may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.  History of Section.P.L. 1992, ch. 445,  1. 
 27-51-9. Utilization of services. No insurer may continue to utilize the services of an MGA on and after December 31, 1992, unless that utilization is in compliance with this chapter.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-1. Short title. This chapter may be cited as the Reinsurance Intermediary Act. History of Section.P.L. 1992, ch. 445,  1. 
 27-52-10. Examination authority. (a) A reinsurance intermediary shall be subject to examination by the commissioner. The commissioner shall have access to all books, bank accounts, and records of the reinsurance intermediary in a form usable to the commissioner. The cost of the examination shall be paid by the insurer in the same manner as the cost of examination of an insurer pursuant to chapter 13 of this title.  (b) A RM may be examined as if it were the reinsurer.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-11. Penalties and liabilities. (a) A reinsurance intermediary, insurer, or reinsurer found by the commissioner, after a hearing conducted in accordance with the Administrative Procedures Act, chapter 35 of title 42, to be in violation of any provision(s) of this chapter, shall:  (1) For each separate violation, pay a penalty in an amount not exceeding five thousand dollars ($5,000);  (2) Be subject to revocation or suspension of its license; and  (3) If a violation was committed by the reinsurance intermediary, the reinsurance intermediary shall make restitution to the insurer, reinsurer, rehabilitator, or liquidator for the net losses incurred by the insurer or reinsurer attributable to the violation.  (b) The decision, determination, or order of the commissioner pursuant to subsection (a) of this section shall be subject to judicial review pursuant to the Administrative Procedures Act, chapter 35 of title 42.  (c) Nothing contained in this section shall affect the right of the commissioner to impose any other penalties provided in the insurance law.  (d) Nothing contained in this chapter is intended to or shall in any manner limit or restrict the rights of policyholders, claimants, creditors, or other third parties or confer any rights to those persons.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-12. Rules and regulations. The commissioner may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-13. Repealed.
 27-52-2. Definitions. As used in this chapter: (1) Actuary means a person who is a member in good standing of the American Academy of Actuaries;  (2) Controlling person means any person, firm, association, or corporation who directly or indirectly has the power to direct or cause to be directed, the management, control, or activities of the reinsurance intermediary;  (3) Insurer means any person, firm, association, or corporation duly licensed in this state pursuant to the applicable provisions of the insurance law as an insurer;  (4) Licensed producer means an agent, broker, or reinsurance intermediary licensed pursuant to the applicable provisions of this title.  (5) Qualified U.S. financial institutions, for the purposes of this chapter, means an institution that:  (i) Is organized or in the case of a U.S. office of a foreign banking organization licensed, under the laws of the United States or any state of the United States;  (ii) Is regulated, supervised, and examined by U.S. federal or state authorities having regulatory authority over banks and trust companies; and  (iii) Has been determined by either the commissioner, or the securities valuation office of the National Association of Insurance Commissioners, to meet the standards of financial condition and standing that are considered necessary and appropriate to regulate the quality of financial institutions whose letters of credit will be acceptable to the commissioner;  (6) Reinsurance intermediary means a reinsurance intermediary broker or a reinsurance intermediary manager as these terms are defined in subdivisions (7) and (8) of this section, but shall not mean an intermediary in an insurance securitization or reinsurance transaction with a protected cell established by a protected cell company organized under the Protected Cell Companies Act, chapter 64 of this title, as those terms are defined or utilized in that Act;  (7) Reinsurance intermediary broker (RB) means any person, other than an officer or employee of the ceding insurer, firm, association, or corporation who solicits, negotiates, or places reinsurance cessions or retrocessions on behalf of a ceding insurer without the authority or power to bind reinsurance on behalf of the insurer;  (8) Reinsurance intermediary manager (RM) means any person, firm, association, or corporation who has authority to bind or manages all or part of the assumed reinsurance business of a reinsurer, including the management of a separate division, department, or underwriting office, and acts as an agent for the reinsurer which is known as a RM, manager, or other similar term. Notwithstanding this definition, the following persons shall not be considered a RM, with respect to the reinsurer, for the purposes of this chapter:  (i) Any employee of the reinsurer;  (ii) A U.S. manager of the United States branch of an alien reinsurer;  (iii) An underwriting manager which, pursuant to contract, manages all the reinsurance operations of the reinsurer, is under common control with the reinsurer, subject to the Insurance Holding Company Systems Act, chapter 35 of this title, and whose compensation is not based on the volume of premiums written;  (iv) The manager of a group, association, pool, or organization of insurers which engage in joint underwriting or joint reinsurance and who are subject to examination by the insurance commissioner of the state in which the managers principal business office is located;  (9) Reinsurer means any person, firm, association, or corporation duly licensed in this state pursuant to the applicable provisions of this title as an insurer with the authority to assume reinsurance; and  (10) To be in violation means that the reinsurance intermediary, insurer, or reinsurer for whom the reinsurance intermediary was acting failed to substantially comply with the provisions of this chapter.  History of Section.P.L. 1992, ch. 445,  1; P.L. 1999, ch. 22,  13; P.L. 2002, ch. 292,  92. 
 27-52-3. Licensure. (a) No person, firm, association, or corporation shall act as an RB in this state if the RB maintains an office either directly or as a member or employee of a firm or association, or an officer, director, or employee of a corporation:  (1) In this state, unless the RB is a licensed producer in this state; or  (2) In another state, unless the RB is a licensed producer in this state or another state having a law substantially similar to this law or the RB is licensed in this state as a nonresident reinsurance intermediary.  (b) No person, firm, association, or corporation shall act as an RM:  (1) For a reinsurer domiciled in this state, unless the RM is a licensed producer in this state;  (2) In this state, if the RM maintains an office either directly or as a member or employee of a firm or association, or an office, director, or employee of a corporation in this state, unless the RM is a licensed producer in this state;  (3) In another state for a nondomestic insurer, unless the RM is a licensed producer in this state or another state having a law substantially similar to this law or the person is licensed in this state as a nonresident reinsurance intermediary.  (c) The commissioner may require a RM subject to subsection (b) of this section to:  (1) File a bond in an amount from an insurer acceptable to the commissioner for the protection of the reinsurer; and  (2) Maintain an errors and omissions policy in an amount acceptable to the commissioner.  (d)(1) The commissioner may issue a reinsurance intermediary license to any person, firm, association, or corporation who has complied with the requirements of this chapter. Any license issued to a firm or association will authorize all the members of the firm or association and any designated employees to act as reinsurance intermediaries under the license, and all these persons shall be named in the application and any supplements to the application. Any license issued to a corporation shall authorize all of the officers, and any designated employees and directors of the corporation to act as reinsurance intermediaries on behalf of the corporation, and all these persons shall be named in the application and any supplements to the application;  (2) If the applicant for a reinsurance intermediary license is a nonresident, the applicant, as a condition precedent to receiving or holding a license, shall designate the commissioner as agent for service of process in the manner, and with the same legal effect, provided for by this chapter for designation of service of process upon unauthorized insurers, and also shall furnish the commission with the name and address of a resident of this state upon whom notices or orders of the commissioner or process affecting the nonresident reinsurance intermediary may be served. The licensee shall promptly notify the commissioner in writing of every change in its designated agent for service of process, and the change shall not become effective until acknowledged by the commissioner;  (3) The commissioner shall promulgate rules and regulations mandating the term of license for each category of license issued pursuant to this chapter and no license shall remain in force for a period in excess of four (4) years. The fee for initial issuance of the license or for renewal of the license shall be one hundred dollars ($100) per annum for each year of the term of the license.  (e) The commissioner may refuse to issue a reinsurance intermediary license if, in his or her judgment, the applicant, any one named on the application, or any member, principal, officer, or director of the applicant, is not trustworthy, or that any controlling person of the applicant is not trustworthy to act as a reinsurance intermediary, or that any of the foregoing has given cause for revocation or suspension of the license, or has failed to comply with any prerequisite for the issuance of the license. Upon written request, the commissioner will furnish a summary of the basis for refusal to issue a license, which document shall be privileged and not subject to the Access to Public Records Act, chapter 2 of title 38.  (f) Licensed attorneys of this state when acting in their professional capacity as attorneys shall be exempt from this section.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-4. Required contract provisions  Reinsurance intermediary  Brokers. Transactions between a RB and the insurer it represents in that capacity shall only be entered into pursuant to a written authorization, specifying the responsibilities of each party. The authorization shall, at a minimum, provide that:  (1) The insurer may terminate the RBs authority at any time;  (2) The RB will render accounts to the insurer accurately detailing all material transactions, including information necessary to support all commissions, charges, and other fees received by, or owing, to the RB, and remit all funds due to the insurer within thirty (30) days of receipt;  (3) All funds collected for the insurers account will be held by the RB in a fiduciary capacity in a bank that is a qualified U.S. financial institution as defined in this chapter;  (4) The RB will comply with  27-52-5;  (5) The RB will comply with the written standards established by the insurer for the cession or retrocession of all risks; and  (6) The RB will disclose to the insurer any relationship with any reinsurer to which business will be ceded or retroceded.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-5. Books and records  Reinsurance intermediary brokers. (a) For at least ten (10) years after the expiration of each contract of reinsurance transacted by the RB, the RB will keep a complete record for each transaction showing:  (1) The type of contract, limits, underwriting restrictions, classes, or risks and territory;  (2) Period of coverage, including effective and expiration dates, cancellation provisions, and notice required of cancellation;  (3) Reporting and settlement requirements of balances;  (4) Rate used to compute the reinsurance premium;  (5) Names and addresses of assuming reinsurers;  (6) Rates of all reinsurance commissions, including the commissions on any retrocessions handled by the RB;  (7) Related correspondence and memoranda;  (8) Proof of placement;  (9) Details regarding retrocessions handled by the RB including the identity of retrocessionaries and percentage of each contract assumed or ceded;  (10) Financial records including, but not limited to, premium and loss accounts; and  (11) When the RB procures a reinsurance contract on behalf of a licensed ceding insurer:  (i) Directly from any assuming reinsurer, written evidence that the assuming reinsurer has agreed to assume the risk; or  (ii) If placed through a representative of the assuming reinsurer, other than an employee, written evidence that the reinsurer has delegated binding authority to the representative.  (b) The insurer will have access and the right to copy and audit all accounts and records maintained by the RB related to its business in a form usable by the insurer.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-6. Duties of insurers utilizing the services of a reinsurance intermediary  Broker. (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.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-7. Required contract provisions  Reinsurance intermediary  Managers. Transactions between a RM and the reinsurer it represents in that capacity shall only be entered into pursuant to a written contract, specifying the responsibilities of each party, which shall be approved by the reinsurers board of directors. At least thirty (30) days before the reinsurer assumes or cedes business through the producer, a true copy of the approved contract shall be filed with the commissioner for approval. The contract shall, at a minimum, provide that:  (1) The reinsurer may terminate the contract for cause upon written notice to the RM. The reinsurer may immediately suspend the authority of the RM to assume or cede business during the pendency of any dispute regarding the cause for termination;  (2) The RM will render accounts to the reinsurer accurately detailing all material transactions, including information necessary to support all commissions, charges, and other fees received by, or owing to the RM, and remit all funds due under the contract to the reinsurer on not less than a monthly basis;  (3) All funds collected for the reinsurers account will be held by the RM in a fiduciary capacity in a bank that is a qualified U.S. financial institution as defined in this chapter. The RM may retain no more than three (3) months estimated claims payments and allocated loss adjustment expenses. The RM shall maintain a separate bank account for each reinsurer that it represents;  (4) For at least ten (10) years after the expiration of each contract of reinsurance transacted by the RM, the RM will keep a complete record for each transaction showing:  (i) The type of contract, limits, underwriting restrictions, classes, or risks and territory;  (ii) Period of coverage, including effective and expiration dates, cancellation provisions, and notice required of cancellation, and disposition of outstanding reserves on covered risks;  (iii) Reporting and settlement requirements of balances;  (iv) Rate used to compute the reinsurance premium;  (v) Names and addresses of reinsurers;  (vi) Rates of all reinsurance commissions, including the commissions on any retrocessions handled by the RM;  (vii) Related correspondence and memoranda;  (viii) Proof of placement;  (ix) Details regarding retrocessions handled by the RM, as the provision of this chapter, including the identity of retrocessionaries and percentage of each contract assumed or ceded;  (x) Financial records including, but not limited to, premium and loss accounts; and  (xi) When the RM places a reinsurance contract on behalf of a ceding insurer:  (A) Directly from any assuming reinsurer, written evidence that the assuming reinsurer has agreed to assume the risk; or  (B) If placed through a representative of the assuming reinsurer, other than an employee, written evidence that the reinsurer has delegated binding authority to the representative;  (5) The reinsurer will have access and the right to copy all accounts and records maintained by the RM related to its business in a form usable by the reinsurer;  (6) The contract cannot be assigned in whole or in part by the RM;  (7) The RM will comply with the written underwriting and rating standards established by the insurer for the acceptance, rejection, or cession of all risks;  (8) Sets forth the rates, terms, and purposes of commissions, charges, and other fees that RM may levy against the reinsurer;  (9) If the contract permits the RM to settle claims on behalf of the reinsurer:  (i) All claims will be reported to the reinsurer in a timely manner;  (ii) A copy of the claim file will be sent to the reinsurer at its request or as soon as it becomes known that the claim:  (A) Has the potential to exceed the lesser of an amount determined by the commissioner or the limit set by the reinsurer;  (B) Involves a coverage dispute;  (C) May exceed the RMs claims settlement authority;  (D) Is open for more than six (6) months; or  (E) Is closed by payment of the lesser of an amount set by the commissioner or an amount set by the reinsurer;  (iii) All claim files will be the joint property of the reinsurer and RM. Upon an order of liquidation of the reinsurer the files shall become the sole property of the reinsurer or its estate; the RM shall have reasonable access to and the right to copy the files on a timely basis;  (iv) Any settlement authority granted to the RM may be terminated for cause upon the reinsurers written notice to the RM or upon the termination of the contract. The reinsurer may suspend the settlement authority during the pendency of the dispute regarding the cause of termination;  (10) If the contract provides for a sharing of interim profits by the RM, the interim profits will not be paid until one year after the end of each underwriting period for property business and five (5) years after the end of each underwriting period for casualty business, or a later period set by the commissioner for specified lines of insurance, and not until the adequacy of reserves on remaining claims has been verified pursuant to the provisions of this chapter;  (11) The RM will annually provide the reinsurer with a statement of its financial condition prepared by an independent certified accountant.  (12) The reinsurer shall periodically, at least semiannually, conduct an onsite review of the underwriting and claims processing operations of the RM;  (13) The RM will disclose to the reinsurer any relationship it has with any insurer prior to ceding or assuming any business with the insurer pursuant to this contract; and  (14) Within the scope of its actual or apparent authority, the acts of the RM are deemed to be the acts of the reinsurer on whose behalf it is acting.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-8. Prohibited acts. The RM shall not: (1) Cede retrocessions on behalf of the reinsurer, except that the RM may cede facultative retrocessions pursuant to obligatory facultative agreements if the contract with the reinsurer contains reinsurance underwriting guidelines for the retrocessions. The guidelines shall include a list of reinsurers with which the automatic agreements are in effect, and for each reinsurer, the coverages and amounts or percentages that may be reinsured, and commission schedules;  (2) Commit the reinsurer to participate in reinsurance syndicates;  (3) Appoint any producer without assuring that the producer is lawfully licensed to transact the type of reinsurance for which he or she is appointed;  (4) Without prior approval of the reinsurer, pay or commit the reinsurer to pay a claim, net of retrocessions, that exceeds the lesser of an amount specified by the reinsurer or one percent (1%) of the reinsurers policyholders surplus as of December 31 of the last complete calendar year;  (5) Collect any payment from a retrocessionaire or commit the reinsurer to any claim settlement with a retrocessionaire, without prior approval of the reinsurer. If prior approval is given, a report must be promptly forwarded to the reinsurer;  (6) Jointly employ an individual who is employed by the reinsurer unless the RM is under common control with the reinsurer subject to chapter 35 of this title; and  (7) Appoint a sub-RM.  History of Section.P.L. 1992, ch. 445,  1. 
 27-52-9. Duties of reinsurers utilizing the services of a reinsurance intermediary  Manager. (a) A reinsurer shall not engage the services of any person, firm, association, or corporation to act as a RM on its behalf unless that person is licensed as required by the provisions of this chapter.  (b) The reinsurer shall annually obtain a copy of statements of the financial condition of each RM which the reinsurer has engaged prepared by an independent certified accountant in a form acceptable to the commissioner.  (c) If an RM establishes loss reserves, the reinsurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the RM. This opinion shall be in addition to any other required loss reserve certification.  (d) Binding authority for all retrocessional contracts or participation in reinsurance syndicates shall rest with an officer of the reinsurer who shall not be affiliated with the RM.  (e) Within thirty (30) days of the termination of a contract with a RM, the reinsurer shall provide written notification of the termination to the commissioner.  (f) A reinsurer shall not appoint to its board of directors any officer, director, employee, controlling shareholder, or subproducer of its RM. This subsection shall not apply to relationships governed by the Insurance Holding Systems Act, chapter 35 of this title.  History of Section.P.L. 1992, ch. 445,  1. 
 27-53.1-1. Purpose. This chapter provides for the regulation of the transfer and novation of contracts of insurance by way of assumption reinsurance. It defines assumption reinsurance and establishes notice and disclosure requirements which protect and define the rights and obligations of policyholders, regulators, and the parties to assumption reinsurance agreements.  History of Section.P.L. 1996, ch. 188,  21. 
 27-53.1-2. Scope. (a) This chapter applies to any insurer authorized in this state which either assumes or transfers the obligations and/or risks on contracts of insurance pursuant to an assumption reinsurance agreement.  (b) This chapter does not apply to:  (1) Any reinsurance agreement or transaction in which the ceding insurer continues to remain directly liable for its insurance obligations and/or risks under the contracts of insurance subject to the reinsurance agreement;  (2) The substitution of one insurer for another upon the expiration of insurance coverage pursuant to statutory or contractual requirements and the issuance of a new contract of insurance by another insurer;  (3) The transfer of contracts of insurance pursuant to mergers or consolidations of two (2) or more insurers to the extent that those transactions are regulated by statute;  (4) Any insurer subject to a judicial order of liquidation or rehabilitation;  (5) Any reinsurance agreement or transaction to which a state insurance guaranty association is a party, provided that policyholders do not lose any rights or claims afforded under their original policies pursuant to chapters 34, 34.1 and 34.3 of this title;  (6) The transfer of liabilities from one insurer to another under a single group policy upon the request of the group policyholder; or  (7) The transfer of liabilities from one insurer to another under chapter 14.5 of this title.  History of Section.P.L. 1996, ch. 188,  21; P.L. 2002, ch. 381,  2. 
 27-53.1-3. Definitions. (a) Assuming insurer means the insurer which acquires an insurance obligation and/or risk from the transferring insurer pursuant to an assumption reinsurance agreement.  (b) Assumption reinsurance agreement means any contract which both:  (1) Transfers insurance obligations and/or risks of existing or in-force contracts of insurance from a transferring insurer to an assuming insurer; and  (2) Is intended to effect a novation of the transferred contract of insurance with the result that the assuming insurer becomes directly liable to the policyholders of the transferring insurer and the transferring insurers insurance obligations and/or risks under the contracts are extinguished.  (c) Contract of insurance means any written agreement between an insurer and policyholder pursuant to which the insurer, in exchange for premium or other consideration, agrees to assume an obligation and/or risk of the policyholder or to make payments on behalf of, or to, the policyholder or its beneficiaries; it shall include all property, casualty, life, health, accident, surety, title insurance transacted by insurers not domiciled in Rhode Island and annuity business authorized to be written pursuant to the insurance laws of this state.  (d) Home service business means insurance business on which premiums are collected on a weekly or monthly basis by an agent of the insurer.  (e) Notice of transfer means the written notice to policyholders required by  27-53.1-4(a).  (f) Policyholder means any individual or entity that has the right to terminate or otherwise alter the terms of a contract of insurance. It includes any certificate holder whose certificate is in force on the proposed effective date on the assumption, if the certificate holder has the right to keep the certificate in force without change in benefit following termination of the group policy. The right to keep the certificate in force referred to in this section shall not include the right to elect individual coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA), 42 U.S.C.  403 et seq., or Section 601 et seq., of the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1161 et seq.  (g) Transferring insurer means the insurer that transfers an insurance obligation and/or risk to an assuming insurer pursuant to an assumption reinsurance agreement.  History of Section.P.L. 1996, ch. 188,  21. 
 27-53.1-4. Notice requirements. (a) Notice to policyholders, agents and brokers.(1) The transferring insurer shall provide or cause to be provided to each policyholder a notice of transfer by first-class mail, addressed to the policyholders last known address or to the address to which premium notices or other policy documents are sent or, with respect to home service business, by personal delivery with acknowledged receipt. A notice of transfer shall also be sent to the transferring insurers agents or brokers of record on the affected policies.  (2) The notice of transfer shall state or provide:  (i) The date the transfer and novation of the policyholders contract of insurance is proposed to take place;  (ii) The name, address and telephone number of the assuming and transferring insurer;  (iii) That the policyholder has the right to either consent to or reject the transfer and novation;  (iv) The procedures and time limit for consenting to or rejecting the transfer and novation;  (v) A summary of any effect that consenting to or rejecting the transfer and novation will have on the policyholders rights;  (vi) A statement that the assuming insurer is licensed to write the type of business being assumed in the state where the policyholder resides, or is authorized, as provided in this section, to assume that business;  (vii) The name and address of the person at the transferring insurer to whom the policyholder should send its written statement of acceptance or rejection of the transfer and novation; and  (viii) The address and phone number of the insurance department where the policyholder resides so that the policyholder may write or call the insurance department for further information regarding the financial condition of the assuming insurer;  (ix) The following financial data for both companies:  (A) Ratings for the last five (5) years, if available, or for any lesser period as is available from two (2) nationally recognized insurance rating services acceptable to the commissioner including the rating services explanation of the meaning of the ratings. If ratings are unavailable for any year of the five (5) year period, this shall also be disclosed;  (B) A balance sheet as of December 31 for the previous three (3) years, if available, or for any lesser period as is available and as of the date of the most recent quarterly statement;  (C) A copy of the managements discussion and analysis that was filed as a supplement to the previous years annual statement; and  (D) An explanation of the reason for the transfer.  (3) Notice in a form identical or substantially similar to  27-53.1-8 shall be deemed to comply with the requirements of subdivision (a)(2).  (4) The notice of transfer shall include a pre-addressed, postage-paid response card, which a policyholder may return as its written statement of acceptance or rejection of the transfer and novation.  (5) The notice of transfer shall be filed as part of the prior approval requirement set forth in subdivision (b)(1).   (b) Notification and prior approval requirements.(1) Prior approval by the commissioner is required for any transaction where an insurer domiciled in this state assumes or transfers obligations and/or risks on contracts of insurance under an assumption reinsurance agreement. No insurer licensed in this state shall transfer obligations and/or risks on contracts of insurance issued to or owned by residents of this state to any insurer that is not licensed in this state. An insurer domiciled in this state shall not assume obligations and/or risks on contracts of insurance issued to or owned by policyholders residing in any other state unless it is licensed in the other state, or the insurance regulatory of that state has approved the assumption.  (2) Any licensed foreign insurer that enters into an assumption reinsurance agreement which transfers the obligations and/or risks on contracts of insurance issued to or owned by residents of this state, shall file or cause to be filed with the commissioner of insurance of this state the assumption certificate, a copy of the notice of transfer and an affidavit that the transaction is subject to substantially similar requirements in the state of domicile of both the transferring and assuming insurer. If no such requirements exist in the domicile of either the transferring or assuming insurers, then the requirements of subdivision (b)(3) shall apply.  (3) Any licensed foreign insurer that enters into an assumption reinsurance agreement which transfers the obligations and/or risks on contracts of insurance issued to or owned by residents of this state, shall obtain prior approval of the commissioner of insurance of this state and be subject to all other requirements of this chapter with respect to residents of this state, unless the transferring and assuming insurers are subject to assumption reinsurance requirements adopted by statute or regulation in the jurisdiction of their domicile which are substantially similar to those contained in this section.  (4) The following factors, along with any other factors that the commissioner deems appropriate under the circumstances, shall be considered by the commissioner in reviewing a request for approval:  (i) The financial condition of the transferring and assuming insurers and the effect the transaction will have on the financial condition of each company;  (ii) The competence, experience and integrity of those persons who control the operation of the assuming insurer;  (iii) The plans or proposals the assuming party has with respect to the administration of the policies subject to the proposed transfer;  (iv) Whether the transfer is fair and reasonable to the policy-holders of both companies; and  (v) Whether the notice of transfer to be provided by the insurer is fair, adequate and not misleading.   History of Section.P.L. 1996, ch. 188,  21. 
 27-53.1-5. Policyholder rights. (a) Policyholders shall have the right to reject the transfer and novation of their contracts of insurance. Policyholders electing to reject the assumption transaction shall return to the transferring insurer the pre-addressed, postage-paid response card or other written notice and indicate on it that the assumption is rejected (collectively referred to as the Response Card).  (b) Payment of any premium to the assuming company during the twenty-four (24) month period after notice is received shall be deemed to indicate the policyholders acceptance of the transfer to the assuming insurer and a novation shall be deemed to have been effected, provided that the premium notice clearly states that payment of the premium to the assuming insurer shall constitute acceptance of the transfer. The premium notice shall also provide a method for the policyholder to pay the premium while reserving the right to reject the transfer. With respect to any home service business or any other business not using premium notices, the disclosures and procedural requirements of this subsection are to be set forth in the notice of transfer required by  27-53.1-4 and in the assumption certificate.  (c) After no fewer than twenty-four (24) months from the mailing of the initial notice of transfer required under  27-53.1-4(a), if positive consent to, or rejection of, the transfer and assumption has not been received or consent has not been deemed to have occurred under subsection (b), the transferring company shall send to the policyholder a second and final notice of transfer as specified in  27-53.1-4(a). If the policyholder does not accept or reject the transfer during the one month period immediately following the date on which the transferring insurer mails the second and final notice of transfer, the policyholders consent will be deemed to have occurred and novation of the contract will be effected. With respect to the home service business, or any other business not using premium notices, the twenty-four (24) and one month periods shall be measured from the date of delivery of the notice of transfer pursuant to  27-53.1-4(a)(1).  (d) The transferring insurer will be deemed to have received the response card on the date it is postmarked. A policyholder may also send its response card by facsimile or other electronic transmission or by registered mail, express delivery or courier service, in which case the response card shall be deemed to have been received by the assuming insurer on the date of actual receipt by the transferring insurer.  History of Section.P.L. 1996, ch. 188,  21. 
 27-53.1-6. Effect of consent. If a policyholder consents to the transfer pursuant to  27-53.1-5, or if the transfer is effected under  27-53.1-7, there shall be a novation of the contract of insurance subject to the assumption reinsurance agreement with the result that the transferring insurer shall be relieved of all insurance obligations and/or risks transferred under the assumption reinsurance agreement, and the assuming insurer shall become directly and solely liable to the policyholder for those insurance obligations and/or risks.  History of Section.P.L. 1996, ch. 188,  21. 
 27-53.1-7. Commissioners discretion. If an insurer domiciled in this state or in a jurisdiction having a substantially similar law is deemed by the domiciliary commissioner to be in hazardous financial condition or an administrative proceeding has been instituted against it for the purpose of reorganizing or conserving the insurer, and the transfer of the obligations and/or risks on contracts of insurance issued to or owned by residents of this state is in their best interest as determined by the Rhode Island commissioner, a transfer and novation may be effected notwithstanding the provisions of this chapter. This may include a form of implied consent and adequate notification to the policyholder of the circumstances requiring the transfer as approved by the commissioner.  History of Section.P.L. 1996, ch. 188,  21. 
 27-53.1-8. Notice of transfer.  NOTICE OF TRANSFER IMPORTANT: THIS NOTICE AFFECTS YOUR CONTRACT RIGHTS. PLEASE READ IT CAREFULLY. Transfer of Policy The [ABC Insurance Company] has agreed to replace us as your insurer under [insert policy/certificate name and number] effective [insert date]. The [ABC Insurance Company's] principal place of business is [insert address] and certain financial information concerning both companies is attached, including (1) ratings for the last five years, if available, or for any lesser period as is available from two nationally recognized insurance rating services; (2) balance sheets for the previous three (3) years, if available, or for any lesser period as is available and as of the date of the most recent quarterly statement; (3) a copy of the management's discussion and analysis that was filed as a supplement to the previous year's annual statement; and (4) an explanation of the reason for the transfer. You may obtain additional information concerning [ABC Insurance Company] from reference materials in your local library or by contacting your insurance Commissioner at [insert address and phone number].  The [ABC Insurance company] is licensed to write this coverage in your state. The Commissioner of Insurance in your state has reviewed the potential effect of the proposed transaction, and has approved the transaction.  Your Rights You may choose to consent to or reject the transfer of your policy to [ABC Insurance Company]. If you want your policy transferred, you may notify us in writing by signing and returning the enclosed pre-addressed, postage-paid card or by writing to us at:  [Insert name, address and facsimile number of contact person.] Payment of your premium to the assuming company will also constitute acceptance of the transaction. However, a method will be provided to allow you to pay the premium while reserving the right to reject the transfer.  If you reject the transfer, you may keep your policy with us or exercise any option under your policy. If we do not receive a written rejection you will, as a matter of law, have consented to the transfer. However, before this consent is final you will be provided a second notice of the transfer twenty-four (24) months from now. After the second notice is provided, you will have one month to reply. If you have paid your premium to the [ABC Insurance Company], without reserving your right to reject the transfer, you will not receive a second notice.  Effect of Transfer. If you accept this transfer, [ABC Insurance Company] will be your insurer. It will have direct responsibility to you for the payment of all claims, benefits and for all other policy obligations. We will no longer have any obligations to you.  If you accept this transfer, you should make all premium payments and claims submissions to [ABC Insurance Company] and direct all questions to [ABC Insurance Company].  If you have any further questions about this agreement, you may contact [XYZ Insurance] or [ABC Insurance].          Sincerely,      _________________________________________    XYZ Insurance Company ABC Insurance Company   111 No Street 222 No Street   Smithville, USA Jonesville, USA   555/555-5555 333/333-3333     For your convenience, we have enclosed a pre-addressed postage-paid response card. Please take time now to read the enclosed notice and complete and return the response card to us. [Notice Date]             _____  Yes, I accept the transfer of my policy from [name of transferring company] to [name of assuming company].           _____  No. I reject the proposed transfer of my policy from [name of transferring company] to [name of assuming company] and wish to retain my policy with [name of transferring company].      __________ ______________  DATE SIGNATURE  Name: _________________________________________  Street Address: _________________________________________  City, State, Zip: _________________________________________   History of Section.P.L. 1996, ch. 188,  21. 
 27-53-1  27-53-7. Repealed.
 27-54.1-1. Definitions. As used in this chapter: (1) Business of insurance means the writing of insurance or the reinsuring of risks by an insurer, including acts necessary or incidental to writing insurance or reinsuring risks and the activities of persons who act as or are officers, directors, agents or employees of insurers, or who are other persons authorized to act on their behalf.  (2) Commissioner means the director of the department of business regulation or his or her designee or the division of insurance.  (3) Fraudulent insurance act means an act or omission committed by a person who, knowingly and with intent to defraud, commits, or conceals any material information concerning, one or more of the following:  (i) Presenting, causing to be presented or preparing with knowledge or belief that it will be presented to or by an insurer, a reinsurer, broker or its agent, false information as part of, in support of or concerning a fact material to one or more of the following:  (A) An application for the issuance or renewal of an insurance policy or reinsurance contract;  (B) The rating of an insurance policy or reinsurance contract;  (C) A claim for payment or benefit pursuant to an insurance policy or reinsurance contract;  (D) Premiums paid on an insurance policy or reinsurance contract;  (E) Payments made in accordance with the terms of an insurance policy or reinsurance contract;  (F) A document filed with the commissioner or the chief insurance regulatory official of another jurisdiction;  (G) The financial condition of an insurer or reinsurer;  (H) The formation, acquisition, merger, reconsolidation, dissolution or withdrawal from one or more lines of insurance or reinsurance in all or part of this state by an insurer or reinsurer;  (I) The issuance of written evidence of insurance; or  (J) The reinstatement of an insurance policy;  (ii) Solicitation of acceptance of new or renewal insurance risks on behalf of an insurer, reinsurer or other person engaged in the business of insurance by a person who knows or should know that the insurer or other person responsible for the risk is insolvent at the time of the transaction;  (iii) Removal, concealment, alteration or destruction of the assets or records of an insurer, reinsurer or other person engaged in the business of insurance;  (iv) Willful embezzlement, abstracting, purloining, or conversion of monies, funds, premiums, credits or other property of an insurer, reinsurer or person engaged in the business of insurance;  (v) Transaction of the business of insurance in violation of laws requiring a license, certificate of authority or other legal authority for the transaction of the business of insurance; or  (vi) Attempt to commit, aiding or abetting in the commission of, or conspiracy to commit the acts or omissions specified in this subsection.  (4) Insurance means a contract or arrangement in which one undertakes to:  (i) Pay or indemnify another as to loss from certain contingencies called risks, including through reinsurance;  (ii) Pay or grant a specified amount or determinable benefit to another in connection with ascertainable risk contingencies;  (iii) Pay an annuity to another; or  (iv) Act as surety.  (5) Insurer means a person entering into arrangements or contracts of insurance or reinsurance and who agrees to perform any of the acts set forth in subdivision (4) of this section or fraternal benefit societies, medical and hospital service corporations, dental service corporations and/or health maintenance organizations. A person is an insurer regardless of whether the person is acting in violation of laws requiring a certificate of authority or regardless of whether the person denies being an insurer.  (6) NAIC means the National Association of Insurance Commissioners.  (7) Person means an individual, a corporation, a partnership, an association, a joint stock company, a trust, an unincorporated organization, or any similar entity or any combination of the foregoing.  (8) Policy means an individual or group policy, group certificate, contract or arrangement of insurance or reinsurance affecting the rights of a resident of this state or bearing a reasonable relation to this state, regardless of whether delivered or issued for delivery in this state.  (9) Reinsurance means a contract, binder of coverage (including placement slip) or arrangement under which an insurer procures insurance for itself in another insurer as to all or part of an insurance risk of the originating insurer.  History of Section.P.L. 2010, ch. 54,  1; P.L. 2010, ch. 71,  1. 
 27-54.1-2. Fraudulent insurance acts, interference and participation of convicted felons prohibited. (a) A person shall not commit a fraudulent insurance act.  (b) A person shall not knowingly or intentionally interfere with the enforcement of the provisions of this chapter or investigations of suspected or actual violations of this chapter.  (c)(1) A person convicted of a felony involving dishonesty or breach of trust shall not participate in the business of insurance without the written consent of the commissioner.  (2) A person in the business of insurance shall not knowingly or intentionally permit a person convicted of a felony involving dishonesty or breach of trust to participate in the business of insurance without the written consent of the commissioner.  History of Section.P.L. 2010, ch. 54,  1; P.L. 2010, ch. 71,  1. 
 27-54.1-3. Fraud warning required. (a) Notwithstanding any similar requirements in title 28, every claim form and application for insurance, regardless of the form of transmission, shall contain the following statement or a substantially similar statement:  Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.  (b) The lack of a statement as required in subsection (a) of this section does not constitute a defense in any prosecution for a fraudulent insurance act.  (c) The requirements of this section shall not apply to reinsurance claims forms or reinsurance applications.  (d) The requirements of this section shall not apply to any claim form for health insurance which is on a form promulgated by the centers for Medicare and Medicaid services or in electronic format pursuant to 45 C.F.R. Part 162.  History of Section.P.L. 2010, ch. 54,  1; P.L. 2010, ch. 71,  1. 
 27-54.1-4. Other law enforcement or regulatory authority. This chapter shall not: (1) Preempt the authority or relieve the duty of other law enforcement or regulatory agencies to investigate, examine and prosecute suspected violations of law;  (2) Prevent or prohibit a person from disclosing voluntarily information concerning insurance fraud to a law enforcement or regulatory agency; or  (3) Limit the powers granted elsewhere by the laws of this state to investigate and examine possible violations of law and to take appropriate action against wrongdoers.  History of Section.P.L. 2010, ch. 54,  1; P.L. 2010, ch. 71,  1. 
 27-54.1-5. Insurer antifraud initiatives. (a) Insurers shall have antifraud initiatives reasonably calculated to detect, report, prosecute and prevent fraudulent insurance acts, antifraud initiatives may include:  (1) Fraud investigators, who may be insurer employees or independent contractors; or  (2) An antifraud plan.  (b) A person engaged in the business of insurance having knowledge or a reasonable belief that a fraudulent insurance act is being, will be or has been committed shall provide such information to the governmental unit responsible for investigation of such act, or if no such unit exists to the commissioner.  History of Section.P.L. 2010, ch. 54,  1; P.L. 2010, ch. 71,  1. 
 27-54.1-6. Penalties. A person who violates this chapter is subject to suspension or revocation of license or certificate of authority or administrative penalties per  42-14-16 or both. Suspension or revocation of license or certificate of authority and imposition of administrative penalties shall be pursuant to an order of the commissioner issued under  42-35-9 and/or 42-35-12. The commissioners order may require a person found to be in violation of this chapter to make restitution to persons aggrieved by violations of this chapter.  History of Section.P.L. 2010, ch. 54,  1; P.L. 2010, ch. 71,  1. 
 27-54-1. Crimes by or affecting persons engaged in the business of insurance. (a) Any person who knowingly and with intent to deceive the director of business regulation (referred to in this section as director) about the financial condition of an insurance company, makes any false statement, representation or report to the director concerning an insurance company; or who knowingly and with intent to deceive the director about the financial condition of the company testifies or affirms falsely under oath or affirmation to any material fact relative to an insurance company in any matter which would materially affect the financial condition of the company; or who knowingly and with intent to deceive the director about the financial condition of the company makes any false entry or memorandum upon any book, paper, report or statement of any insurance company; or, who, knowingly and with intent to deceive the director or his or her designee or any agent appointed to examine the affairs of an insurance company, or knowingly and with intent to deceive, defraud or injure the stockholders, policyholders or any officer or director of an insurance company about the financial condition of the company makes a statement, representation or report to the director or the directors designee which the individual knows materially overvalues any asset, property or security of an insurance company; or who knowingly and with intent to deceive the director about the financial condition of the company fails to disclose material information, and any person who, with like intent, aids or abets another in any violation of any provision of this section, shall upon conviction, be fined not exceeding fifty thousand dollars ($50,000) or imprisoned not exceeding twenty (20) years, or both.  History of Section.P.L. 1994, ch. 86,  1. 
 27-54-10. Limitation on actions. The statute of limitations for offenses under this chapter shall be ten (10) years. History of Section.P.L. 1994, ch. 86,  1; G.L. 1956,  27-54-9. 
 27-54-11. Severability. If any provision of this chapter or the application of this chapter to any person or circumstances is held invalid or unconstitutional, the invalidity or unconstitutionality shall not affect other provisions or applications of this chapter which can be given effect without the invalid or unconstitutional provision or application, and to this end, the provisions of this chapter are declared to be severable.  History of Section.P.L. 1994, ch. 86,  1; G.L. 1956,  27-54-10. 
 27-54-2. Civil penalties. In addition to the criminal penalties set forth in  27-54-1, the attorney general or the director or his or her designee may bring a civil action against any person who engages in conduct constituting an offense under this chapter and, upon proof of that conduct by a preponderance of the evidence, the person shall be subject, for each violation, to a civil penalty not exceeding fifty thousand dollars ($50,000) or the amount of damages caused by that conduct, whichever is greater. If the insurance company is placed in conservation, rehabilitation, or liquidation, the conservator or receiver shall also be entitled to bring a civil action, and the penalty shall be paid to the conservator or receiver for the benefit of the policyholders, claimants, and creditors of the insurer. The imposition of a civil penalty under this subsection does not preclude any other criminal or civil statutory, common law, or administrative remedy, which is available by law to the state of Rhode Island or any other person.  History of Section.P.L. 1994, ch. 86,  1. 
 27-54-3. Investigations. (a) Pursuant to chapter 13.1 of this title, the director or the directors designee may conduct investigations as he or she deems necessary in order to ascertain whether any person has violated or is violating any provision of this chapter.  (b) Whenever the director or the directors designee has reason to believe that a provision of this chapter has been violated, he or she may report the violation of law to the attorney general who may bring an action in the court of appropriate jurisdiction. Within one hundred twenty (120) days of receipt of the directors report, the attorney general shall inform the director or the directors designee as to the status of the reported violations. Where the affected insurer has become the subject of a court order for conservation, rehabilitation or liquidation, the director or the directors designee may also refer the matter to the receiver for action under  27-54-2.  History of Section.P.L. 1994, ch. 86,  1; P.L. 2002, ch. 292,  93; P.L. 2009, ch. 310,  9. 
 27-54-4. Duty to notify. (a) Whenever an officer or director of an insurance company knows that a material false statement or representation has been made to the director or the directors designee, or that false testimony has been given, or that a material false entry has been made in the books of the insurance company, or that the assets, property or securities of an insurance company have been materially overvalued, or that material information has been withheld from the director or the directors designee, in violation of  27-54-1 of this chapter, he or she shall notify the director or the directors designee of those matters as soon as reasonably possible but in no event later than ten (10) days after the officer or director knows or has reasons to know of those matters. Failure to report as such will subject the violator to a fine of up to one thousand dollars ($1000) and imprisonment of up to one year, or both.  (b) The director or the directors designee shall review each report and undertake any further investigations he or she deems necessary and proper to determine the validity of the allegations.  History of Section.P.L. 1994, ch. 86,  1. 
 27-54-5. Disqualification of officer and directors. No person may serve as a director, officer or senior management official of an insurance company who has been convicted of a felony involving fraud, dishonesty, or a breach of trust.  History of Section.P.L. 1994, ch. 86,  1. 
 27-54-6. Injunctions. If the attorney general or the director or his or her designee has reason to believe that a person is engaged in conduct prohibited by this chapter, he or she may petition an appropriate court for an order prohibiting that person from further engaging in that conduct. The filing of a petition under this section does not preclude any other remedy that is available by law.  History of Section.P.L. 1994, ch. 86,  1. 
 27-54-7. Whistleblower protections. (a) Prohibition against discrimination. No person subject to the provisions of this chapter may discharge, demote, threaten or otherwise discriminate against any person or employee with respect to compensation, terms, conditions, or privileges of employment as a reprisal because the person or employee (or any person acting pursuant to the request of the employee) provided or attempted to provide information to the director or his or her designee regarding possible violation of this chapter.  (b) Enforcement. Any person or employee or former employee subject to the provisions of this chapter who believes that he or she has been discharged or discriminated against in violation of subsection (a) of this section may file a civil action within three (3) years of the date of the discharge or discrimination.  (c) Remedies. If the court determines that a violation has occurred, the court may order the person who committed the violation to:  (1) Reinstate the employee to the employees former position;  (2) Pay compensatory damages, costs of litigation and attorneys fees; and/or  (3) Take other appropriate actions to remedy any past discrimination.  (d) Limitation. The protections of this section shall not apply to any person or employee who:  (1) Deliberately causes or participates in the alleged violation of law or regulation; or  (2) Knowingly or recklessly provides substantially false information to the director or his or her designee.  History of Section.P.L. 1994, ch. 86,  1. 
 27-54-8. Disclosure of arson conviction. (a) Every insurance provider doing business within this state shall require applicants for property insurance, real or personal, to disclose whether or not the applicant or applicants have been convicted of any degree of the crime of arson as described in chapter 4 of title 11 within ten (10) years of the application date.  (b) An insurance provider may use the existence of an arson conviction within ten (10) years as a reason to deny coverage.  (c) Failure to disclose the existence of an arson conviction when requested upon an insurance application shall be a misdemeanor punishable by a sentence of not more than one year imprisonment.  (d) The insurance application form shall indicate the existence of a criminal penalty for failure to disclose a conviction for arson.  (e) For the purpose of this section, applicant means a natural person, trust, partnership, association, corporation or other form of business organization; provided, that if the applicant is a trust, the beneficiaries of the trust shall be included, and if the applicant is a partnership, association, corporation or other form of business organization, each member, director, shareholder owning more than twenty percent (20%) of the common stock issued by the corporation, and the principal officer of the corporation shall be included.  (f) The provisions of this section do not apply to any policy with respect to highly protected risks. A highly protected risk means a fire resistive building that meets the highest standards of fire safety according to insurance company underwriting requirements.  History of Section.P.L. 1995, ch. 63,  2; P.L. 1997, ch. 226,  1; G.L. 1956,  27-54-11; P.L. 2005, ch. 175,  3; P.L. 2005, ch. 410,  13. 
 27-54-9. Other law enforcement authority, powers and duties not affected or impaired. This chapter shall not: (1) Preempt the authority or relieve the duty of other law enforcement agencies to investigate and prosecute suspected violations of the law.  (2) Limit any of the powers granted elsewhere in this title or other laws granting authority to the director or his or her designee to investigate possible violations of this chapter and take appropriate action against wrongdoers.  History of Section.P.L. 1994, ch. 86,  1; G.L. 1956,  27-54-8. 
 27-55-1. Definitions. For the purpose of this chapter, the following words and terms have the following meanings:  (1) Drug or drugs means any substance prescribed by a licensed healthcare provider acting within the scope of the providers license and that is intended for use in the diagnosis, mitigation, treatment or prevention of disease that is taken by mouth, injected into a muscle, the skin, a blood vessel or cavity of the body; applied to the skin; or otherwise assimilated by the body. The term includes only those substances that are approved by the FDA for at least one indication;  (2) FDA means the Federal Food and Drug Administration;  (3) Health insurer means all persons, firms, corporations, or other organizations offering and assuring health services on a prepaid or primarily expense-incurred basis including, but not limited to, policies of accident or sickness insurance, as defined in chapter 18 of this title, nonprofit hospital or medical service plans, whether organized under chapter 19 or 20 of this title or under any public law or by special act of the general assembly, health maintenance organizations, and any other entity which insures or reimburses for diagnostic, therapeutic, or preventive services to a determined population on the basis of a periodic premium;  (4) Medical literature means published scientific studies published in at least two (2) articles from major peer-reviewed medical journals that present data supporting the proposed off-label use, or uses, as generally safe and effective unless there is clear and convincing contradictory evidence presented in a major peer reviewed medical journal;  (5) Peer-reviewed medical journals means a published study in a journal or other publication in which original manuscripts have been critically reviewed for scientific accuracy, validity, and reliability by unbiased independent experts, and that has been determined by the International Committee of Medical Journal Editors to have met its Uniform Requirements for Manuscripts Submitted to Biomedical Journals. It does not include publications or supplements to publications that are sponsored to a significant extent by a pharmaceutical manufacturing company or any health insurer, healthcare center, hospital service corporation, medical service corporation, or fraternal benefit society that delivers, issues for delivery, renews, amends, or continues a health insurance policy in this state;  (6) Standard reference compendia means: (i) The United States Pharmacopoeia drug information, (ii) The American Medical Association drug evaluations, or (iii) The American Hospital Formulary Service drug information.  History of Section.P.L. 1994, ch. 339,  1; P.L. 2016, ch. 95,  1; P.L. 2016, ch. 105,  1. 
 27-55-2. Prescription drug coverage. (a) No health insurer issuing a policy which provides coverage for prescription drugs shall exclude coverage of any drug used for the treatment of cancer or disabling or life-threatening chronic disease on the grounds that the drug has not been approved by the FDA for that indication; provided that the drug is recognized for treatment of that indication in one of the standard reference compendia, or in the medical literature. It is the responsibility of the prescribing physician to submit to the insurer documentation supporting the proposed off-label use or uses, if requested by the issuer.  (b) Any coverage of a drug which serves as the primary treatment required by this chapter shall also include medically necessary services associated with the administration of the drug.  (c) No coverage is required under this chapter: (1) For any drug which has not been fully licensed or approved by the FDA; (2) For the use of any drug when the FDA has determined that use to be contraindicated; or (3) For any experimental drug not approved for any indication by the FDA. The provisions of this section apply to drugs used in the treatment for cancer or disabling or life-threatening chronic disease only and nothing in this section is construed to create, impair, alter, limit, modify, enlarge, abrogate, or prohibit reimbursement for medications used in the treatment of any other disease or condition.  (d) Nothing in this section is construed to prevent the application of contractual deductibles or co-payment provisions or managed-care review.  History of Section.P.L. 1994, ch. 339,  1; P.L. 2016, ch. 95,  1; P.L. 2016, ch. 105,  1. 
 27-55-3. Advisory panel on off-label uses of prescription drugs. The director of the department of health shall appoint an advisory panel of seven (7) medical experts. The purpose of the advisory panel is to make recommendations to the director regarding whether a particular off-label use is medically appropriate, whenever a particular dispute about payment for this off-label use is referred to the director of the department of health. Parties seeking to refer a dispute to the director shall do so in writing within thirty (30) days of the denial of coverage of the drug. The members of the panel shall include seven (7) licensed Rhode Island physicians, including: (1) a physician appointed by a hospital and medical services corporation; (2) a physician appointed by the Rhode Island Medical Society; (3) three (3) medical oncologists appointed by the society of Rhode Island Clinical Oncologists; (4) a physician appointed by the Rhode Island Association of Health Maintenance Organizations from a member plan; and (5) a Rhode Island physician appointed by the Health Insurance Association of America. The members of the advisory panel shall serve at the pleasure of the director of the department of health and shall receive no compensation for their service on this advisory panel.  History of Section.P.L. 1994, ch. 339,  1. 
 27-56-1. Report. (a) Every insurer domiciled in this state shall file a report with the commissioner disclosing material acquisitions and dispositions of assets or material nonrenewals, cancellations or revisions of ceded reinsurance agreements unless the acquisitions and dispositions of assets or material nonrenewals, cancellations or revisions of ceded reinsurance agreements have been submitted to the commissioner for review, approval or information purposes pursuant to other provisions of the insurance code, laws, regulations, or other requirements.  (b) The report required in subsection (a) of this section is due within fifteen (15) days after the end of the calendar month in which any of the foregoing transactions occur.  (c) One complete copy of the report, including any exhibits or other attachments, shall be filed with:  (1) The insurance department of the insurers state of domicile; and  (2) The National Association of Insurance Commissioners.  (d) All reports obtained by or disclosed to the commissioner pursuant to this chapter shall be given confidential treatment and shall not be subject to subpoena and shall not be made public by the commissioner, the National Association of Insurance Commissioners, or any other person, except to insurance departments of other states, without the prior written consent of the insurer to which it pertains unless the commissioner, after giving the insurer who would be affected notice and an opportunity to be heard, determines that the interest of policyholders, shareholders or the public will be served by publication, in which event the commissioner may publish all or any part in the manner the commissioner may deem appropriate.  History of Section.P.L. 1995, ch. 113,  1. 
 27-56-2. Acquisitions and dispositions of assets. (a) Materiality. No acquisitions or dispositions of assets need to be reported pursuant to  27-56-1 if the acquisitions or dispositions are not material. For the purposes of this chapter, a material acquisition (or the aggregate of any series of related acquisitions during any thirty-day period) or disposition (or the aggregate of any series of related dispositions during any thirty-day period) is one that is non-recurring and not in the ordinary course of business and involves more than five percent (5%) of the reporting insurers total admitted assets as reported in its most recent statutory statement filed with the insurance department of the insurers state of domicile.  (b) Scope.(1) Asset acquisitions subject to this chapter include every purchase, lease, exchange, merger, consolidation, succession or other acquisition other than the construction or development of real property by or for the reporting insurer or the acquisition of materials for that purpose.  (2) Asset dispositions subject to this chapter include every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, assignment (whether for the benefit of creditors or otherwise), abandonment, destruction or other disposition.   (c) Information to be Reported.(1) The following information is required to be disclosed in any report of a material acquisition or disposition of assets:  (i) Date of the transaction;  (ii) Manner of acquisition or disposition;  (iii) Description of the assets involved;  (iv) Nature and amount of the consideration given or received;  (v) Purpose of, or reason for, the transaction;  (vi) Manner by which the amount of consideration was determined;  (vii) Gain or loss recognized or realized as a result of the transaction; and  (viii) Name(s) of the person(s) from whom the assets were acquired or to whom they were disposed.  (2) Insurers are required to report material acquisitions and dispositions on a non-consolidated basis unless the insurer is part of a consolidated group of insurers which utilizes a pooling arrangement or one hundred percent (100%) reinsurance agreement that affects the solvency and integrity of the insurers reserves and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than one million dollars ($1,000,000) total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement, and the net income of the business not subject to the pooling arrangement represents less than five percent (5%) of the insurers capital and surplus.   History of Section.P.L. 1995, ch. 113,  1. 
 27-56-3. Nonrenewals, cancellations or revisions of ceded reinsurance agreements. (a) Materiality and scope.(1) No nonrenewals, cancellations or revisions of ceded reinsurance agreements need to be reported pursuant to  27-56-1 if the nonrenewals, cancellations or revisions are not material. For the purposes of this chapter, a material nonrenewal, cancellation or revision is one that affects:  (i) As respects property and casualty business, including accident and health business written by a property and casualty insurer:  (A) More than fifty percent (50%) of the insurers total ceded written premium; or  (B) More than fifty percent (50%) of the insurers total ceded indemnity and loss adjustment reserves.  (ii) As respects life, annuity, and accident and health business: more than fifty percent (50%) of the total reserve credit taken for business ceded, on an annualized basis, as indicated in the insurers most recent annual statement.  (iii) As respects either property and casualty or life, annuity, and accident and health business, either of the following events shall constitute a material revision that must be reported:  (A) An authorized reinsurer representing more than ten percent (10%) of a total cession is replaced by one or more unauthorized reinsurers; or  (B) Previously established collateral requirements have been reduced or waived as respects one or more unauthorized reinsurers representing collectively more than ten percent (10%) of a total cession.  (2) No filing shall be required if:  (i) As respects property and casualty business, including accident and health business written by a property and casualty insurer: the insurers total ceded written premium represents, on an annualized basis, less than ten percent (10%) of its total written premium for direct and assumed business, or  (ii) As respects life, annuity, and accident and health business: the total reserve credit taken for business ceded represents, on an annualized basis, less than ten percent (10%) of the statutory reserve requirement prior to any cession.   (b) Information to be reported.(1) The following information is required to be disclosed in any report of a material nonrenewal, cancellation or revision of ceded reinsurance agreements:  (i) Effective date of the nonrenewal, cancellation or revision;  (ii) The description of the transaction with an identification of the initiator of it;  (iii) Purpose of, or reason for, the transaction; and  (iv) If applicable, the identity of the replacement reinsurers.  (2) Insurers are required to report all material nonrenewals, cancellations or revisions of ceded reinsurance agreements on a non-consolidated basis unless the insurer is part of a consolidated group of insurers which utilizes a pooling arrangement or one hundred percent (100%) reinsurance agreement that affects the solvency and integrity of the insurers reserves and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than one million dollars ($1,000,000) total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement and the net income of the business not subject to the pooling arrangement represents less than five percent (5%) of the insurers capital and surplus.   History of Section.P.L. 1995, ch. 113,  1. 
 27-56-4. Repealed.
 27-57.1-1. Interception of insurance payments. (a) Every domestic insurer or insurance company authorized to issue policies of liability insurance pursuant to this title, and also any workers compensation insurer, within thirty (30) days prior to the making of any payment equal to or in excess of five hundred dollars ($500) to any claimant, for third party for personal injury or workers compensation benefits under a contract of insurance, shall review information provided by the executive office of health and human services pursuant to  27-57.1-4, indicating whether the claimant has received medical assistance in accordance with chapter 8 of title 40.  (b) If the insurer determines from the information provided by the executive office of health and human services pursuant to  27-57.1-4 that the claimant or payee has not received medical assistance, the insurer may make the payment to the claimant in accordance with the contract of the insurance.  (c) If the insurer determines from the information provided by the executive office of health and human services pursuant to  27-57.1-4 that the claimant or payee has received medical assistance, the insurer shall, except to the extent payments are subject to liens, written notices, or interests described in  27-57.1-3, withhold from payment the amount to the extent of the distribution for medical assistance as a result of the accident or loss, dating back to the date of the incident, pay that amount to the executive office of health and human services and pay the balance to the claimant or other persons entitled to it. The executive office of health and human services shall provide written notice to the claimant and his or her attorney, if any. The notice shall reflect the date, name, social security number, case number, amount of the payment being withheld to reimburse the state, reason for payment and opportunity to request a hearing as provided for in subsection (e) of this section. Any insurer or insurance company, its directors, agents, and employees and central reporting organizations and their respective employees authorized by an insurer to act on its behalf that releases information in accordance with the provisions of this chapter, or who withholds an amount from payment based upon the latest information supplied by the executive office of health and human services pursuant to  27-57.1-4 and disburses in accordance with  27-57.1-3, shall be immune from any liability to the claimant, payee lien holder, payee who provided written notice, or security interest holder. Any withholding from payments in accordance with this chapter and payment made to the executive office of health and human services is further subject to the provisions of  40-6-9, regarding rights of assignment and subrogation by medical assistance recipients. Said payments to the executive office of health and human services shall be for reimbursement of distributed medical assistance incurred as a result of the accident or loss, dating back to the date of the incident.  (d) Workers compensation claimants who receive medical assistance, provided in accordance with chapter 8 of title 40, shall be subject to the provisions of this chapter. However, the workers compensation reimbursement payments made to the executive office of health and human services in accordance with this chapter shall be limited to that set forth in chapter 33 of title 28 and  40-6-10.  (e) Any claimant aggrieved by any action taken under this section may within thirty (30) days of the mailing of the notice to the claimant in subsection (c) of this section, request a hearing from the executive office of health and human services. Any payments made by an insurer pursuant to this chapter shall be made to the executive office of health and human services, should there be no request for a hearing within thirty (30) days of receipt of notice, or within ten (10) business days of a decision after a hearing and in accordance with the decision of any hearing that takes place as provided for in this subsection.  History of Section.P.L. 2012, ch. 241, art. 11,  1. 
 27-57.1-2. Notice of interception of insurance settlements. In any case where the executive office of health and human services has intercepted an insurance payment, that office shall notify the recipient.  History of Section.P.L. 2012, ch. 241, art. 11,  1. 
 27-57.1-3. Certain liens not affected. 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 or  40-6-10. Funds subject to liens, written notices, or security interests shall be paid to the lien or interest holder. Funds available to be paid pursuant to chapter 57 of this title for the payment of child support shall supersede any payment made pursuant to this chapter.  History of Section.P.L. 2012, ch. 241, art. 11,  1. 
 27-57.1-4. Information to be provided by the executive office of health and human services. (a) The executive office of health and human services shall periodically within each year furnish the insurance companies and insurers subject to this section with a list or compilation of claimants, who have received medical assistance, as a result of the accident or loss which is the basis of the claim and who have been identified and matched through the centralized database provided for in this chapter. The information provided to the insurance companies and insurers shall be the names of individuals, with last known addresses, who as of the date of the list or compilation have received medical assistance in excess of five hundred dollars ($500).  (b) In order to facilitate the efficient and prompt reporting of those medical assistance recipients in one centralized location, it is the duty and responsibility of the insurance companies doing business in the state to utilize one centralized database, to which the executive office of health and human services shall report and administer. Any insurer receiving information identifying an individual as a medical assistance recipient shall maintain the confidentiality of that information. Minimal data elements shall be shared with an agency contracted by the executive office of health and human services which maintains a centralized database of insurance claims. The contracted centralized database is required to keep confidential any personal and personnel information; records sufficient to identify an applicant for or recipient of medical assistance; preliminary drafts, notes, impressions, memoranda, working papers, and work products; as well as any other records, reports, opinions, information, and statements deemed confidential pursuant to state or federal law or regulation, or rule of court. That data shall not be disclosed to the insurer. Matched results are returned to the executive office of health and human services through its contracted agency. Proper quality assurance shall be performed by the contracted agency to insure the claim is open and collect additional information from the insurer including but not limited to contact information.  History of Section.P.L. 2012, ch. 241, art. 11,  1. 
 27-57-1. Interception of insurance payments. (a) Every domestic insurer or insurance company authorized to issue policies of liability insurance pursuant to this title, and also any workers compensation insurer, shall, within thirty (30) days prior to the making of any payment equal to or in excess of five hundred dollars ($500) to any claimant who is a resident of the state of Rhode Island or to any claimant who has an accident or loss that occurred in the state of Rhode Island, for third party for personal injury or workers compensation benefits under a contract of insurance, review information provided by the department of human service, office of child support services, child support enforcement pursuant to  27-57-4 indicating whether the claimant owes past-due child support.  (b) If the insurer determines from the information provided by the department pursuant to  27-57-4 that the claimant or payee does not owe past-due support, the insurer may make the payment to the claimant in accordance with the contract of the insurance.  (c) If the insurer determines from the information provided by the department pursuant to  27-57-4 that the claimant or payee owes past-due child support, the insurer shall, except to the extent payments are subject to liens, written notices, or interests described in  27-57-3, withhold from payment the amount of past-due support and pay that amount to the family court which shall credit the persons child support obligation account for the amount so paid, and the insurer shall pay the balance to the claimant or other person entitled to it. The insurer or insurance company shall provide written notice to the claimant and his or her attorney, if any, and notice by e-mail or other electronic means, to the department of the payment to the family court. The payment shall be deposited in the registry of the family court for a period of forty-five (45) days, or if an application for review has been filed pursuant to subsection (d), until further order of the court. The notice shall reflect the date, name, social security number, case number, and amount of the payment. Any insurer or insurance company, its directors, agents, and employees and central reporting organizations and their respective employees, authorized by an insurer to act on its behalf, who release information in accordance with the provisions of this chapter, or who withhold amounts from payment based upon the latest information supplied by the department pursuant to  27-57-4 and makes disbursements in accordance with  27-57-3, shall be in compliance and shall be immune from any liability to the claimant, payee lienholder, payee who provided written notice, or security interest holder for taking that action.  (d) Any claimant aggrieved by any action taken under this section may within thirty (30) days of the making of the notice to the claimant in subsection (c) of this section, seek judicial review in the family court, which may in its discretion, issue a temporary order prohibiting the disbursement of funds under this section, pending final adjudication.  [See  12-1-15 of the General Laws.] History of Section.P.L. 1995, ch. 370, art. 29,  7; P.L. 1995, ch. 374,  7; P.L. 1997, ch. 170,  20; P.L. 1998, ch. 370,  5; P.L. 2000, ch. 378,  1; P.L. 2012, ch. 241, art. 11,  2. 
 27-57-2. Notice provided to obligors of interception of insurance settlements. In any case where the department of human services, office of child support services, child support enforcement unit has intercepted an insurance payment, the department shall notify the obligor parent of this action upon crediting the obligors account.  [See  12-1-15 of the General Laws.] History of Section.P.L. 1995, ch, 370, art. 29,  7; P.L. 1995, ch. 374,  7; P.L. 1997, ch. 170,  20; P.L. 2012, ch. 241, art. 11,  2. 
 27-57-3. Certain liens not affected. Nothing in this chapter affects the validity or priority of liens or written notices of health care 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.] History of Section.P.L. 1995, ch. 370, art. 29,  7; P.L. 1995, ch. 374,  7; P.L. 2000, ch. 378,  1. 
 27-57-4. Information to be provided by the department of human services, office of child support services, child support enforcement. (a) The department shall periodically within each year furnish the insurance companies and insurers subject to this section with a list or compilation of names of individuals, with last known addresses, who as of the date of the list or compilation owe past due support in excess of five hundred dollars ($500) as shown on the Rhode Island family court/department of human services, office of child support services, child support enforcement computer system (CSE system). For the purposes of this section, the terms used in this section have the meaning and definitions specified in  15-16-2.  (b) In order to facilitate the efficient and prompt reporting of those arrearages in one centralized location, it is the duty and responsibility of the insurance companies doing business in the state to utilize one centralized database to which the department shall report and administer.  [See  12-1-15 of the General Laws.] History of Section.P.L. 1995, ch. 370, art. 29,  7; P.L. 1995, ch. 374,  7; P.L. 1997, ch. 170,  20; P.L. 1998, ch. 370,  5; P.L. 2012, ch. 241, art. 11,  2. 
 27-58-1. Short title. This act may be cited as the Financial Institution Insurance Sales Act. History of Section.P.L. 1996, ch. 325,  1. 
 27-58-10. Confidential customer information. (a) As used in this section, unless the context requires otherwise:  (1) Customer means a person with an investment, security, deposit, trust, or credit relationship with a financial institution; and  (2) Nonpublic customer information means information regarding a person that has been derived from a record of a financial institution, including information concerning the terms and conditions of insurance coverage, insurance expirations, insurance claims, or insurance history of an individual. Nonpublic customer information does not include customer names, addresses or telephone numbers.  (b) No financial institution shall use any nonpublic customer information for the purpose of selling or soliciting the purchase of insurance or provide the nonpublic customer information to a third party for the purpose of anothers sale or solicitation of the purchase of insurance.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-11. Insurance in connection with a loan. (a) If insurance is required as a condition of obtaining a loan, the credit and insurance transactions shall be completed independently and through separate documents.  (b) A loan for premiums on required insurance shall not be included in the primary credit without the written consent of the customer.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-12. Physical location of insurance activities. The place of solicitation or sale of insurance by any financial institution shall be from an office physically separated from the banking activities of the institution. Physical separation shall not be defined as a separate building. The commissioner shall have the authority to promulgate rules and regulations to implement this section pursuant to  27-58-4.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-13. Penalties. Any person who violates the provisions of this chapter, or who fails to perform any duties imposed by this chapter, or who violates any administrative regulation promulgated pursuant to this chapter shall be liable for a civil penalty not to exceed the sum of one hundred dollars ($100) for each day which the violation continues, and in addition, may be concurrently enjoined from any further violations by the superior court upon petition of the insurance commissioner.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-2. Purpose. The purpose of this chapter is to regulate financial institutions in the conduct of the business of insurance in this state.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-3. Definitions. (a) For the purposes of this chapter, financial institution includes:  (1) A bank, savings bank, or trust company, as defined in title 19, its affiliates or subsidiaries, or any of its officers, agents, representatives, or employees, or any bank, savings bank, or savings and loan association chartered pursuant to federal law and located in Rhode Island, its affiliates or subsidiaries, or any of its officers, agents, representatives, or employees;  (2) A bank holding company as defined in 12 U.S.C.  1841, except any bank holding company that is exempt as provided in 12 U.S.C.  1843(d), its affiliates or subsidiaries, or any of its officers, agents, representatives, or employees; or  (3) Any other individual, corporation, partnership, or association authorized to take deposits and to make loans of money under the provisions of chapters 5, 14, 14.1, and 14.2 of title 19 or any of its officers, agents, representatives, or employees.  (b) Insurance includes all products defined or regulated as insurance by the department of business regulation except:  (1) Credit life, credit accident and health, credit involuntary unemployment insurance; group credit insurance, forced, placed or voluntary credit personal property insurance; group mortgage cancellation life insurance, or group mortgage accident and health insurance and annuities;  (2) Insurance placed by a financial institution in connection with collateral pledged as security for a loan when the debtor breaches the contractual obligation to provide that insurance; and  (3) Private mortgage insurance.  History of Section.P.L. 1996, ch. 325,  1; P.L. 1997, ch. 114,  1; P.L. 1997, ch. 197,  2. 
 27-58-4. Authorization for implementing regulations. The commissioner may promulgate administrative regulations to effectuate the purposes of this chapter and to ensure the safety and soundness of the banking and insurance businesses.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-5. Licensure requirement. Any insurance transaction conducted by a financial institution shall be conducted only by a Rhode Island licensed insurance producer representing a Rhode Island authorized insurer or representing a Rhode Island eligible surplus lines insurer.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-6. Anti-tying provisions. (a) No financial institution may offer a banking product or service, or fix or vary the conditions of this offer, on a condition or requirement that the customer obtains insurance from the financial institution, or any particular insurance producer.  (b) No person shall require or imply that the purchase of an insurance product from a financial institution by a customer or prospective customer of the institution is required as a condition of, or is in any way related to, the lending of money or extension of credit, the establishment or maintenance of a trust account, the establishment or maintenance of a checking or savings account or other deposit account, or the provision of services related to any of these activities.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-7. Disclosures. (a) A financial institution shall prominently disclose in writing, in clear and concise language, to the institutions customers, including in any advertisement or promotional material, pursuant to regulations prescribed by the commissioner, that insurance offered, recommended, sponsored, or sold by the financial institution:  (1) Is not a deposit;  (2) Is not insured by the Federal Deposit Insurance Corporation; and  (3) Is not guaranteed by the financial institution or an affiliated insured depository institution; and  (4) Where appropriate, involves investment risk, including potential loss of principal.  (b) A financial institution, for any loan for which insurance is required shall disclose in writing to the institutions customers, in clear and concise language prior to the signing of a loan or mortgage application, that by law the purchase of insurance from that financial institution cannot be required as a condition of loan or mortgage approval.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-8. Sales 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.  History of Section.P.L. 1996, ch. 325,  1. 
 27-58-9. No discrimination against non-affiliated agents. No financial institution may: (1) Require as a condition of providing any product or service to any customer, or any renewal of any contract for providing the product or service, that the customer acquire, finance, or negotiate any policy or contract of insurance through a particular insurer, or insurance producer;  (2) In connection with a loan or extension of credit that requires a borrower to obtain insurance, reject an insurance policy because that policy has been issued or underwritten by any person who is not associated with that institution;  (3) Impose any requirement on any insurance producer who is not associated with the financial institution that is not imposed on any insurance producer who is associated with that institution; or  (4) Unless otherwise authorized by any applicable federal or state law, require any debtor, insurer, or producer to pay a separate charge in connection with the handling of insurance that is required under a contract.  History of Section.P.L. 1996, ch. 325,  1. 
 27-59-1. Definitions. As used in this chapter, unless the context requires otherwise: (1) Alien insurance company means any insurance company incorporated or organized under the laws of any country other than the United States.  (2) Commissioner means the director of the department of business regulation.  History of Section.P.L. 1997, ch. 67,  1. 
 27-59-2. Licensing authority. Any alien insurance company, with the approval of the commissioner, may be treated, in whole or in part, as a domestic insurer of this state; provided, that:  (1) The alien insurance company appoints a resident registered agent to accept service of process and to act on its behalf in this state. Whenever the registered agent cannot with reasonable diligence be found at the registered office of the alien insurance company, the commissioner shall be an agent of the alien insurance company on which any process, notice, or demand may be served; and  (2) The alien insurance company obtains from the commissioner a license authorizing it to do insurance business in the state.  History of Section.P.L. 1997, ch. 67,  1. 
 27-59-3. Approval of the commissioner. The commissioner in determining whether to approve an alien insurance company may consider:  (1) Maintenance of an appropriate trust account, surplus account, or other financial mechanisms in this state;  (2) Maintenance of all books and records of the United States operations in this state;  (3) Maintenance of a separate financial reporting system for its United States operations; and  (4) Any other provisions deemed necessary by the insurance commissioner.  History of Section.P.L. 1997, ch. 67,  1. 
 27-59-4. Deposits of security  Amounts. (a) Every alien insurance company authorized to transact business in this state shall at all times maintain a deposit with the general treasurer of the state of Rhode Island in cash or in securities in which insurance companies are authorized to invest, a sum equal to the greater of total United States liabilities or one million dollars ($1,000,000). The securities shall be approved, and the amount of the deposit shall be determined, by the commissioner. The commissioner, in the commissioners discretion, may permit the withdrawal of interest earnings.  (b) In lieu of the deposits provided in this section, an alien insurance company may file with the commissioner a bond of equal amount executed by a licensed United States surety company so conditioned for the protection of Rhode Island creditors and policyholders.  (c) An alien insurance company shall not be granted a certificate of authority to transact business in this state, or renewal of the certificate, until the deposit is made, and the commissioner may revoke the certificate of authority of an alien insurance company which fails to make the deposit in a reasonable period of time.  History of Section.P.L. 1997, ch. 67,  1. 
 27-59-5. Laws applicable. All provisions of this title shall apply to alien insurance companies as if they were domestic insurance companies. If the provisions of this chapter are inconsistent with the provisions of any other law, general, special, or local, the provisions of this chapter shall be controlling.  History of Section.P.L. 1997, ch. 67,  1. 
 27-59-6. Regulations. The commissioner shall promulgate any rules and regulations required to implement this chapter.  History of Section.P.L. 1997, ch. 67,  1. 
 27-6.1-1. Purpose. The purpose of this chapter is to: (1) Promote the public welfare by regulating lender-placed insurance on real property.  (2) Create a legal framework within which lender-placed insurance on real property may be written in this state.  (3) Help maintain the separation between lenders/servicers and insurers/insurance producers.  (4) Minimize the possibilities of unfair competitive practices in the sale, placement, solicitation, and negotiation of lender-placed insurance.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-10. Enforcement and judicial review. The commissioner shall have all rights and powers to enforce the provisions of this chapter as provided by  42-14-16. All proceedings, including judicial review, shall be conducted in accordance with the administrative procedures act, chapter 35 of title 42. Any penalties shall be assessed in accordance with  42-14-16.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-11. Regulatory authority. The commissioner may, after notice and hearing, promulgate reasonable regulations and orders to carry out and effectuate the provisions of this chapter.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-12. Severability provisions. If any provision of this chapter, or the application of the provision to any person or circumstance, is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances shall not be affected thereby.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-2. Scope. (a) This chapter applies to insurers and insurance producers engaged in any transaction involving lender-placed insurance as defined in this chapter.  (b) All lender-placed insurance written in connection with mortgaged real property, including manufactured and mobile homes, is subject to the provisions of this chapter, except:  (1) Transactions involving extensions of credit primarily for business, commercial, or agricultural purposes.  (2) Insurance offered by the lender or servicer and elected by the mortgagor at the mortgagors option.  (3) Insurance purchased by a lender or servicer on real estate owned property.  (4) Insurance for which no specific charge is made to the mortgagor or the mortgagors account.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-3. Definitions. As used in this chapter: (1) Affiliate means a person that directly, or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, the person specified.  (2) Commissioner shall have the meaning established in  42-14-5.  (3) Individual lender-placed insurance means coverage for individual real property evidenced by a certificate of coverage under a master lender-placed insurance policy or a lender-placed insurance policy for individual real property.  (4) Insurance producer means a person or entity (or its affiliates) required to be licensed under the laws of this state to sell, solicit, or negotiate insurance.  (5) Insurer means an insurance company, association, or exchange authorized to issue lender-placed insurance in this state (or its affiliates).  (6) Investor means a person or entity (and its affiliates) holding a beneficial interest in loans secured by real property.  (7) Lapse means the moment in time in which a mortgagor has failed to secure or maintain valid and/or sufficient insurance upon mortgaged real property as required by a mortgage agreement.  (8) Lender means a person or entity (and its affiliates) making loans secured by an interest in real property.  (9) Lender-placed insurance means insurance obtained by a lender or servicer when a mortgagor does not maintain valid and/or sufficient insurance upon mortgaged real property as required by the terms of the mortgage agreement. It may be purchased unilaterally by the lender or servicer, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss, expense, or damage to collateralized property as a result of fire, theft, collision, or other risks of loss that would either impair a lender, servicer, or investors interest or adversely affect the value of collateral covered by limited dual interest insurance. It is purchased according to the terms of the mortgage agreement as a result of the mortgagors failure to provide evidence of required insurance.  (10) Loss ratio means the ratio of incurred losses to earned premium.  (11) Master lender-placed insurance policy means a group policy issued to a lender or servicer providing coverage for all loans in the lender or servicers loan portfolio as needed.  (12) Mortgage agreement means the written document that sets forth an obligation or a liability of any kind secured by a lien on real property and due from, owing, or incurred by a mortgagor to a lender on account of a mortgage loan, including the security agreement, deed of trust, and any other document of similar effect, and any other documents incorporated by reference.  (13) Mortgage loan means a loan, advance, guarantee, or other extension of credit from a lender to a mortgagor.  (14) Mortgage transaction means a transaction by the terms of which the repayment of money loaned or payment of real property sold is to be made at a future date or dates.  (15) Mortgagee means the person who holds mortgaged real property as security for repayment of a mortgage agreement.  (16) Mortgagor means the person who is obligated on a mortgage loan pursuant to a mortgage agreement.  (17) Person means an individual or entity.  (18) Real estate owned property means property owned or held by a lender or servicer following foreclosure under the related mortgage agreement or the acceptance of a deed in lieu of foreclosure.  (19) Replacement cost value (RCV) is the estimated cost to replace covered property at the time of loss or damage without deduction for depreciation. RCV is not market value, but it is instead the cost to replace covered property to its pre-loss condition.  (20) Servicer means a person or entity (and its affiliates) contractually obligated to service one or more mortgage loans for a lender or investor. The term servicer includes entities involved in subservicing arrangements.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-4. Term of insurance policy. (a) Lender-placed insurance shall become effective no earlier than the date of lapse of insurance upon mortgaged real property subject to the terms of a mortgage agreement and/or any other state or federal law requiring the same.  (b) Individual lender-placed insurance shall terminate on the earliest of the following dates:  (1) The date the insurance that is acceptable under the mortgage agreement becomes effective, subject to the mortgagor providing sufficient evidence of such acceptable insurance.  (2) The date the applicable real property no longer serves as collateral for a mortgage loan pursuant to a mortgage agreement.  (3) Such other date as specified by the individual policy or certificate of insurance.  (4) Such other date as specified by the lender or servicer.  (5) The termination date of the policy.  (c) An insurance charge shall not be made to a mortgagor for lender-placed insurance for a term longer than the scheduled term of the lender-placed insurance, nor may an insurance charge be made to the mortgagor for lender-placed insurance before the effective date of the lender-placed insurance.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-5. Calculation of coverage and payment of premiums. (a) Any lender-placed insurance coverage, and subsequent calculation of premium, should be based upon the replacement cost value of the property as best determined as follows:  (1) The dwelling coverage amount set forth in the most recent evidence of insurance coverage provided by the mortgagee (last known coverage amount or LKCA), if known to the lender or servicer.  (2) The insurer shall inquire of the insured, at least once, as to the LKCA; and if it is not able to obtain the LKCA from the insured or in another manner, the insurer may proceed as set forth below.  (3) If the LKCA is unknown, the replacement cost of the property serving as collateral as calculated by the insurer, unless the use of replacement cost for this purpose is prohibited by other state or federal law.  (4) If the LKCA is unknown and the replacement cost is not available or its use is prohibited, the unpaid principal balance of the mortgage loan.  (b) In the event of a covered loss, any replacement cost coverage provided by an insurer in excess of the unpaid principal balance of the mortgage loan shall be paid to the mortgagor.  (c) An insurer shall not write lender-placed insurance for which the premium rate differs from that determined by the schedules of the insurer on file with the commissioner as of the effective date of any such policy.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-6. Prohibited practices. (a) An insurer or insurance producer shall not issue lender-placed insurance on mortgaged property that the insurer or insurance producer or an affiliate of the insurer or insurance producer owns, performs the servicing for, or owns the servicing right to the mortgaged property.  (b) An insurer or insurance producer shall not compensate a lender, insurer, investor, or servicer (including through the payment of commissions) on lender-placed property insurance policies issued by the insurer.  (c) An insurer or insurance producer shall not share lender-placed insurance premium or risk with the lender, investor, or servicer that obtained the lender-placed insurance.  (d) An insurer or insurance producer shall not offer contingent commissions, profit sharing, or other payments dependent on profitability or loss ratios to any person affiliated with a servicer or the insurer in connection with lender-placed insurance.  (e) An insurer shall not provide free or below-cost outsourced services to lenders, investors, or servicers, and an insurer will not outsource its own functions to lenders, insurance producers, investors, or servicers on an above-cost basis.  (f) An insurer or insurance producer shall not make any payments, including, but not limited to, the payment of expenses to a lender, insurer, investor, or servicer for the purpose of securing lender-placed insurance business or related outsourced services.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-7. Non-circumvention. Nothing in this chapter shall be construed to allow an insurance producer or an insurer solely underwriting lender-placed insurance to circumvent the requirements set forth within this chapter. This chapter shall apply to all insurers and insurance producers involved in lender-placed insurance.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-8. Evidence of coverage. Lender-placed insurance shall be set forth in an individual policy or certificate of insurance. A copy of the individual policy, certificate of insurance, or other evidence of insurance coverage shall be mailed, first-class mailed, or delivered in person to the last known address of the mortgagor or delivered in accordance with chapter 14 of title 42. Notwithstanding any other statutory or regulatory required information, the individual policy or certificate of insurance coverage shall include the following information:  (1) The address and identification of the insured property;  (2) The coverage amount or amounts if multiple coverages are provided;  (3) The effective date of the coverage;  (4) The term of coverage;  (5) The premium charge for the coverage;  (6) Contact information for filing a claim; and  (7) A complete description of the coverage provided.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6.1-9. Filing, approval and withdrawal of forms and rates. (a) All policy forms and certificates of insurance to be delivered or issued for delivery in this state and the schedules of premium rates pertaining thereto shall be filed with the commissioner.  (b) The commissioner shall review the rates to determine whether the rates are excessive, inadequate, or unfairly discriminatory. This analysis shall include a determination as to whether expenses included by the insurer in the rate are appropriate.  (c) All insurers shall re-file lender-placed property insurance rates at least once every four (4) years.  (d) All insurers writing lender-placed insurance shall have separate rates for lender-placed insurance and voluntary insurance obtained by a mortgage servicer on real estate owned property.  (e) Upon the introduction of a new lender-placed insurance program, the insurer shall reference its experience in existing programs in the associated filings. Nothing in this chapter shall limit an insurers discretion, as actuarially appropriate, to distinguish different terms, conditions, exclusions, eligibility criteria, or other unique or different characteristics. Moreover, an insurer may, where actuarially acceptable, rely upon models or, in the case of flood filings where applicable experience is not credible, on Federal Emergency Management Agency (FEMA) National Flood Insurance Program (NFIP) data.  (f) No later than April 1 of each year, each insurer with at least one hundred thousand dollars ($100,000) in direct written premium for lender-placed insurance in this state during the prior calendar year shall report to the commissioner the following information for the prior calendar year. This report shall be separately produced for each lender-placed program and presented on both an individual-jurisdiction and countrywide basis containing the following information:  (1) Actual loss ratio;  (2) Earned premium;  (3) Any aggregate schedule rating debit/credit to earned premium;  (4) Itemized expenses;  (5) Paid losses; and  (6) Loss reserves, including case reserves and reserves for incurred but not reported losses.  (g) Except in the case of lender-placed flood insurance, to which this paragraph does not apply, if an insurer experiences an annual loss ratio of less than thirty-five percent (35%) in any lender-placed program for two (2) consecutive years, it shall submit a rate filing (either adjusting its rates or supporting their continuance) to the commissioner no more than ninety (90) days after the submission of the data required pursuant to subsection (f).  (h) Except as specifically set forth in this section, rate and form filing requirements shall be subject to the insurance laws of this state.  History of Section.P.L. 2022, ch. 404,  7, effective June 30, 2022; P.L. 2022, ch. 405,  7, effective June 30, 2022. 
 27-6-1. Purpose. 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 rate making 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.  History of Section.P.L. 1948, ch. 2088,  1; G.L. 1956,  27-6-1. 
 27-6-10. Review of filings. The commissioner shall review filings as soon as reasonably possible after they have been made in order to determine whether they meet the requirements of this chapter.  History of Section.P.L. 1948, ch. 2088,  4; G.L. 1956,  27-6-10. 
 27-6-11.1. Costs. For the purpose of determining whether the filing meets the requirements of this chapter, the director may employ staff personnel and outside consultants, including, but not limited to, those authorized pursuant to  27-9-52. The reasonable costs related to the review of rate filings, including the conduct of the hearing, shall be borne by the rating organizations or insurers making the filing.  History of Section.P.L. 2005, ch. 174,  1. 
 27-6-11. Waiting period  Effective date of filings. Subject to the exception specified in  27-6-10, each filing shall be on file for a waiting period of thirty (30) days before it becomes effective, which period may be extended by the commissioner for an additional period not to exceed thirty (30) days if the commissioner gives written notice within that waiting period to the insurer or rating organization which made the filing that he or she needs that additional time for the consideration of the filing. Upon written application by the insurer or rating organization, the commissioner may authorize a filing that he or she has reviewed to become effective before the expiration of the waiting period or any extension. A filing shall be deemed to meet the requirements of this chapter and to become effective unless disapproved by the commissioner within the waiting period or any extension; provided, that if the commissioner gives written notice to the insurer or rating organization within the waiting period or any extension that he or she will hold a hearing on the filing, the filing shall not become effective before or until the commissioner issues his or her decision. Upon giving that notice the commissioner shall also give public notice of the hearing by causing a notice to be published in a newspaper of general circulation in the state at least ten (10) days prior to the hearing stating the name of the insurer or rating organization which has made the filing and including a general description of the subject matter and sending a copy of that notice to the consumer protection unit of the department of attorney general. The commissioner shall hold a hearing on major filings. The hearing shall be held and a decision issued by the commissioner as soon as reasonably possible.  History of Section.P.L. 1948, ch. 2088,  4; G.L. 1956,  27-6-11; P.L. 1968, ch. 286,  2; P.L. 1971, ch. 191. 
 27-6-12. Effective date of inland marine rates. 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.  History of Section.P.L. 1948, ch. 2088,  4; G.L. 1956,  27-6-12. 
 27-6-13. Suspension or modification of requirements  Examinations as to fairness. Under the rules and regulations that he or she 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 he or she may deem advisable to ascertain whether any rates affected by an order meet the standards set forth in  27-6-4(2).  History of Section.P.L. 1948, ch. 2088,  4; G.L. 1956,  27-6-13. 
 27-6-14. Rates on specific risks exceeding filed rates. Upon the written consent of the insured, stating the insureds reasons, filed with and approved by the commissioner, a rate in excess of that provided by an applicable filing may be used on any specific risk.  History of Section.P.L. 1948, ch. 2088,  4; G.L. 1956,  27-6-14. 
 27-6-15. Compliance with rate filings required. No insurer shall make or issue a contract or policy at a rate or premium in excess of filings that are in effect for that insurer as provided in this chapter or in accordance with  27-6-13 or  27-6-14. This section shall not apply to contracts or policies for inland marine risks as to which filings are not required.  History of Section.P.L. 1948, ch. 2088,  4; G.L. 1956,  27-6-15. 
 27-6-16. Review of rates not provided for by filings. Within ten (10) days after any insurer has made or issued a contract or policy at a rate or premium other than as provided for by any filing made with the commissioner by or in its behalf, the insurer shall notify the commissioner in writing of that action in any form the commissioner may require. The commissioner shall review the notice as soon as reasonably possible after it has been received, in order to determine whether the contract or policy has been written at a rate or premium that meets the requirements of this chapter. When the notice is not accompanied by the information upon which the insurer supports the rate or premium, and the commissioner does not have sufficient information to determine whether the rate or premium meets the requirements of the chapter, the commissioner shall require the insurer to furnish within ten (10) days after receipt of the notice of that requirement, the information upon which it supports the rate or premium. Unless, within thirty (30) days after receipt of the notice or supporting information, the commissioner shall issue an order following a hearing, as provided in  27-6-19, the rate or premium charged for the contract or policy shall be deemed to meet the requirements of this chapter; provided, that all contract and policies issued under the provisions of this section shall state that the rate or premium charged has not been reviewed by the commissioner and that it is subject to disapproval or modification as of the effective date of the contracts or policies.  History of Section.P.L. 1948, ch. 2088,  4; G.L. 1956,  27-6-16. 
 27-6-17. Notice of disapproval within waiting period. If, within the waiting period or any extension, as provided in  27-6-11, the commissioner finds that a filing does not meet the requirements of this chapter, the commissioner shall send to the insurer or rating organization which made that filing written notice of disapproval of that filing specifying in what respects he or she finds that filing fails to meet the requirements of this chapter and stating that that filing shall not become effective.  History of Section.P.L. 1948, ch. 2088,  5; G.L. 1956,  27-6-17. 
 27-6-18. Disapproval of specific inland marine rates. If, within thirty (30) days after a specific inland marine rate on a risk specially rated by a rating organization, subject to  27-6-12, has become effective, the commissioner finds that the filing does not meet the requirements of this chapter, the commissioner shall send to the rating organization which made the filing written notice of disapproval of the filing specifying in what respects he or she finds that the filing fails to meet the requirements of this chapter and stating when, within a reasonable period after this, the filing shall be deemed no longer effective. This disapproval shall not affect any contract made or issued prior to the expiration of the period set forth in the notice.  History of Section.P.L. 1948, ch. 2088,  5; G.L. 1956,  27-6-18. 
 27-6-19. Suspension of rates or filings after review period  Removal of discriminatory applications of rates. If, at any time subsequent to the applicable review period provided for in  27-6-17 or 27-6-18, the commissioner finds that a rate or filing does not meet the requirements of this chapter, the commissioner shall, after a hearing held upon not less than ten (10) days written notice, specifying the matters to be considered at the hearing, to every insurer and rating organization which used the rate or made the filing, issue an order specifying in what respects he or she 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 which 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.  History of Section.P.L. 1948, ch. 2088,  5; G.L. 1956,  27-6-19. 
 27-6-2. Applicability. (a) This chapter applies to fire, marine, and inland marine insurance on risks located in this state. Inland marine insurance shall include insurance now or defined by statute, or by interpretation of a statute, or if not defined or interpreted by statute, by ruling of the insurance commissioner, referred to throughout this chapter as commissioner, or as established by general custom of the business, as inland marine insurance.  (b) This chapter shall not apply:  (1) To reinsurance, other than joint reinsurance to the extent stated in  27-6-37 and 27-6-38;  (2) To insurance of vessels or craft, their cargoes, marine builders risks, marine protection and indemnity, or other risks commonly insured under marine, as distinguished from inland marine, insurance policies;  (3) To insurance of hulls of aircraft, including their accessories and equipment, or against liability arising out of the ownership, maintenance, or use of aircraft; or  (4) To motor vehicle insurance, or to insurance against liability arising out of the ownership, maintenance, or use of motor vehicles.  History of Section.P.L. 1948, ch. 2088,  2; G.L. 1956,  27-6-2. 
 27-6-20. Hearings on application by persons aggrieved by filings  Order terminating filing  Removal of discrimination. (a) Any person or organization aggrieved with respect to any rate or filing which 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 his or her 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 which 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 he or she 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 which 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.  History of Section.P.L. 1948, ch. 2088,  5; G.L. 1956,  27-6-20; P.L. 1968, ch. 286,  3. 
 27-6-21. Competitive rates as evidence of fairness  Profit as evidence of adequacy. 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.  History of Section.P.L. 1948, ch. 2088,  5; G.L. 1956,  27-6-21. 
 27-6-22. Filed schedules and plans not to be disapproved if rates meet requirements. No manual, minimum, or class rate, rating schedule, rating plan, rating rule, or any modification of any of these which has been filed pursuant to the requirements of  27-6-8  27-6-16 shall be disapproved if the rates produced meet the requirements of this chapter.  History of Section.P.L. 1948, ch. 2088,  5; G.L. 1956,  27-6-22. 
 27-6-23. Licensing of rating organizations. (a) A corporation, an unincorporated association, a partnership, or an individual, whether located within or outside this state, may make an application to the commissioner for a license as a rating organization for those kinds of insurance, or a subdivision or a class of risk or a part or combination of it as are specified in its application and shall file with the application:  (1) A copy of its constitution, its articles of agreement or association or its certificate of incorporation, and its bylaws, rules, and regulations governing the conduct of its business;  (2) A list of its members and subscribers;  (3) The name and address of a resident of this state upon whom notices or orders of the commissioner or process affecting the rating organization may be served; and  (4) A statement of its qualification as a rating organization.  (b) If the commissioner finds that the applicant is competent, trustworthy, and otherwise qualified to act as a rating organization and that its constitution, its articles of agreement or association or certificate of incorporation, and its bylaws, rules, and regulations governing the conduct of its business conform to the requirements of law, the commissioner shall issue a license specifying the kinds of insurance, or a subdivision or a class or a risk or part or combination of it, for which the applicant is authorized to act as a rating organization. Every application shall be granted or denied in whole or in part by the commissioner within sixty (60) days of the date of its filing with him or her. Licenses issued pursuant to this section shall remain in effect for three (3) years unless suspended or revoked by the commissioner. The fee for the license shall be three hundred dollars ($300). All in force licenses shall be transitioned into a three (3) year licensing cycle beginning June 1, 2006, to expire every three (3) years thereafter. License fees may be prorated for the initial renewal period as deemed appropriate by the director.  (c) Licenses issued pursuant to this section may be suspended or revoked by the commissioner, after hearing upon notice, in the event the rating organization ceases to meet the requirements of this section. Every rating organization shall notify the commissioner promptly of every change in:  (1) Its constitution, its articles of agreement or association or its certificate of incorporation, and its bylaws, rules, and regulations governing the conduct of its business;  (2) Its list of members and subscribers; and  (3) The name and address of the resident of this state designated by it upon whom notices or orders of the commissioner or process affecting the rating organization may be served.  History of Section.P.L. 1948, ch. 2088,  6; G.L. 1956,  27-6-23; P.L. 1960, ch. 71, art. 1,  3; P.L. 2005, ch. 174,  2. 
 27-6-24. Admission of and services to subscribers. Subject to rules and regulations which 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 insurers 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, he or she shall make an order affirming its action.  History of Section.P.L. 1948, ch. 2088,  6; G.L. 1956,  27-6-24. 
 27-6-25. Regulation by rating organizations of payments by insurers to policyholders or members. 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.  History of Section.P.L. 1948, ch. 2088,  6; G.L. 1956,  27-6-25. 
 27-6-26. Cooperation among rating organizations and insurers  Review of cooperative practices. Cooperation among rating organizations or among rating organizations and insurers and concert of action among insurers under the same general management or control, in rate making or in other matters within the scope of this chapter, are authorized, provided the filings resulting are subject to all the provisions of this chapter which are applicable to filings generally. The commissioner may review those cooperative activities and practices and if, after a hearing, the commissioner finds that any activity or practice is unfair or unreasonable or inconsistent with the provisions of this chapter, he or she 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.  History of Section.P.L. 1948, ch. 2088,  6; G.L. 1956,  27-6-26. 
 27-6-27. Examination of policies and records by rating organizations. Any rating organization may provide for the examination of policies, daily reports, binders, renewal certificates, endorsements, or other evidences of insurance, or the cancellation of insurance, and may make reasonable rules governing their submission. Those rules shall contain a provision that in the event any insurer does not within sixty (60) days furnish satisfactory evidence to the rating organization of the correction of any error or omission previously called to its attention by the rating organization, it shall be the duty of the rating organization to notify the commissioner. All information submitted for examination shall be confidential.  History of Section.P.L. 1948, ch. 2088,  6; G.L. 1956,  27-6-27. 
 27-6-28. Actuarial and technical services furnished by rating organizations. 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.  History of Section.P.L. 1948, ch. 2088,  6; G.L. 1956,  27-6-28. 
 27-6-29. Adherence to rating organization filings  Deviation filings. Every member of or subscriber to a rating organization shall adhere to the filings made on its behalf by the organization; except that any insurer which is a member or subscriber may file with the commissioner a deviation from the class rates, schedules, rating plans, or rules respecting any kind of insurance or class of risk within a kind of insurance or combination of it. The deviation filing shall specify the basis for the modification and a copy shall also be sent simultaneously to the rating organization. Any deviation filing shall be on file for a waiting period of thirty (30) days before it becomes effective unless the commissioner reviews and authorizes the filing to become effective before the expiration of that period and shall be subject to the provisions of  27-6-17  27-6-22. Each deviation shall be effective for a period of not less than one year from the date the deviation is filed unless terminated with the approval of the commissioner or in accordance with the provisions of  27-6-17  27-6-22.  History of Section.P.L. 1948, ch. 2088,  6; G.L. 1956,  27-6-29. 
 27-6-3. Insurers to which chapter applicable  Election between applicable laws. This chapter applies to all insurers that, under any provision of the laws of this state, write any of the kinds of insurance to which this chapter applies. If any kind of insurance, or subdivision or combination of it, or type of coverage, subject to this chapter, is also subject to regulation by another rate regulatory act of this state, an insurer to which both acts are applicable shall file with the commissioner a designation as to which rate regulatory act shall be applicable to it with respect to that kind of insurance, or subdivision or combination of it, or type of coverage.  History of Section.P.L. 1948, ch. 2088,  2; G.L. 1956,  27-6-3. 
 27-6-30. Appeals from action of rating organization on changes in filings. (a) Any member of or subscriber to a rating organization may appeal to the commissioner from any action or decision of the rating organization in approving or rejecting any proposed change in or addition to the filings of the rating organization, and the commissioner shall, after a hearing held upon not less than ten (10) days written notice to the appellant and to the rating organization, issue an order approving the action or decision of the rating organization or directing it to give further consideration to the proposal and to take action or make a decision upon it within thirty (30) days, or if the appeal is from the action or decision of the rating organization in rejecting a proposed addition to its filings, the commissioner may, in the event he or she finds that the action or decision was unreasonable, issue an order directing the rating organization to make an addition to its filings, on behalf of its members and subscribers, in a manner consistent with his or her findings, within a reasonable time after the issuance of the order; provided, if the appeal is from the action of the rating organization with regard to a rate on a proposed change in or addition to its filings relating to the character and extent of coverage, the commissioner shall approve the rate applied by the rating organization or the rate suggested by the appellant if either rate is in accordance with this chapter.  (b) The failure of a rating organization to take action or make a decision within thirty (30) days after submission to it of a proposal under this section shall constitute a rejection of that proposal within the meaning of this section.  History of Section.P.L. 1948, ch. 2088,  7; G.L. 1956,  27-6-30. 
 27-6-31. Rate information furnished to insured. Every rating organization and every insurer which makes its own rates shall, within a reasonable time after receiving written request for it and upon payment of any reasonable charge it may make, furnish to any insured affected by a rate made by it, or to the authorized representative of that insured, all pertinent information as to that rate.  History of Section.P.L. 1948, ch. 2088,  8; G.L. 1956,  27-6-31. 
 27-6-32. Review of application of rating system to insured. Every rating organization and every insurer which makes its own rates shall provide within this state reasonable means where any person aggrieved by the application of its rating system may be heard, in person or by his or her authorized representative, on his or her written request to review the manner in which the rating system has been applied in connection with the insurance afforded that person. If the rating organization or insurer fails to grant or reject that request within thirty (30) days after it is made, the applicant may proceed in the same manner as if the application had been rejected. Any party affected by the action of the rating organization or insurer on his or her request may, within thirty (30) days after written notice of the action, appeal to the commissioner, who, after a hearing held upon not less than ten (10) days written notice to the appellant and to the rating organization or insurer, may affirm or reverse the action.  History of Section.P.L. 1948, ch. 2088,  8; G.L. 1956,  27-6-32. 
 27-6-33. Advisory organization defined. Every group, association, or other organization of insurers, whether located within or outside of this state, which assists insurers which make their own filings or rating organizations in rate making, 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.  History of Section.P.L. 1948, ch. 2088,  9; G.L. 1956,  27-6-33. 
 27-6-34. Documents filed by advisory organizations. Every advisory organization shall file with the commissioner: (1) A copy of its constitution, its articles of agreement or association or its certificate of incorporation, and its bylaws, rules, and regulations governing its activities;  (2) A list of its members;  (3) The name and address of a resident of this state upon whom notices or orders of the commissioner or process issued at the commissioners direction may be served; and  (4) An agreement that the commissioner may examine that advisory organization in accordance with the provisions of  27-6-39 and 27-6-40.  History of Section.P.L. 1948, ch. 2088,  9; G.L. 1956,  27-6-34. 
 27-6-35. Unlawful practices of advisory organizations. If, after a hearing, the commissioner finds that the furnishing of any information or assistance by a rating organization involves any act or practice which is unfair or unreasonable or inconsistent with the provisions of this chapter, the commissioner may issue a written order specifying in what respects that act or practice is unfair or unreasonable or otherwise inconsistent with the provisions of this chapter, and requiring the discontinuance of that act or practice.  History of Section.P.L. 1948, ch. 2088,  9; G.L. 1956,  27-6-36. 
 27-6-36. Use of information from noncomplying advisory organization. No insurer which makes its own filings or any rating organization shall support its filings by statistics, or adopt rate making recommendations, furnished to it by an advisory organization which has not complied with  27-6-33  27-6-35, or with an order of the commissioner involving those statistics or recommendations issued under  27-6-35. If the commissioner finds any insurer or rating organization to be in violation of this section the commissioner may issue an order requiring the discontinuance of that violation.  History of Section.P.L. 1948, ch. 2088,  9; G.L. 1956,  27-6-36. 
 27-6-37. Provisions applicable to joint underwriting and reinsurance. Every group, association, or other organization of insurers which engages in joint underwriting or joint reinsurance shall be subject to regulation with respect to it as provided in  27-6-38, subject, with respect to joint underwriting, to all other provisions of this chapter and, with respect to joint reinsurance, to  27-6-39, 27-6-40, and 27-6-46  27-6-52.  History of Section.P.L. 1948, ch. 2088,  10; G.L. 1956,  27-6-37. 
 27-6-38. Unlawful practices of joint underwriters or reinsurers. 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.  History of Section.P.L. 1948, ch. 2088,  10; G.L. 1956,  27-6-38. 
 27-6-39. Examination of rating and advisory organizations and underwriting and reinsurance groups. 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 he or she 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.  History of Section.P.L. 1948, ch. 2088,  11; G.L. 1956,  27-6-39; P.L. 1960, ch. 71, art. 1,  3; P.L. 2008, ch. 371,  2. 
 27-6-4. Considerations in rate making. Rates shall be made in accordance with the following provisions: (1) Manual, minimum, or class rates, rating schedules, or rating plans shall be made and adopted, except in the case of specific inland marine rates, on risks specially rated;  (2) Rates shall not be excessive, inadequate, or unfairly discriminatory; and  (3) Due consideration shall be given to past and prospective loss experience within and outside of this state, to the conflagration and catastrophe hazards, to a reasonable margin for underwriting profit and contingencies, to dividends savings or unabsorbed premium deposits allowed or returned by insurers to their policyholders, members, or subscribers, to past and prospective expenses both country-wide and those specially applicable to this state, and to all other relevant factors within and outside of this state. In the case of fire insurance rates consideration shall be given to the experience of the fire insurance business during a period of not less than the most recent five (5) year period for which that experience is available.  History of Section.P.L. 1948, ch. 2088,  3; G.L. 1956,  27-6-4. 
 27-6-40. Reports on examinations  Hearing and filing. The commissioner shall prepare a report of any examination held pursuant to  27-6-39 and shall, within a reasonable time following completion of that report, furnish each rating organization, group, association, or other organization examined with a copy of it. Any rating organization, advisory organization, group, association, or other organization may, within thirty (30) days after the receipt of a copy of the report, request the commissioner for a hearing on the report, which shall be held by the commissioner upon ten (10) days written notice to the rating organization, advisory organization, group, association, or other organization. Following that hearing the commissioner may affirm, modify, or withdraw the report. Any report or modification of the report shall be filed in the office of the commissioner as a public record, or if no hearing is requested within the period of thirty (30) days, the report shall be filed at the expiration of that period.  History of Section.P.L. 1948, ch. 2088,  11; G.L. 1956,  27-6-40. 
 27-6-41. Collection and compilation of experience statistics. The commissioner shall promulgate reasonable rules and statistical plans, reasonably adapted to each of the rating systems on file with the commissioner, which may be modified and which shall be used by each insurer in the recording and reporting of its loss and countrywide expense experience, in order that the experience of all insurers may be made available at least annually in the form and detail necessary to aid him or her in determining whether rating systems comply with the standards set forth in  27-6-4  27-6-7. Those rules and plans may also provide for the recording and reporting of expense experience items that are specially applicable to this state and are not susceptible of determination by a prorating of countrywide expense experience. In promulgating those rules and plans, the commissioner shall give due consideration to the rating systems on file with the commissioner and, in order that those rules and plans may be as uniform as is practicable among the several states, to the rules and to the form of the plans used for the rating systems in other states. No insurer shall be required to record or report its loss experience on a classification basis that is inconsistent with the rating system filed by it. The commissioner may designate one or more rating organizations or other agencies to assist him or her in gathering that experience and making compilations of the experience, and those compilations shall be made available, subject to reasonable rules promulgated by the commissioner, to insurers and rating organizations.  History of Section.P.L. 1948, ch. 2088,  12; G.L. 1956,  27-6-41. 
 27-6-42. Interchange of rating plan data. Reasonable rules and plans may be promulgated by the commissioner for the interchange of data necessary for the application of rating plans.  History of Section.P.L. 1948, ch. 2088,  12; G.L. 1956,  27-6-42. 
 27-6-43. Cooperation with other states. In order to further uniform administration of rate regulatory laws, the commissioner and every insurer and rating organization may exchange information and experience data with insurance supervisory officials, insurers, and rating organizations in other states and may consult with them with respect to rate making and the application of rating systems.  History of Section.P.L. 1948, ch. 2088,  12; G.L. 1956,  27-6-43. 
 27-6-44. Rules and regulations. The commissioner may make reasonable rules and regulations necessary to effect the purposes of this chapter.  History of Section.P.L. 1948, ch. 2088,  12; G.L. 1956,  27-6-44. 
 27-6-45. False or misleading information. No person or organization shall willfully withhold information from, or knowingly give false or misleading information to, the commissioner, any statistical agency designated by the commissioner, any rating organization, or any insurer, which will affect the rates or premiums chargeable under this chapter. A violation of this section shall subject the one guilty of that violation to the penalties provided in  27-6-47 and 27-6-48.  History of Section.P.L. 1948, ch. 2088,  13; G.L. 1956,  27-6-45. 
 27-6-46. [Repealed.] History of Section.P.L. 1948, ch. 2088,  14; G.L. 1956,  27-6-46; repealed by P.L. 2022, ch. 404,  10, effective June 30, 2022; repealed by P.L. 2022, ch. 405,  10, effective June 30, 2022. 
 27-6-47. Penalty for violations. Any person or organization willfully violating any provision of this chapter shall, upon conviction, be fined not less than one hundred dollars ($100) and not more than five hundred dollars ($500) for each violation. That penalty may be in addition to any other penalty provided by law.  History of Section.P.L. 1948, ch. 2088,  15; G.L. 1956,  27-6-47. 
 27-6-48. Suspension or revocation of licenses. (a) The commissioner may suspend the license of any rating organization or insurer which fails to comply with an order of the commissioner within the time limited by the order, or any extension which the commissioner may grant. The commissioner shall not suspend the license of any rating organization or insurer for failure to comply with an order until the time prescribed for an appeal has expired or, if an appeal has been taken, until the order has been affirmed.  (b) The commissioner may determine when a suspension of a license shall become effective, and it shall remain in effect for the period fixed by the commissioner, unless he or she modifies or rescinds that suspension, or until the order upon which that suspension is based is modified, rescinded, or reversed.  (c) No license shall be suspended or revoked except upon a written order of the commissioner, stating the commissioners findings made after a hearing held upon not less than ten (10) days written notice to the person or organization specifying the alleged violation.  History of Section.P.L. 1948, ch. 2088,  15; G.L. 1956,  27-6-48. 
 27-6-49. Hearings on decisions of commissioner. Any insurer or rating organization 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 to the insurer or organization make a written request to the commissioner for a hearing, except that a hearing provided for by  27-6-17  27-6-22 shall be held as provided in those sections. Within twenty (20) days after receipt of that 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 his or her previous action, specifying his or her reasons. Pending the hearing and decision, the commissioner may suspend or postpone the effective date of his or her previous action.  History of Section.P.L. 1948, ch. 2088,  16; G.L. 1956,  27-6-49. 
 27-6-5. Uniformity of rates. Except to the extent necessary to meet the provisions of  27-6-4(2), uniformity among insurers in any matters within the scope of  27-6-4 is neither required or prohibited. History of Section.P.L. 1948, ch. 2088,  3; G.L. 1956,  27-6-5. 
 27-6-50. Pleadings and evidence at hearings. At any hearing before the commissioner, observance of formal rules of pleading or evidence shall not be required.  History of Section.P.L. 1948, ch. 2088,  16; G.L. 1956,  27-6-50. 
 27-6-51. Judicial review of orders and decisions. (a) Any final order or decision of the commissioner, including any order made after a hearing under the provisions of  27-6-17  27-6-22 or  27-6-49, shall be subject to review by a 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.  (b) The court shall determine whether the order or decision of the commissioner shall be stayed pending 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.  (c) An appeal may be taken from the decision of the superior court to the supreme court, and that appeal shall follow the course of equity.  History of Section.P.L. 1948, ch. 2088,  16; G.L. 1956,  27-6-51. 
 27-6-52. Severability. 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.  History of Section.P.L. 1948, ch. 2088,  18; G.L. 1956,  27-6-52. 
 27-6-53. Use of credit rating. (a) An insurer may use insurance scoring for rating and underwriting of homeowners 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 his, her or its 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 customers 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 customers 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 customers 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 customers 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 insures; 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 customers 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 customers 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 that information was used in determining an insurance score which 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 insurers 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 his or her own credit information;  (2) Inquiries relating to insurance coverage, if so identified on a consumers credit report;  (3) Collection accounts with a medical industry code, if so identified on the consumers credit report;  (4) Multiple lender inquiries, if coded by the consumer reporting agency on the consumers 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 consumers 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 consumers 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 consumers insurance may expire and the terms and conditions of the consumers 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 insurers 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.  History of Section.P.L. 2002, ch. 303,  2; P.L. 2003, ch. 316,  1; P.L. 2003, ch. 370,  1. 
 27-6-6.1. Approval of policies. (a) Every insurance company and every rating/advisory organization issuing policies covering fire and marine insurance provided for in this chapter shall file with the director a copy of the form of the policies proposing to use. A policy may not be issued until the director has approved the form.  (b) Any policy form, subject to this chapter and filed by an insurer or rating/advisory organization on behalf of its members or subscribers with the director, shall be deemed public information at the time of filing.  History of Section.P.L. 2002, ch. 175,  1. 
 27-6-6. Contracts as to commissions or compensation. Nothing in this chapter shall abridge or restrict the freedom of contract between insurers and insurance producers with respect to commissions or between insurers and their employees or other persons with respect to compensation for goods or services.  History of Section.P.L. 1948, ch. 2088,  3; G.L. 1956,  27-6-6. 
 27-6-7. Use of rates. Rates made in accordance with  27-6-4  27-6-6 may be used subject to the provisions of this chapter. History of Section.P.L. 1948, ch. 2088,  3; G.L. 1956,  27-6-7. 
 27-6-8.1. Rating for nonbusiness policies. (a) Notwithstanding the requirements of  27-6-8, a filing made by an insurer under this section that provides for an overall statewide rate increase or decrease of no more than five percent (5%) in the aggregate for all coverages that are subject to the filing may take effect the date it is filed. The five percent (5%) limitation does not apply on an individual insured basis. No more than one rate filing may be made by an insurer pursuant to the expedited process provided in this subsection during any twelve (12) month period, unless a rate filing, when combined with any other rate filing or filings made by an insurer within the preceding twelve (12) months, does not result in an overall statewide increase or decrease of more than five percent (5%) in the aggregate for all coverages that are subject to the filing.  (b) Rate filings falling outside of the limitation provided for in subsection (a) of this section shall be subject to  27-6-11, unless those filings are other exempt from those provisions pursuant to another section of the insurance code.  (c) A filing submitted pursuant to subsection (a) of this section is considered to comply with state law. However, if the commissioner of insurance determines that the filing is inadequate or unfairly discriminatory, he/she shall issue a written order specifying in detail the provisions of the insurance code the insurer has violated and the reasons the filing is inadequate or unfairly discriminatory and stating a reasonable future date on which the filing is to be considered no longer effective. An order by the commissioner pursuant to this subsection that is issued more than thirty (30) days from the date on which the commissioner received the rate filing is prospective only and does not affect any contract issued or made before the effective date of the order. For purposes of this act, unfairly discriminatory means a rate for a risk that is classified in whole or in part on the basis of race, color, creed or national origin.  (d) No rate increase within the limitation specified in subsection (a) of this section may be implemented with regard to an individual existing policy, unless the increase is applied at the time of a renewal or conditional renewal of an existing policy and the insurer, at least thirty (30) days in advance of the end of the insureds policy period, mails or delivers to the named insured, at the address shown in the policy, a written notice that clearly and conspicuously discloses its intention to change the rate. A notice of renewal or conditional renewal that clearly and conspicuously discloses the renewal premium applicable to the policy shall be deemed to be in compliance with this subsection.  History of Section.P.L. 2004, ch. 481,  2. 
 27-6-8.2. Premium reduction for fire code safety prevention. Every schedule of rates, rating plan, or rating system for commercial property insurance filed with the commissioner shall provide for a reduction of, or credit in premium for insureds that install and maintain fire prevention and suppression equipment and/or other equipment that has been demonstrated to minimize or lessens an insured loss from fire including, but not limited to, sprinkler system, alarms, and any other equipment required or recommended by the state of Rhode Island for fire safety and/or prevention. Insurers shall also provide for a reduction of, or credit in premium for the use of building materials and/or building techniques that have been demonstrated to minimize or lessen an insured loss from fire. Any reduction of, or credit in premium required by this section must be actuarially supported and information sufficient to document such support must be included in the filing to the department.  History of Section.P.L. 2008, ch. 391,  1. 
 27-6-8. Filing of rate schedules and plans. (a) Every insurer shall file with the commissioner, except as to inland marine risks which by general custom of the business are not written according to manual rates or rating plans, every manual, minimum, or class rate, rating schedule or rating plan, and every other rating rule, and every modification of any of these which it proposes to use; provided, that rates other than class rates determined by the application of any rating schedule or rating plan may be modified without additional filing to produce rates for individual risks which are lower than those filed and which evaluate variations in physical or moral hazards, individual risk experience, or expense provisions and which are not inadequate or unfairly discriminatory. Every filing shall state the proposed effective date, and shall indicate the character and extent of the coverage contemplated.  (b) When a filing is not accompanied by the information upon which the insurer supports that filing, and the commissioner does not have sufficient information to determine whether that filing meets the requirements of the chapter, the commissioner shall require the insurer to furnish the information upon which it supports that filing. The information furnished in support of a filing may include: (1) the experience or judgment of the insurer or rating organization making the filing, (2) its interpretation of any statistical data it relies upon, (3) the experience of other insurers or rating organizations, or (4) any other relevant factors. A filing and any supporting information shall be open to public inspection. Specific inland marine rates on risks specially rated, made by a rating organization, shall be filed with the commissioner.  History of Section.P.L. 1948, ch. 2088,  4; G.L. 1956,  27-6-8; P.L. 1968, ch. 286,  1. 
 27-6-9. Filings by rating organizations. An insurer may satisfy its obligation to make the filings referred to in  27-6-8 by becoming a member of, or subscriber to, a licensed rating organization which makes those filings, and by authorizing the commissioner to accept those filings on its behalf; provided, that nothing contained in this chapter shall be construed as requiring any insurer to become a member of or a subscriber to any rating organization.  History of Section.P.L. 1948, ch. 2088,  4; G.L. 1956,  27-6-9. 
 27-60.1-1. Short title. This chapter shall be known and may be cited as the Unfair Discrimination Against Subjects of Abuse in Property and Casualty Insurance Act.  History of Section.P.L. 2013, ch. 99,  1; P.L. 2013, ch. 109,  1. 
 27-60.1-2. Purpose. The purpose of this chapter is to prohibit unfair discrimination by property and casualty insurers and insurance professionals on the basis of abuse status. Nothing in this chapter shall be construed to create or imply a private cause of action for a violation of this chapter.  History of Section.P.L. 2013, ch. 99,  1; P.L. 2013, ch. 109,  1. 
 27-60.1-3. Scope. This chapter applies to all property and casualty insurers and insurance professionals involved in issuing or renewing, in this state, a policy of property and casualty insurance.  History of Section.P.L. 2013, ch. 99,  1; P.L. 2013, ch. 109,  1. 
 27-60.1-4. Definitions. 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 without proper authority, under circumstances that place the person 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 claim means a claim under a property and casualty policy for a loss resulting from an act of abuse.  (3) Abuse status means the fact or perception that a natural person is, has been, or may be a subject of abuse, irrespective of whether the natural person has incurred abuse-related claims.  (4) Commissioner means the director of the department of business regulation or his or her designee.  (5) Confidential abuse information means information about acts of abuse or abuse status of a subject of abuse, the address and telephone number (home and work) of a subject of abuse or the status of an applicant or insured as a family member, employer or associate of, or a person in a relationship with, a subject of abuse.  (6) Insurance professional means a producer, broker, adjuster or third-party administrator as defined in the insurance laws of this state.  (7) Insured means the party named on a policy or certificate as the individual with legal rights to the benefits provided by such policy.  (8) Insurer means a person or other entity engaged in the business of property and casualty insurance in this state including all residual market mechanisms.  (9) Policy means a contract of insurance, including endorsements, riders or binders issued, proposed for issuance, or intended for issuance by an insurer or insurance professional.  (10) Subject of abuse means a natural 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.  History of Section.P.L. 2013, ch. 99,  1; P.L. 2013, ch. 109,  1. 
 27-60.1-5. Unfairly discriminatory acts relating to property and casualty insurance. (a) It is unfairly discriminatory to deny, refuse to issue, renew or reissue; to cancel or otherwise terminate; restrict or exclude coverage on or to add a premium differential to a property and casualty insurance policy on the basis of the applicants or insureds abuse status.  (b) It is unfairly discriminatory to:  (1) Exclude or limit payment for a covered loss or deny a covered claim incurred as a result of abuse by a person other than a co-insured; or  (2) Use exclusions or limitations on coverage which the commissioner has determined by regulation promulgated pursuant to this chapter unreasonably restrict the ability of subjects of abuse to be indemnified for losses.  (c) This section shall not require payment in excess of the loss or policy limits.  (d) Nothing in this chapter shall be construed to prohibit an insurer or insurance professional from applying reasonable standards of proof to claims under this section.  (e) When the insurer or insurance professional has information in its possession that clearly indicates that the insured, applicant or claimant is a subject of abuse, it is unfairly discriminatory, by a person employed by or contracting with an insurer, to disclose or transfer confidential abuse information, as defined in this chapter, for any purpose or to any person, except:  (1) To the subject of abuse or an individual specifically designated in writing by the subject of abuse;  (2) When ordered by the commissioner or a court of competent jurisdiction or otherwise required by law;  (3) When necessary for a valid business purpose to transfer information that includes confidential abuse information that cannot reasonably be segregated without undue hardship, confidential abuse information may be disclosed only if the recipient has executed a written agreement to be bound by the prohibitions of this chapter in all respects and to be subject to the enforcement of this chapter by the courts of this state for the benefit of the applicant or the insured, and only to the following persons:  (i) A reinsurer that seeks to indemnify or indemnifies all or any part of a policy covering a subject of abuse and that cannot underwrite or satisfy its obligations under the reinsurance agreement without that disclosure;  (ii) A party to a proposed or consummated sale, transfer, merger or consolidation of all or part of the business of the insurer or insurance professional;  (iii) Medical or claims personnel contracting with the insurer or insurance professional, only where necessary to process an application or perform the insurers or insurance professionals duties under the policy or to protect the safety or privacy of a subject of abuse (also includes parent or affiliate companies of the insurer or insurance professional that have service agreements with the insurer or insurance professional); or  (iv) With respect to address and telephone number, to entities with whom the insurer transacts business when the business cannot be transacted without the address and telephone number;  (4) To an attorney who needs the information to represent the insurer or insurance professional effectively, provided the insurer or insurance professional notifies the attorney of its obligations under this chapter and requests that the attorney exercise due diligence to protect the confidential abuse information consistent with the attorneys obligation to represent the insurer or insurance professional; or  (5) To any other entities deemed appropriate by the commissioner.  (f) It is unfairly discriminatory to request information relating to acts of abuse or an applicants or insureds abuse status, or to make use of that information, however obtained, except for the limited purposes of complying with legal obligations or verifying a persons claim to be a subject of abuse.  (g) Paragraph (e) does not preclude a subject of abuse from obtaining his or her insurance records.  (h) Paragraph (f) above does not prohibit a property and casualty insurer from asking an applicant or insured about a property and casualty claim, even if the claim is abuse-related, or from using information thereby obtained in evaluating and carrying out its rights and duties under the policy, to the extent otherwise permitted under this chapter and other applicable law.  History of Section.P.L. 2013, ch. 99,  1; P.L. 2013, ch. 109,  1. 
 27-60.1-6. Justification of adverse insurance decisions. An insurer or insurance professional that takes an action not prohibited by  27-60.1-5 that adversely affects an applicant or insured on the basis of claim or other underwriting information that the insurer or insurance professional knows or has reason to know is abuse-related shall explain the reason for its action to the applicant or insured in writing and shall be able to demonstrate that its action, and any applicable policy provision:  (1) Does not have the purpose of treating abuse status as an underwriting criterion; and  (2) Is otherwise permissible by law and applies in the same manner and to the same extent to all applicants and insureds with a similar claim or claims history without regard to whether the claims are abuse-related.  History of Section.P.L. 2013, ch. 99,  1; P.L. 2013, ch. 109,  1. 
 27-60.1-7. Insurance protocols for subjects of abuse. Insurers shall develop and adhere to written policies specifying procedures to be followed by employees and by insurance professionals they contract with, for the purpose of protecting the safety and privacy of a subject of abuse and shall otherwise implement the provisions of this chapter when taking an application, investigating a claim, pursuing subrogation or taking any other action relating to a policy or claim involving a subject of abuse. Insurers shall distribute their written policies to employees and insurance professionals.  History of Section.P.L. 2013, ch. 99,  1; P.L. 2013, ch. 109,  1. 
 27-60.1-8. Effective date. This chapter applies to all actions taken on or after the effective date, except where otherwise explicitly stated. Nothing in this chapter shall require an insurer or insurance professional to conduct a comprehensive search of its contract files existing on the effective date solely to determine which applicants or insureds are subjects of abuse.  History of Section.P.L. 2013, ch. 99,  1; P.L. 2013, ch. 109,  1. 
 27-60-1. Short title. This chapter may be cited as the Unfair Discrimination Against Subjects of Abuse in Health Benefit Plans Act.  History of Section.P.L. 1997, ch. 163,  1. 
 27-60-2. Definitions. For the purpose of this chapter: (1) Abuse means the occurrence of one or more of the following acts:  (i) Attempting to cause or intentionally, knowingly or recklessly causing another person, including a minor child, 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 a minor child, 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, including a minor child, 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, including a minor child.  (2) Abuse-related medical condition means a medical condition sustained by a subject of abuse which 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) Health benefit plan or plan means a policy, contract, certificate or agreement offered by a carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. Health benefit plan includes accident only, credit health, dental, vision, Medicare supplement or long-term care insurance, coverage issued as a supplement to liability insurance, short-term and catastrophic health insurance policies, and a policy that pays on a cost-incurred basis. Health benefit plan does not include workers compensation or similar insurance.  (6) Health carrier means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation or any other entity providing a plan of health insurance, health benefits or health services.  (7) Insured means a party named on a health benefit plan as the person with legal rights to the benefits provided by the health benefit plan. For group plans, insured includes a person who is a beneficiary covered by a group health benefit plan.  (8) Subject of abuse means a person to whom a family member, or a current or former household member, intimate partner, or caretaker, or a perpetrator of sexual assault, a stalker or a sex offender has directed an act defined in subdivision (1) of this section; 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.  History of Section.P.L. 1997, ch. 163,  1. 
 27-60-3. Unfair discrimination against subjects of abuse prohibited. A health carrier shall not engage, directly or indirectly, in an unfairly discriminatory act or practice against a subject of abuse.  History of Section.P.L. 1997, ch. 163,  1. 
 27-60-4. Unfairly discriminatory acts relating to health benefit plans. The following acts are prohibited as unfairly discriminatory: (1) Denying, refusing to issue, renew or reissue, canceling or terminating a health benefit plan, or restricting or excluding health benefit plan coverage or adding a premium differential to any health benefit plan on the basis of the applicants or insureds abuse status;  (2) Excluding or limiting coverage for losses or denying a claim incurred by an insured as a result of abuse on the basis of the insureds abuse status;  (3) Terminating group coverage for a subject of abuse because coverage was originally issued in the name of the abuser and the abuser has divorced, separated from, or lost custody of the subject of abuse, or the abusers coverage has terminated voluntarily or involuntarily. Nothing in this subsection prohibits the health carrier from requiring the subject of abuse to pay the full premium for coverage under the health plan or from requiring as a condition of coverage that the subject of abuse reside or work within its service area, if the requirements are applied to all insured of the health carrier. The health carrier may terminate group coverage after the continuation coverage required by this subsection has been in force for eighteen (18) months, and the health carrier shall offer conversion to an equivalent individual plan providing the conversion plan already exists and is offered to all the insured of the health carrier. The continuation coverage required by this section shall be satisfied by coverage required under P.L. 99-272, the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, provided to a subject of abuse and is not intended to be in addition to coverage provided under COBRA; or  (4) Disclosure or transfer by a person employed by or contracting with a health carrier of any information relating to a persons abuse status, a persons medical condition which the health carrier knows or has reason to know is abuse-related or a persons family, household, social or employment relationship with a subject of abuse, except to the extent necessary for the direct provision of health care services, compliance with abuse reporting laws or compliance with an order of the commissioner or a court of competent jurisdiction. This subsection shall not preclude a subject of abuse from obtaining his or her own medical records. This subsection shall not be construed to prohibit a health carrier from asking an applicant or insured about a medical condition, even if the condition is abuse-related, or using information obtained for the purpose of acts or practices permitted by this chapter. A subject of abuse may provide evidence of abuse to a health carrier for the limited purpose of facilitating treatment of an abuse-related condition or demonstrating that a medical condition is abuse-related, and this section shall not be construed as authorizing the health carrier to disregard that information.  History of Section.P.L. 1997, ch. 163,  1. 
 27-60-5. Justification of adverse insurance decisions. A health carrier that takes an action that adversely affects a subject of abuse on the basis of a medical condition that the health carrier knows or has reason to know is abuse-related shall explain the reason for its action to the applicant or insured, in writing, and shall be able to demonstrate that its action, and any applicable plan provision:  (1) Does not have the purpose or effect of treating abuse status as a medical condition or underwriting criterion;  (2) Is not based upon any actual or perceived correlation between a medical condition and abuse;  (3) Is permissible by law and applies in the same manner and to the same extent to all applicants and the insured with a similar medical condition without regard to whether the condition or claim is abuse-related; and  (4) Is based on a determination, made in conformance with sound actuarial principles and supported by reasonable statistical evidence, that there is a correlation between the medical condition and a material increase in insurance risk.  History of Section.P.L. 1997, ch. 163,  1. 
 27-60-6. Insurance protocols for subjects of abuse. Health carriers shall develop, file with the commissioner and adhere to protocols specifying how health carrier employees, contractors, agents and brokers will pursue an insurance action, including claims investigation and subrogation, that may impact the safety of a subject of abuse involved with that action.  History of Section.P.L. 1997, ch. 163,  1. 
 27-60-7. Enforcement. Violations of this chapter are subject to the provisions of  27-29-8 and 27-29-9 and may include injunctive relief and/or a requirement for restitution. The powers and duties set forth in this section are in addition to all other authority of the commissioner.  History of Section.P.L. 1997, ch. 163,  1. 
 27-61-1. Short title. This chapter may be cited as the Unfair Discrimination Against Subjects of Abuse in Life Insurance Act.  History of Section.P.L. 1997, ch. 163,  1. 
 27-61-2. Definitions. 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.  History of Section.P.L. 1997, ch. 163,  1. 
 27-61-3. Unfair discrimination against subjects of abuse prohibited. No insurer issuing or renewing a policy of life insurance in this state shall engage in an unfairly discriminatory act or practice against a subject of abuse, and that act or practice is deemed to be an unfair or deceptive act or practice under chapter 29 of this title.  History of Section.P.L. 1997, ch. 163,  1. 
 27-61-4. Unfair discriminatory acts relating to life insurance. (a) The following acts are prohibited as unfairly discriminatory:  (1) Denying, refusing to issue, renew or reissue, canceling or otherwise terminating, restricting or excluding insurance coverage on or adding a premium differential to a life insurance policy for an applicant or insured on the basis of the applicants or insureds abuse status;  (2) Excluding, limiting or denying benefits on a life insurance policy on the basis of an insureds abuse status except as permitted or required by the laws of this state relating to acts of abuse committed by a life insurance beneficiary;  (3)(i) When the insurer has information in its possession that clearly indicates that the insured or applicant is a subject of abuse, disclosure or transfer by a person employed by or contracting with an insurer of confidential abuse information, which is information about acts of abuse or abuse status of a subject of abuse, the address and telephone number (home and work) of a subject of abuse, or the status of an applicant or insured as a family member, employer or associate of, or a person in a relationship with, a subject of abuse, for any purpose or to any person, except:  (A) To a subject of abuse or an individual specifically designated in writing by the subject of abuse;  (B) To a health care provider for the direct provision of health care services;  (C) To a licensed physician identified and designated by the subject of abuse;  (D) When ordered by the commissioner or a court of competent jurisdiction or required by law;  (E) When necessary for a valid business purpose to transfer information that includes confidential abuse information that cannot reasonably be segregated, confidential abuse information may be disclosed only to the following persons:  (I) A reinsurer that seeks to indemnify or indemnifies all or any part of a policy covering a subject of abuse and that cannot underwrite or satisfy its obligations under the reinsurance agreement without that disclosure;  (II) A party to a proposed or consummated sale, transfer, merger or consolidation of all or part of the business of the insurer;  (III) Medical or claims personnel contracting with the insurer, only where necessary to process an application or perform the insurers duties under the policy or to protect the safety or privacy of a subject of abuse (also includes parent or affiliate companies of the insurer that have service agreements with the insurer); or  (IV) With respect to address and telephone number, to entities with whom the insurer transacts business when the business cannot be transacted without the address and telephone number;  (F) An attorney who needs the information to represent the insurer effectively, provided the insurer notifies the attorney of its obligations under this chapter and requests that the attorney exercise due diligence to protect the confidential abuse information consistent with the attorneys obligation to represent the insurer;  (G) To the policyowner or assignee, in the course of delivery of the policy, if the policy contains information about abuse status; and  (H) To any other entities deemed appropriate by the commissioner.  (ii) This subsection does not preclude a subject of abuse from obtaining his or her insurance records.  (4) Requesting information about abuse status, or making use of this information, however obtained.  (b) This section does not prohibit a life insurer from declining to issue a life insurance policy if:  (1) The applicant or prospective owner of the policy lacks an insurable interest in the insured;  (2) The applicant or prospective owner of the policy is known, on the basis of medical, police or court records, to have committed an act of abuse against the proposed insured; or  (3) The insured or prospective insured is a subject of abuse, and that person, or a person who has assumed the care of that person if a minor or incapacitated, has objected to the issuance of the policy on the ground that the policy would be issued to or for the direct or indirect benefit of the abuser.  (c) This section does not prohibit a life insurer from asking about a medical condition or from using medical information to underwrite or to carry out its duties under the policy, even if the medical information is related to a medical condition that the insurer knows or has reason to know is abuse-related, to the extent otherwise permitted under this chapter and other applicable law.  (d) A life insurer shall not be held civilly or criminally liable for the death of or injury to an insured resulting from any action taken in a good faith effort to comply with the requirements of this chapter. This subsection does not prevent an action to investigate or enforce a violation of this chapter or to assert any other claims authorized by law.  History of Section.P.L. 1997, ch. 163,  1. 
 27-61-5. Justification of adverse insurance decisions. An insurer of an individual or group policy that takes an underwriting action that adversely affects a subject of abuse on the basis of a medical condition that the insurer knows is abuse-related shall explain the reason for its action to the applicant or insured in writing and shall be able to demonstrate that its action:  (1) Does not treat abuse status as a medical condition;  (2) Is permissible by law and applies in the same manner and to the same extent to all applicants and the insured with a similar medical condition without regard to whether the condition or claims abuse-related; and  (3) Is based on a determination, made in conformance with sound actuarial principles or related actual or reasonably anticipated experience, that there is a correlation between the medical condition and a material increase in insurance risk.  History of Section.P.L. 1997, ch. 163,  1. 
 27-61-6. Insurance protocols for subjects of abuse. Insurers shall develop and adhere to written policies specifying procedures to be followed by employees, contractors, producers, agents and brokers for the purpose of protecting the safety and privacy of a subject of abuse and implement the provisions of this chapter when taking an application, investigating a claim, pursuing subrogation or taking any other action relating to a policy or claim involving a subject of abuse.  History of Section.P.L. 1997, ch. 163,  1. 
 27-61-7. Enforcement. Violations of this chapter are subject to the provisions of  27-29-8 and 27-29-9 and may include injunctive relief and/or a requirement for restitution. The powers and duties set forth in this section are in addition to all other authority of the commissioner.  History of Section.P.L. 1997, ch. 163,  1. 
 27-62-1. Purpose. The purpose of this chapter is to provide rules for life insurance policy illustrations that will protect consumers and foster consumer education. The chapter provides illustration formats, prescribes standards to be followed when illustrations are used, and specifies the disclosures that are required in connection with illustrations. The goals of this chapter are to ensure that illustrations do not mislead purchasers of life insurance and to make illustrations more understandable. Insurers will, as far as possible, eliminate the use of footnotes and caveats and define terms used in the illustration in language that would be understood by a typical person within the segment of the public to which the illustration is directed.  History of Section.P.L. 1998, ch. 56,  1. 
 27-62-10. Annual certifications. (a) The board of directors of each insurer shall appoint one or more illustration actuaries.  (b) The illustration actuary shall certify that the disciplined current scale used in illustration is in conformity with the actuarial standard of practice of compliance with the NAIC model regulation on life insurance illustration promulgated by the actuarial standards board, and that the illustrated scales used in insurer-authorized illustrations meet the requirements of this regulation.  (c) The illustration actuary shall:  (1) Be a member in good standing of the American Academy of Actuaries;  (2) Be familiar with the standard of practice regarding life insurance policy illustrations;  (3) Not have been found by the director of the department of business regulation, following appropriate notice and hearing, to have:  (i) Violated any provision of, or any obligation imposed by, the insurance law or other law in the course of his or her dealings as an illustration actuary;  (ii) Been found guilty of fraudulent or dishonest practices;  (iii) Demonstrated incompetence, lack of cooperation, or untrustworthiness to act as an illustration actuary; or  (iv) Resigned or been removed as an illustration actuary within the past five (5) years as a result of acts or omissions indicated in any adverse report on examination or as a result of a failure to adhere to generally acceptable actuarial standards;  (4) Not fail to notify the insurance division of the department of business regulation of any action taken by another state similar to that under subdivision (3) of this subsection;  (5) Disclose in the annual certification whether, since the last certification, a currently payable scale applicable for business issued within the previous five (5) years and within the scope of the certification has been reduced for reasons other than changes in the experience factors underlying the disciplined current scale. If non-guaranteed elements illustrated for new policies are not consistent with those illustrated for similar in force policies, this must be disclosed in the annual certification. If non-guaranteed elements illustrated for both new and in force policies are not consistent with the non-guaranteed elements actually being paid, charged or credited to the same or similar forms, this must be disclosed in the annual certification; and  (6) Disclose in the annual certification the method used to allocate overhead expenses for all illustrations:  (i) Fully allocated expenses;  (ii) Marginal expenses; or  (iii) A generally recognized expense table based on fully allocated expenses representing a significant portion of insurance companies and approved by the commissioner.  (d)(1) The illustration actuary shall file a certification with the board and with the insurance division of the department of business regulation:  (i) Annually for all policy forms for which illustrations are used; and  (ii) Before a new policy form is illustrated.  (2) If an error in a previous certification is discovered, the illustration actuary shall promptly notify the board of directors of the insurer and the insurance division of the department of business regulation.  (e) If an illustration actuary is unable to certify the scale for any policy form illustration the insurer intends to use, the actuary shall notify the board of directors of the insurer and the commissioner promptly of his or her inability to certify.  (f) A responsible officer of the insurer, other than the illustration actuary, shall annually certify :  (1) That the illustration formats meet the requirements of this regulation and that the scales used in insurer-authorized illustrations are those scales certified by the illustration actuary; and  (2) That the company has provided its agents with information about the expense allocation method used by the company in its illustration and disclosed as required in subdivision (c)(6) of this section.  (g) The annual certifications shall be provided to the insurance division of the department of business regulation by a date determined by the insurer.  (h) If an insurer changes the illustration actuary responsible for all or a portion of the companys policy forms, the insurer shall promptly notify the insurance division of the department of business regulation of that fact and disclose the reason for the change.  History of Section.P.L. 1998, ch. 56,  1. 
 27-62-11. Violations. Any violation of this chapter shall be sanctioned in accordance with the provisions of chapter 13.1 of title 6, the Deceptive Trade Practices Act.  History of Section.P.L. 1998, ch. 56,  1. 
 27-62-2. Applicability and scope. This chapter applies to all group and individual life insurance policies and certificates except:  (1) Variable life insurance;  (2) Individual and group annuity contracts;  (3) Credit life insurance; and  (4) Life insurance policies with no illustrated death benefits on any individual exceeding ten thousand dollars ($10,000).  History of Section.P.L. 1998, ch. 56,  1. 
 27-62-3. Definitions. (a) Actuarial standards board means the board established by the American Academy of Actuaries to develop and promulgate standards of actuarial practice.  (b) Contract premium means the gross premium that is required to be paid under a fixed premium policy, including the premium for a rider for which benefits are shown in the illustration.  (c) Currently payable scale means a scale of non-guaranteed elements in effect for a policy form as of the preparation date of the illustration or declared to become effective within the next ninety-five (95) days.  (d) Disciplined current scale means a scale of non-guaranteed elements constituting a limit on illustrations currently being illustrated by an insurer that is reasonably based on actual recent historical experience, as certified annually by an illustration actuary designated by the insurer. Further guidance in determining the disciplined current scale as contained in standards established by the Actuarial Standards Board may be relied upon if the standards:  (1) Are consistent with all provisions of this chapter;  (2) Limit a disciplined current scale to reflect only actions that have already been taken or events that have already occurred;  (3) Do not permit a disciplined current scale to include any projected trends of improvements in experience or any assumed improvements in experience beyond the illustration date; and  (4) Do not permit assumed expenses to be less than minimum assumed expenses.  (e) Generic name means a short title descriptive of the policy being illustrated such as whole life, term life, or flexible premium adjustable life.  (f) Guaranteed elements and non-guaranteed elements:  (1) Guaranteed elements means the premiums, benefits, values, credits, or charges under a policy of life insurance that are guaranteed and determined at issue.  (2) Non-guaranteed elements means the premiums, benefits, values, credits, or charges under a policy of life insurance that are not guaranteed or not determined at issue.  (g) Illustrated scale means a scale of non-guaranteed elements currently being illustrated that is not more favorable to the policy owner than the lesser of:  (1) The disciplined current scale; or  (2) The currently payable scale.  (h) Illustration means a presentation or depiction that includes non-guaranteed elements of a policy of life insurance over a period of years and that is one of the three (3) types defined in subdivisions (h)(1-3):  (1) Basic illustration means a ledger or proposal used in the sale of a life insurance policy that shows both guaranteed and non-guaranteed elements.  (2) Supplemental illustration means an illustration furnished in addition to a basic illustration that meets the applicable requirements of this chapter, and that may be presented in a format differing from the basic illustration, but may only depict a scale of non-guaranteed elements that is permitted in a basic illustration.  (3) In force illustration means an illustration furnished at any time after the policy that it depicts has been in force for one year or more.  (i) Illustration actuary means an actuary meeting the requirements of  27-62-10 who certifies to illustrations based on the standard of practice promulgated by the Actuarial Standards Board.  (j) Lapse-supported illustration means an illustration of a policy form failing the test of self-supporting as defined in this chapter, under a modified persistency rate assumption using persistency rates underlying the disciplined current scale for the first five (5) years and one hundred percent (100%) policy persistency thereafter.  (k)(1) Minimum assumed expenses means the minimum expenses that may be used in the calculation of the disciplined current scale for a policy form. The insurer may choose to designate each year the method of determining assumed expenses for all policy forms from the following:  (i) Fully allocated expenses;  (ii) Marginal expenses; and  (iii) A generally recognized expense table based on fully allocated expenses representing a significant portion of insurance companies and approved by the commissioner.  (2) Marginal expenses may be used only if greater than a generally recognized expense table. If no generally recognized expense table is approved, fully allocated expenses must be used.  (l) Non-term group life means a group policy or individual policies of life insurance issued to members of an employer group or other permitted group where:  (1) Every plan of coverage was selected by the employer or other group representative;  (2) Some portion of the premium is paid by the group or through payroll deduction; and  (3) Group underwriting or simplified underwriting is used.  (m) Policy owner means the owner named in the policy or the certificate holder in the case of a group policy.  (n) Premium outlay means the amount of premium assumed to be paid by the policy owner or other premium payer out-of-pocket.  (o) Self-supporting illustration means an illustration of a policy form for which it can be demonstrated that, when using experience assumptions underlying the disciplined current scale, for all illustrated points in time on or after the fifteenth (15th) policy anniversary or the twentieth (20th) policy anniversary for second-or-later-to-die policies (or upon policy expiration if sooner), the accumulated value of all policy cash flows equals or exceeds the total policy owner value available. For this purpose, policy owner value will include cash surrender values and any other illustrated benefit amounts available at the policy owners election.  History of Section.P.L. 1998, ch. 56,  1. 
 27-62-4. Policies to be illustrated. (a) Each insurer marketing policies to which this chapter is applicable shall notify the commissioner whether a policy form is to be marketed with or without an illustration. For all policy forms being actively marketed on January 1, 1999, the insurer shall identify in writing those forms and whether or not an illustration will be used with them. For policy forms filed after January 1, 1999, the identification shall be made at the time of filing. Any previous identification may be changed by notice to the commissioner.  (b) If the insurer identifies a policy form as one to be marketed without an illustration, any use of an illustration for any policy using that form prior to the first policy anniversary is prohibited.  (c) If a policy form is identified by the insurer as one to be marketed with an illustration, a basic illustration prepared and delivered in accordance with this chapter is required, except that a basic illustration need not be provided to individual members of a group or to individuals insured under multiple lives coverage issued to a single applicant unless the coverage is marketed to these individuals. The illustration furnished an applicant for a group life insurance policy or policies issued to a single applicant on multiple lives may be either an individual or composite illustration representative of the coverage on the lives of members of the group or the multiple lives covered.  (d) Potential enrollees of non-term group life subject to this chapter shall be furnished a quotation with the enrollment materials. The quotation shall show potential policy values for sample ages and policy years on a guaranteed and non-guaranteed basis appropriate to the group and the coverage. This quotation shall not be considered an illustration for purposes of this chapter, but all information provided shall be consistent with the illustrated scale. A basic illustration shall be provided at delivery of the certificate to enrollees for non-term group life who enroll for more than the minimum premium necessary to provide pure death benefit protection. In addition, the insurer shall make a basic illustration available to any non-term group life enrollee who requests it.  History of Section.P.L. 1998, ch. 56,  1. 
 27-62-5. General rules and prohibitions. (a) An illustration used in the sale of a life insurance policy shall satisfy the applicable requirements of this chapter, be clearly labeled life insurance illustration and contain the following basic information:  (1) Name of insurer;  (2) Name and business address of producer or insurers authorized representative, if any;  (3) Name, age and sex of proposed insured, except where a composite illustration is permitted under this chapter;  (4) Underwriting or rating classification upon which the illustration is based;  (5) Generic name of policy, the company product name, if different, and form number;  (6) Initial death benefit; and  (7) Dividend option election or application of non-guaranteed elements, if applicable.  (b) When using an illustration in the sale of life insurance policy, an insurer or its producers or other authorized representative shall not:  (1) Represent the policy as anything other than a life insurance policy;  (2) Use or describe non-guaranteed elements in a manner that is misleading or has the capacity or tendency to mislead;  (3) State or imply that the payment or amount of non-guaranteed elements is guaranteed;  (4) Use an illustration that does not comply with the requirements of this chapter;  (5) Use an illustration that at any policy duration depicts policy performance more favorable to the policy owner than that produced by the illustrated scale of the insurer whose policy is being illustrated;  (6) Provide an applicant with an incomplete illustration;  (7) Represent in any way that premium payments will not be required for each year of the policy in order to maintain the illustrated death benefits, unless that is the fact;  (8) Use the term vanish or vanishing premium, or a similar term that implies the policy becomes paid up, to describe a plan for using non-guaranteed elements to pay a portion of future premiums;  (9) Except for policies that can never develop nonforfeiture values, use an illustration that is lapse supported; or  (10) Use an illustration that is not self-supporting.  (c) If an interest rate used to determine the illustrated non-guaranteed elements is shown, it shall not be greater than the earned interest rate underlying the disciplined current scale.  History of Section.P.L. 1998, ch. 56,  1. 
 27-62-6. Standards for basic illustrations. (a) Format. A basic illustration shall conform to the following requirements:  (1) The illustration shall be labeled with the date on which it was prepared.  (2) Each page, including any explanatory notes or pages, shall be numbered and show its relationship to the total number of pages in the illustration (e.g., the fourth page of a seven (7) page illustration shall be labeled page 4 of 7 pages).  (3) The assumed dates of payment receipt and benefit pay-out within a policy year shall be clearly identified.  (4) If the age of the proposed insured is shown as a component of the tabular detail, it shall be issue age plus the numbers of years the policy is assumed to have been in force.  (5) The assumed payments on which the illustrated benefits and values are based shall be identified as premium outlay or contract premium, as applicable. For policies that do not require a specific contract premium, the illustrated payments shall be identified as premium outlay.  (6) Guaranteed death benefits and values available upon surrender, if any, for the illustrated premium outlay or contract premium shall be shown and clearly labeled guaranteed.  (7) If the illustration shows any non-guaranteed elements, they cannot be based on a scale more favorable to the policy owner than the insurers illustrated scale at any duration. These elements shall be clearly labeled non-guaranteed.  (8) The guaranteed elements, if any, shall be shown before corresponding non-guaranteed elements and shall be specifically referred to on any page of an illustration that shows or described only the non-guaranteed elements (e.g., see page one for guaranteed elements.)  (9) The account or accumulation value of a policy, if shown, shall be identified by the name this value is given in the policy being illustrated and shown in close proximity to the corresponding value available upon surrender.  (10) The value available upon surrender shall be identified by the name this value is given in the policy being illustrated and shall be the amount available to the policy owner in a lump sum after deduction of surrender charges, policy loans and policy loan interest, as applicable.  (11) Illustrations may show policy benefits and values in graphic or chart form in addition to the tabular form.  (12) Any illustration of non-guaranteed elements shall be accompanied by a statement indicating that:  (i) The benefits and values are not guaranteed;  (ii) The assumptions on which they are based are subject to change by the insurer; and  (iii) Actual results may be more or less favorable.  (13) If the illustration shows that the premium payer may have the option to allow policy charges to be paid using non-guaranteed values, the illustration must clearly disclose that a charge continues to be required and that, depending on actual results, the premium payer may need to continue or resume premium outlays. Similar disclosure shall be made for premium outlay of lesser amounts or shorter durations than the contract premium. If a contract premium is due, the premium outlay display shall not be left blank or show zero unless accompanied by an asterisk or similar mark to draw attention to the fact that the policy is not paid up.  (14) If the applicant plans to use dividends or policy values, guaranteed or non-guaranteed, to pay all or a portion of the contract premium or policy charges, or for any other purpose, the illustration may reflect those plans and the impact on future policy benefits and values.  (b) Narrative Summary. A basic illustration shall include the following:  (1) A brief description of the policy being illustrated, including a statement that it is a life insurance policy;  (2) A brief description of the premium outlay or contract premium, as applicable, for the policy. For a policy that does not require payment of a specific contract premium, the illustration shall show the premium outlay that must be paid to guarantee coverage for the term of the contract, subject to maximum premiums allowable to qualify as a life insurance policy under the applicable provisions of the Internal Revenue Code, Title 26 of the U.S. Code;  (3) A brief description of any policy features, riders or options, guaranteed or non-guaranteed, shown in the basic illustration and the impact they may have on the benefits and values of the policy;  (4) Identification and a brief definition of column headings and key terms used in the illustration; and  (5) A statement containing in substance the following: This illustration assumes that the currently illustrated non-guarantee elements will continue unchanged for all years shown. This is not likely to occur, and actual results may be more or less favorable than those shown.  (c) Numeric Summary.(1) Following the narrative summary, a basic illustration shall include a numeric summary of the death benefits and values and the premium outlay and contract premium, as applicable. For a policy that provides for a contract premium, the guaranteed death benefits and values shall be based on the contract premium. This summary shall be shown for at least policy years five (5), ten (10) and twenty (20) and at age seventy (70), if applicable, on the three (3) bases shown below. For multiple life policies the summary shall show policy years five (5), ten (10), twenty (20) and thirty (30).  (i) Policy guarantees;  (ii) Insurers illustrated scale;  (iii) Insurers illustrated scale used but with the non-guaranteed elements reduced as follows:  (A) Dividends at fifty percent (50%) of the dividends contained in the illustrated scale used;  (B) Non-guaranteed credited interest at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used; and  (C) All non-guaranteed charges, including, but not limited to, term insurance charges, mortality and expense charges, at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used.  (2) In addition, if coverage would cease prior to policy maturity or age one hundred (100), the year in which coverage ceases shall be identified for each of the three (3) bases.   (d) Statements. Statements substantially similar to the following shall be included on the same page as the numeric summary and signed by the applicant, or the policy owner in the case of an illustration provided at time of delivery, as required in this chapter.  (1) A statement to be signed and dated by the applicant or policy owner reading as follows: I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either higher or lower. The agent has told me they are not guaranteed.  (2) A statement to be signed and dated by the insurance producer or other authorized representative of the insurer reading as follows: I certify that this illustration has been presented to the applicant and that I have explained that any non-guaranteed elements illustrated are subject to change. I have made no statements that are inconsistent with the illustration.  (e) Tabular detail.(1) A basic illustration shall include the following for at least each policy year from one to ten (10) and for every fifth policy year thereafter ending at age one hundred (100), policy maturity or final expiration; and except for term insurance beyond the 20th year, for any year in which the premium outlay and contract premium, if applicable, is to change:  (i) The premium outlay and mode the applicant plans to pay and the contract premium, as applicable;  (ii) The corresponding guaranteed death benefit, as provided in the policy; and  (iii) The corresponding guaranteed value available upon surrender, as provided in the policy.  (2) For a policy that provides for a contract premium, the guaranteed death benefit and value available upon surrender shall correspond to the contract premium.  (3) Non-guaranteed elements may be shown if described in the contract. In the case of an illustration for a policy on which the insurer intends to credit terminal dividends, they may be shown if the insurers current practice is to pay terminal dividends. If any non-guaranteed elements are shown they must be shown at the same durations as the corresponding guaranteed elements, if any. If no guaranteed benefit or value is available at any duration for which a non-guaranteed benefit or value is shown, a zero shall be displayed in the guaranteed column.   History of Section.P.L. 1998, ch. 56,  1. 
 27-62-7. Standards for supplemental illustrations. (a) A supplemental illustration may be provided so long as:  (1) It is appended to, accompanied by, or preceded by a basic illustration that complies with this chapter;  (2) The non-guaranteed elements shown are not more favorable to the policy owner than the corresponding elements based on the scale used in the basic illustration;  (3) It contains the same statement required of a basic illustration that non-guaranteed elements are not guaranteed; and  (4) For a policy that has a contract premium, the contract premium underlying the supplemental illustration is equal to the contract premium shown in the basic illustration. For policies that do not require a contract premium, the premium outlay underlying the supplemental illustration shall be equal to the premium outlay shown in the basic illustration.  (b) The supplemental illustration shall include a notice referring to the basic illustration for guaranteed elements and other important information.  History of Section.P.L. 1998, ch. 56,  1. 
 27-62-8. Delivery of illustration and record retention. (a)(1) If a basic illustration is used by an insurance producer or other authorized representative of the insurer in the sale of a life insurance policy and the policy is applied for as illustrated, a copy of that illustration, signed in accordance with this chapter, shall be submitted to the insurer at the time of policy application. A copy also shall be provided to the applicant.  (2) If the policy is issued other than as applied for, a revised basic illustration conforming to the policy as issued shall be sent with the policy. The revised illustration shall conform to the requirements of this regulation, shall be labeled Revised Illustration and shall be signed and dated by the applicant or policy owner and producer or other authorized representative of the insurer no later than the time the policy is delivered. A copy shall be provided to the insurer and the policy owner.  (b)(1) If no illustration is used by an insurance producer or other authorized representative in the sale of a life insurance policy or if the policy is applied for other than as illustrated, the producer or representative shall certify to that effect in writing on a form provided by the insurer. On the same form the applicant shall acknowledge that no illustration conforming to the policy applied for was provided, and shall further acknowledge an understanding that an illustration conforming to the policy as issued will be provided no later than at the time of policy delivery. This form shall be submitted to the insurer at the time of policy application.  (2) If the policy is issued, a basic illustration conforming to the policy as issued shall be sent with the policy and signed no later than the time the policy is delivered. A copy shall be provided to the insurer and the policy owner.  (c) If the basic illustration or revised illustration is sent to the applicant or policy owner by mail from the insurer, it shall include instructions for the applicant or policy owner to sign the duplicate copy of the numeric summary page of the illustration for the policy issued and return the signed copy to the insurer. The insurers obligation under this subsection shall be satisfied if it can demonstrate that it has made a diligent effort to secure a signed copy of the numeric summary page. The requirement to make a diligent effort shall be deemed satisfied if the insurer includes in the mailing a self-addressed postage prepaid envelope with instructions for the return of the signed numeric summary page.  (d) A copy of the basic illustration and a revised basic illustration, if any, signed as applicable, along with any certification that either no illustration was used or that the policy was applied for other than as illustrated, shall be retained by the insurer until three (3) years after the policy is no longer in force. A copy need not be retained if no policy is issued.  History of Section.P.L. 1998, ch. 56,  1. 
 27-62-9. Annual report  Notice to policy owners. (a) In the case of a policy designated as one for which illustrations will be used, the insurer shall provide each policy owner with an annual report on the status of the policy that shall contain at least the following information:  (1) For universal life policies, the report shall include the following:  (i) The beginning and end date of the current report period;  (ii) The policy value at the end of the previous report period and at the end of the current report period;  (iii) The total amounts that have been credited or debited to the policy value during the current report period, identifying each by type (e.g., interest, mortality, expense and riders);  (iv) The current death benefit at the end of the current report period on each life covered by the policy;  (v) The net cash surrender value of the policy as of the end of the current report period;  (vi) The amount of outstanding loans, if any, as of the end of the current report period; and  (vii) For fixed premium policies: if, assuming guaranteed interest, mortality and expense loads and continued scheduled premium payments, the policys net cash surrender value is such that it would not maintain insurance in force until the end of the next reporting period, a notice to this effect shall be included in the report; or  (viii) For flexible premium policies: if, assuming guaranteed interest, mortality and expense loads, the policys net cash surrender value will not maintain insurance in force until the end of the next reporting period unless further premium payments are made, a notice to this effect shall be included in the report.  (2) For all other policies, where applicable:  (i) Current death benefit;  (ii) Annual contract premium;  (iii) Current cash surrender value;  (iv) Current dividend;  (v) Application of current dividend; and  (vi) Amount of outstanding loan.  (3) Insurers writing life insurance policies that do not build nonforfeiture values shall only be required to provide an annual report with respect to these policies for those years when a change has been made to non-guaranteed policy elements by the insurer.  (b) If the annual report does not include an in force illustration, it shall contain the following notice displayed prominently: IMPORTANT POLICY OWNER NOTICE: You should consider requesting more detailed information about your policy to understand how it may perform in the future. You should not consider replacement of your policy or make changes in your coverage without requesting a current illustration. You may annually request, without charge, a current illustration by calling [insurers phone number], writing to [insurers name] at [insurers address] or contacting your agent. If you do not receive a current illustration of your policy within thirty (30) days from your request, you should contact your state insurance department. The insurer may vary the sequential order of the methods for obtaining an in force illustration.  (c) Upon the request of the policy owner, the insurer shall furnish an in force illustration of current and future benefits and values based on the insurers present illustrated scale. This illustration shall comply with the requirements of  27-62-5 and 27-62-6. No signature or other acknowledgment of receipt of this illustration shall be required.  (d) If an adverse change in non-guaranteed elements that could affect the policy has been made by the insurer since the last annual report, the annual report shall contain a notice of that fact and the nature of the change prominently displayed.  History of Section.P.L. 1998, ch. 56,  1. 
 27-63-1. Immunity for reporting health care fraud. (a) No insurer, agent authorized by the insurer to act on its behalf, or other person shall be subject to any civil or criminal liability in any cause of action for releasing or providing in good faith to a law enforcement agency factually accurate information relating to suspected or discovered health insurance fraud.  (b) No employer shall discharge, or in any manner discriminate or retaliate against any person who, in good faith, makes a report to law enforcement, testifies, or is about to testify in any proceeding about the health care fraud.  (c) Nothing contained in this chapter shall be construed to limit the rights and remedies available to a person pursuant to chapter 33 of title 9 or chapter 50 of title 28.  History of Section.P.L. 1998, ch. 59,  1. 
 27-64-1. Short title. This chapter may be cited as the Protected Cell Companies Act. History of Section.P.L. 1999, ch. 22,  1. 
 27-64-10. Penalties. Any person violating the provisions of this chapter shall be subject to any and all enforcement procedures either currently employed or subsequently promulgated by the commissioner including, but not limited to, the imposition of fines, sanctions, or civil penalties, or an order to cease and desist from the establishment of additional protected cells. In no event shall the commissioner have the authority to cease the business of an existing protected cell, except by placement under administrative supervision or by order of rehabilitation, conservation or liquidation in accordance with the provisions of this chapter.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1. 
 27-64-11. No transaction of insurance business. A protected cell company insurance securitization shall not be deemed to be an insurance or reinsurance contract. An investor in a protected cell company insurance securitization shall not, by sole means of this investment, be deemed to be transacting an insurance business in this state. The underwriters or selling agents (and their partners, directors, officers, members, managers, employees, agents, representatives and advisors) involved in a protected cell company insurance securitization shall not be deemed to be conducting an insurance or reinsurance agency, brokerage, intermediary, advisory or consulting business by virtue of their activities in connection with those businesses.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1. 
 27-64-12. Rules. The commissioner may promulgate reasonable rules and regulations as may be necessary to effectuate the purposes of this chapter.  History of Section.P.L. 1999, ch. 22,  1. 
 27-64-2. Purpose. This act is adopted to provide a basis for the creation of protected cells by a domestic insurer as one means of accessing alternative sources of capital and achieving the benefits of insurance securitization or voluntary restructuring as contemplated under chapter 14.5 of this title, including through effectuating insurance business transfers in accordance with the procedures promulgated by the commissioner under  27-14.5-6. Investors in fully funded insurance securitization transactions provide funds that are available to pay the insurers insurance obligations or to repay the investors or both. The creation of protected cells is intended to be a means to achieve more efficiencies in conducting insurance securitizations or voluntary restructurings.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1; P.L. 2018, ch. 218,  3; P.L. 2018, ch. 290,  3. 
 27-64-3. Definitions. As used in this chapter: (1) Commissioner means the director of the department of business regulation.  (2) Domestic insurer means an insurance or reinsurance company domiciled in the state or a captive insurance or reinsurance company domiciled in the state.  (3) Fair value of an asset (or liability) means the amount at which that asset (or liability) could be bought (or incurred) or sold (or settled) in a current transaction between willing parties, that is, other than in a forced or liquidation sale. Quoted market prices in active markets are the best evidence of fair value and shall be used as the basis for the measurement, if available. If a quoted market price is available, the fair value is the product of the number of trading units times market price. If quoted market prices are not available, the estimate of fair value shall be based on the best information available. The estimate of fair value shall consider prices for similar assets and liabilities and the results of valuation techniques to the extent available in the circumstances. Examples of valuation techniques include the present value of estimated expected future cash flows using a discount rate commensurate with the risks involved, option-pricing models, matrix pricing, option-adjusted spread models, and fundamental analysis. Valuation techniques for measuring financial assets and liabilities and servicing assets and liabilities shall be consistent with the objective of measuring fair value. Those techniques shall incorporate assumptions that market participants would use in their estimates of values, future revenues, and future expenses, including assumptions about interest rates, default, prepayment, and volatility. In measuring financial liabilities and servicing liabilities at fair value by discounting estimated future cash flows, an objective is to use discount rates at which those liabilities could be settled in an arms-length transaction. Estimates of expected future cash flows, if used to estimate fair value, shall be the best estimate based on reasonable and supportable assumptions and projections. All available evidence shall be considered in developing estimates of expected future cash flows. The weight given to the evidence shall be commensurate with the extent to which the evidence can be verified objectively. If a range is estimated for either the amount or timing of possible cash flows, the likelihood of possible outcomes shall be considered in determining the best estimate of future cash flows.  (4) Fully funded means that, with respect to any exposure attributed to a protected cell, the fair value of the protected cell assets, on the date on which the insurance securitization is effected, equals or exceeds the maximum possible exposure attributable to the protected cell with respect to those exposures.  (5) General account means the assets and liabilities of a protected cell company other than protected cell assets and protected cell liabilities.  (6) Indemnity trigger means a transaction term by which relief of the issuers obligation to repay investors is triggered by its incurring a specified level of losses under its insurance or reinsurance contracts.  (7) Non-indemnity trigger means a transaction term by which relief of the issuers obligation to repay investors is triggered solely by some event or condition other than the individual protected cell company incurring a specified level of losses under its insurance or reinsurance contracts.  (8) Protected cell means an identified pool of assets and liabilities of a protected cell company segregated and insulated by means of this Act from the remainder of the protected cell companys assets and liabilities.  (9) Protected cell account means a specifically identified bank or custodial account established by a protected cell company for the purpose of segregating the protected cell assets of one protected cell from the protected cell assets of other protected cells and from the assets of the protected cell companys general account.  (10) Protected cell assets means all assets, contract rights, and general intangibles, identified with and attributable to a specific protected cell of a protected cell company.  (11) Protected cell company means a domestic insurer that has one or more protected cells.  (12) Protected cell company insurance securitization means the issuance of debt instruments, the proceeds from which support the exposures attributed to the protected cell, by a protected cell company, where repayment of principal and/or interest to investors pursuant to the transaction terms is contingent upon the occurrence or nonoccurrence of an event with respect to which the protected cell company is exposed to loss under insurance or reinsurance contracts it has issued.  (13) Protected cell liabilities means all liabilities and other obligations identified with and attributable to a specific protected cell of a protected cell company.  (14) Receiver means the commissioner, where the commissioner is acting as a rehabilitator, liquidator, or administrative supervisor of a company, or any person appointed to carry out an order of rehabilitation or liquidation of a company.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1. 
 27-64-4. Establishment of protected cells. (a) A protected cell company may establish one or more protected cells, with the prior written approval of the commissioner of a plan of operation or amendments to it submitted by the protected cell company with respect to each protected cell. Upon the written approval of the commissioner of the plan of operation, which shall include, but not be limited to, the specific business objectives and investment guidelines of the protected cell, the protected cell company may, in accordance with the approved plan of operations attribute to the protected cell amounts both reflective of insurance obligations with respect to its insurance business and obligations relating to the insurance securitization and assets to fund the obligations. Each protected cell of a protected cell company shall have its own distinct name or designation, which shall include the words protected cell. The protected cell company shall transfer all assets attributable to each protected cell to one or more separately established and identified protected cell accounts, bearing the name or designation of that protected cell. Protected cell assets shall be held in the protected cell accounts for the purpose of satisfying the obligations of that protected cell.  (b) All attributions of assets and liabilities between a protected cell and the general account shall be in accordance with the plan of operation approved by the commissioner or shall be otherwise approved by the commissioner. Unless otherwise approved by the commissioner, no other attribution of assets or liabilities may be made by a protected cell company between the protected cell companys general account and one or more of its protected cells. Any attribution of assets and liabilities between the general account and a protected cell, or from investors in the form of principal on a debt instrument issued by a protected cell company in connection with a protected cell company securitization shall be in cash or readily marketable securities with established market values unless otherwise approved in advance in writing by the commissioner.  (c) The creation of a protected cell does not create, in respect of that protected cell, a legal person separate from the protected cell company. Amounts attributed to a protected cell under this chapter, including assets transferred to a protected cell account, are owned by the protected cell company and the protected cell company may not be, nor hold itself out to be, a trustee with respect to those protected cell assets of that protected cell account. Notwithstanding the foregoing, the protected cell company may allow for a security interest to attach to protected cell assets or a protected cell account when in favor of a creditor of the protected cell and otherwise allowed under applicable law.  (d) Nothing in this chapter shall be construed to prohibit the protected cell company from contracting with or arranging for an investment advisor, commodity trading advisor, or other third party to manage the protected cell assets of a protected cell, provided that all remuneration, expenses, and other compensation of the third party advisor or manager are payable from the protected cell assets of that protected cell and not from the protected cell assets of other protected cells or the assets of the protected cell companys general account. The contract shall clearly reference the protected cell or cells for which the contract has been arranged and shall contain a non-recourse provision in favor of the company that prohibits the contracting party from seeking recourse against, or attaching, the assets of the general account, or the assets of another protected cell, to satisfy the obligations of any one or more protected cells which are the subject of the contract.  (e) A protected cell company shall establish any administrative and accounting procedures that are necessary to properly identify the one or more protected cells of the protected cell company and the protected cell assets and protected cell liabilities attributable to the protected cells. It shall be the duty of the directors of a protected cell company to: (1) keep protected cell assets and protected cell liabilities separate and separately identifiable from the assets and liabilities of the protected cell companys general account, and (2) to keep protected cell assets and protected cell liabilities attributable to one protected cell separated and separately identifiable from protected cell assets and protected cell liabilities attributable to other protected cells. Notwithstanding the foregoing, and subject to the provisions of  27-64-10, if this section is violated, the remedy of tracing shall be applicable to protected cell assets when commingled with protected cell assets of other protected cells or the assets of the protected cell companys general account. The remedy of tracing shall not be construed as an exclusive remedy.  (f) Unless otherwise approved by the commissioner, the protected cell company shall, when establishing a protected cell, attribute to the protected cell assets with a value at least equal to the reserves and other insurance liabilities attributed to that protected cell.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1. 
 27-64-5. Use and operation of protected cells. (a) The protected cell assets of any protected cell may not be charged with liabilities arising out of any other business the protected cell company may conduct. All contracts or other documentation reflecting protected cell liabilities shall clearly indicate that only the protected cell assets are available for the satisfaction of those protected cell liabilities.  (b) Unless otherwise approved by the commissioner, assets attributed to a protected cell shall be valued at their fair value on the date of valuation.  (c) The income, gains and losses, realized or unrealized, from protected cell assets and protected cell liabilities shall be credited to or charged against the protected cell without regard to other income, gains, or losses of the protected cell company, including income, gains, or losses of other protected cells. Amounts attributed to any protected cell and accumulations on the attributed amounts may be invested and reinvested without regard to any requirements or limitations imposed on investments of insurance companies domiciled in this state and the investments in any protected cell or cells may not be taken into account in applying the investment limitations otherwise applicable to the investments of the protected cell company, subject to any restrictions that may be imposed by the commissioner in accordance with  27-64-12.  (d) As permitted by the commissioner, a protected cell company may, in respect of any of its protected cells, engage in fully funded indemnity triggered and/or fully funded non-indemnity triggered insurance securitization to support in full the protected cell exposures attributable to that protected cell. A protected cell company insurance securitization that is non-indemnity triggered shall qualify as an insurance securitization under the terms of this chapter only after the commissioner, in accordance with the authority granted under  27-64-12, adopts regulations addressing the methods of funding of the portion of the risk that is not indemnity based, accounting, disclosure, risk based capital treatment, and assessing risks associated with those securitizations. A protected cell company insurance securitization that is not fully funded, whether indemnity triggered or nonindemnity triggered is prohibited. Protected cell assets may be used to pay interest or other consideration on any outstanding debt or other obligation attributable to that protected cell, and nothing in this section shall be construed or interpreted to prevent a protected cell company from entering into a swap agreement or other transaction for the account of the protected cell that has the effect of guaranteeing that interest or other consideration.  (e) In all protected cell company insurance securitizations, the contracts or other documentation effecting the transaction shall contain provisions identifying the protected cell to which the transaction will be attributed. In addition, the contracts or other documentation shall clearly disclose that the assets of that protected cell, and only those assets, are available to pay the obligations of that protected cell. Notwithstanding the foregoing, and subject to the provisions of this chapter and any other applicable law, rule or regulation, the failure to include that language in the contracts or other documentation shall not be used as the sole basis by creditors, reinsurers or other claimants to circumvent the provisions of this chapter.  (f) At the cessation of business of a protected cell, and in absence of any placement under administrative supervision or order of conservation, rehabilitation or liquidation attributable to that protected cell or the protected cell company, the protected cell company shall voluntarily close out the protected cell account in accordance with a plan approved by the commissioner.  (g) A protected cell company shall only be authorized to attribute to a protected cell account the insurance obligations relating to the protected cell companys general account. Under no circumstances shall a protected cell be authorized to issue insurance or reinsurance contracts directly to policyholders or reinsureds or have any obligation to the policyholders or reinsureds of the protected cell companys general account.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1. 
 27-64-6. Reach of creditors and other claimants. (a)(1) Protected cell assets shall only be available to the creditors of the protected cell company that are creditors in respect to that protected cell and shall be entitled, in conformity with the provisions of this chapter, to have recourse to the protected cell assets attributable to that protected cell, and shall be absolutely protected from the creditors of the protected cell company that are not creditors in respect of that protected cell and, who accordingly, shall not be entitled to have recourse to the protected cell assets attributable to that protected cell. Creditors with respect to a protected cell shall not be entitled to have recourse against the protected cell assets of other protected cells or the assets of the protected cell companys general account.  (2) Protected cell assets shall only be available to creditors of a protected cell company after all protected cell liabilities have been extinguished or provided for in accordance with the plan of operation relating to that protected cell.  (b) When an obligation of a protected cell company to a person arises from a transaction, or is imposed, in respect of a protected cell: (1) That obligation of the protected cell company shall extend only to the protected cell assets attributable to that protected cell, and the person shall, with respect to that obligation, be entitled to have recourse only to the protected cell assets attributable to that protected cell; and (2) That obligation of the company shall not extend to the protected cell assets of any other protected cell or the assets of the protected cell companys general account, and that person shall not, with respect to that obligation, be entitled to have recourse to the protected cell assets of any other protected cell or the assets of the protected cell companys general account.  (c) When an obligation of a protected cell company relates solely to the general account, the obligation of the protected cell company shall extend only to, and that creditor shall, with respect to that obligation, be entitled to have recourse only to the assets of the protected cell companys general account.  (d) Other than with regard to the application of this section, the activities, assets, and obligations relating to a protected cell are not subject to the provisions of chapters 34, 34.1, and 34.3 of this title and neither a protected cell nor a protected cell company shall be assessed by or be required to contribute to any guaranty fund or guaranty association in this state with respect to the activities, assets or obligations of a protected cell. Nothing in this section shall affect the activities or obligations of an insurers general account.  (e) In no event shall the establishment of one or more protected cells alone constitute or be deemed to be a fraudulent conveyance; an intent by the protected cell company to defraud creditors; or the carrying out of business by the protected cell company for any other fraudulent purpose.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1; P.L. 2008, ch. 475,  97; P.L. 2017, ch. 389,  2; P.L. 2017, ch. 434,  2. 
 27-64-7. Conservation, rehabilitation and liquidation of protected cell companies. (a) Notwithstanding any contrary provision in the insurance code of this state, the rules and regulations promulgated under the insurance code, or any other applicable law or regulation, upon placement under administrative supervision or upon any order of conservation, rehabilitation or liquidation of a protected cell company, the receiver shall be bound to deal with the protected cell companys assets and liabilities including protected cell assets and protected cell liabilities in accordance with the requirements set forth in this chapter.  (b) With respect to amounts recoverable under a protected cell company insurance securitization, the amount recoverable by the receiver shall not be reduced or diminished as a result of the placement under administrative supervision or entry of an order of conservation, rehabilitation or liquidation with respect to the protected cell company or any of its protected cells, notwithstanding any provisions to the contrary in the contracts or other documentation governing the protected cell company insurance securitization.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1. 
 27-64-8. Rehabilitation and liquidation of protected cells. (a) If in relation to one or more protected cells of a protected cell company, the commissioner is satisfied that the protected cell assets attributable to that protected cell are insufficient to discharge the claims of creditors or other claimants with respect to that protected cell, the commissioner may place under administrative supervision or apply for an order of conservation, rehabilitation or liquidation with respect to that protected cell. In carrying out the administrative supervision, conservation, rehabilitation, or liquidation of a protected cell, the receiver shall follow generally the provisions of chapters 1, 12.2 and 14.1  14.4 of this title, as applicable, and any rules and regulations promulgated under those chapters, except that at all times the receiver shall be bound to deal with the protected cell assets and protected cell liabilities in accordance with the requirements of this chapter.  (b) An order of rehabilitation or conservation may not be requested or made with respect to any protected cell of a protected cell company if a receiver has been appointed to act in respect of a protected cell company and the commissioner may still apply for an order of liquidation with respect to that protected cell. Any prior order of rehabilitation or conservation with respect to a protected cell shall cease to be of effect upon an order of rehabilitation with respect to the protected cell company, without prejudice to the prior acts of the receiver or its agents.  (c) An order of rehabilitation, conservation or liquidation may not be requested or made with respect to any protected cell of a protected cell company if a liquidator has been appointed to act in respect of the protected cell company. Any prior order of rehabilitation, conservation or liquidation with respect to a protected cell shall cease to be of effect upon an order of liquidation with respect to the protected cell company, without prejudice to the prior acts of the receiver or its agent.  (d) During any period of conservation or rehabilitation, or upon an order of liquidation, with respect to a protected cell, the directors of the protected cell company shall cease in respect of the business of, and the protected cell assets and protected cell liabilities attributable to the protected cell, which is the subject of the rehabilitation, conservation or liquidation.  (e) In the event that a petition for an order of rehabilitation, conservation or liquidation of a protected cell is challenged, prior to the entry or denial of the order, the directors of the protected cell company shall cease in respect of the business of, and the protected cell assets and protected cell liabilities attributable to, the protected cell which is the subject of the petition and the commissioner shall carry out the business of the protected cell until the order has been entered or denied. In the event the order is denied, the commissioner shall immediately return possession and control of the protected cell to the directors of the protected cell company.  (f) No resolution for the voluntary winding up of a protected cell company with any protected cell which has been placed under administrative supervision or is the subject of an order of rehabilitation, conservation or liquidation shall be effective without permission of the commissioner and, in the case of rehabilitation, conservation or liquidation, the court supervising the rehabilitation, conservation or liquidation.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1. 
 27-64-9. Remuneration of receivers. (a) With respect to orders of rehabilitation, conservation or liquidation directed at a protected cell company, the remuneration, expenses, and other compensation of the receiver shall be payable from the assets of the companys general account, in accordance with the priority of distribution set forth in  27-14.3-46 and 27-14.4-22.  (b) With respect to orders of rehabilitation, conservation or liquidation directed at a protected cell, the remuneration, expenses, and other compensation of the receiver shall be payable from the protected cell assets attributable to that protected cell. In the case where more than one protected cell is the subject of the order, the receiver shall account for remuneration, expenses, and other compensation separately for each protected cell in accordance with actual time and expenses attributable to the rehabilitation, conservation or liquidation of each respective protected cell.  (c) With respect to orders of rehabilitation, conservation or liquidation directed at a protected cell company during a pending rehabilitation, conservation or liquidation of one or more protected cells, the remuneration, expenses, and other compensation of the receiver of the protected cells shall be satisfied from the protected cell assets of the protected cell or cells in accordance with the provisions of subsection (b) of this section, and the remuneration, expenses, and other compensation of the receiver of the protected cell company shall be satisfied from the assets of the companys general account.  History of Section.P.L. 1999, ch. 22,  1; P.L. 2001, ch. 156,  1. 
 27-65-1. Commercial special risks. (a) Commercial special risks. Notwithstanding any other provisions of this title to the contrary and except as limited in subsection (b) of this section, insurers shall not be required to file with, nor to receive approval from, the insurance division of the department of business regulation for policy forms or rates used in the insurance of commercial special risks located in this state. Commercial special risks are defined as:  (1) Risks written as commercial lines insurance, defined as insurance issued for purposes other than for personal, family, or household and that are written on an excess or umbrella basis;  (2) Those risks, or portions of them, written as commercial lines insurance, defined as insurance issued for purposes other than for personal, family, or household and that are not rated according to manuals, rating plans, or schedules including A rates;  (3) Risks written as commercial lines insurance that employ or retain the services of a risk manager and that also meet any one of the following criteria:  (i) Net worth over ten million dollars ($10,000,000);  (ii) Net revenue/sales of over five million dollars ($5,000,000);  (iii) More than twenty-five (25) employees per individual company or fifty (50) employees per holding company in the aggregate;  (iv) Aggregates premiums of over thirty thousand dollars ($30,000), excluding group life, group health, workers compensation and professional liability (including, but not limited to, errors and omissions and directors and officers liability);  (v) Is a not for profit or public entity with an annual budget or assets of at least twenty-five million dollars ($25,000,000); or  (vi) Is a municipality with a population of over twenty thousand (20,000);  (4) Specifically designated commercial special risks including:  (i) All risks classified as highly protected risks.  Highly protected risk means a fire resistive building that meets the highest standards of fire safety according to insurance company underwriting requirements;  (ii) All commercial insurance aviation risks;  (iii) All credit property insurance risks that are defined as insurance of personal property of a commercial debtor against loss, with the creditor as sole beneficiary or insurance of personal property of a commercial debtor, with the creditor as primary beneficiary and the debtor as beneficiary of proceeds not paid to the creditor. For the purposes of this definition, personal property means furniture, fixtures, furnishings, appliances, and equipment designed for use in a business, trade, or profession and not used by a debtor for personal or household use;  (iv) All boiler and machinery and equipment breakdown risks;  (v) All inland marine risks written as commercial lines insurance defined as insurance issued for purposes other than for personal, family, or household;  (vi) All fidelity and surety risks;  (vii) All crime and burglary and theft risks; and  (viii) All directors and officers, fiduciary liability, employment practices liability, kidnap and ransom, and management liability risks.  (b) Notwithstanding subsection (a) of this section, the following lines of business shall remain subject to all filing and approval requirements contained in this title even if written for risks which qualify as commercial special risks:  (1) Life insurance;  (2) Annuities;  (3) Accident and health insurance;  (4) Automobile insurance that is mandated by statute;  (5) Workers compensation and employers liability insurance; and  (6) Issuance through residual market mechanisms.  (c) Any insurer that provides coverage to a commercial special risk shall disclose to the insured that forms used and rates charges are exempt from filing and approval requirements by this section. Records of all such disclosures shall be maintained by the insurer.  (d) Brokers for exempt commercial policyholders as defined in subsection (a)(3) of this section shall be exempt from the due diligence requirements of  27-3-38(c).  (e) Notwithstanding any other provisions of this title, the requirements of  27-5-2 shall not apply to any policy insuring one or more commercial special risks located in this state.  History of Section.P.L. 1999, ch. 47,  1; P.L. 2002, ch. 292,  94; P.L. 2004, ch. 52,  2; P.L. 2004, ch. 60,  2; P.L. 2004, ch. 91,  1; P.L. 2004, ch. 320,  1; P.L. 2006, ch. 108,  1; P.L. 2006, ch. 138,  1; P.L. 2011, ch. 18,  3; P.L. 2011, ch. 25,  3; P.L. 2015, ch. 82,  14; P.L. 2015, ch. 105,  14; P.L. 2022, ch. 404,  6, effective June 30, 2022; P.L. 2022, ch. 405,  6, effective June 30, 2022. 
 27-65-2. Risk manager defined. As used in this chapter, risk manager means a full-time employee of, or a person certified and licensed and retained by, an exempt commercial policyholder who is qualified through: (1) education and experience; or (2) training and experience; to assess an exempt commercial policyholders insurance needs and analyze and negotiate a policy of insurance and having primary responsibility or oversight of the risk management activities/function of an exempt commercial policyholder. A risk manager shall not receive commission, fees, or other consideration from the insurer in connection with the purchase of a commercial policy of insurance by the exempt commercial policyholder.  History of Section.P.L. 1999, ch. 47,  1. 
 27-66-1. Short title. This chapter shall be known and may be cited as The Health Insurance Conversions Act.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-10. Investigation  Notice to attend  Court order to appear  Contempt. (a) The director and/or the department of the attorney general may conduct investigations in discharging the duties required under this chapter. For purposes of this investigation the director or the attorney general may require any person, agent, trustee, fiduciary, consultant, institution, association, or corporation directly related to the proposed conversion to appear at any time and place that the director or the attorney general may designate, then and there under oath to produce for the use of the director or the attorney general any and all documents and other information.  (b) Whenever the director or the attorney general may require the attendance of any person as provided in subsection (a) of this section, the director or the attorney general shall issue a notice setting the time and place when the attendance is required and shall cause the notice to be delivered or sent by registered or certified mail to the person at least fourteen (14) days before the date fixed in the notice for the attendance.  (c) If any person receiving notice pursuant to this provision neglects to attend or remain in attendance so long as may be necessary for the purposes for which the notice was issued, or refuses to produce information requested, any justice of the superior court for the county within which the inquiry is carried on or within which the person resides or transacts business, upon application by the director or the attorney general, or any transacting party shall have jurisdiction to hear and consider on an expedited basis the request, and if appropriate and relevant to the consideration of proposed conversion, may issue to the person an order requiring the person to appear before the director or the attorney general there to produce for the use of the director or the attorney general evidence in accordance with the terms of the order of the court, and any failure to obey the order of the superior court may be punished by the court as contempt of court.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-11. Perjury. Any person who is found to have testified falsely under oath before the general assembly, department of business regulation or department of attorney general, pursuant to this chapter shall be subject to prosecution for perjury and be subject to the penalties set forth in  11-33-1.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-12. Licensing fees. Nothing contained in this chapter shall be deemed to affect the licensing fees set forth in chapters 19, 20 and 41 of this title.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-13. Concurrent approval  License. A decision of the director required by this chapter shall be subject to chapter 35 of title 42. For any conversion subject to this chapter, the director may combine any hearings required by this chapter with any hearings on similar or related matters required by chapters 19, 20 and 41 of this title and shall consider issues of market share especially as they affect quality, access, and affordability of service.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-14. No derogation of attorney general. (a) No provision of this chapter shall derogate from the common law or statutory authority of the attorney general nor shall any provision be construed as a limitation on the common law or statutory authority of the attorney general, including the authority to investigate at any time charitable trusts for the purpose of determining and ascertaining whether they are being administered in accordance with law and with the terms and purposes of those trusts.  (b) No provision of this chapter shall be construed as a limitation on the application of the doctrine of cy pres or any other legal doctrine applicable to charitable assets and/or charitable trusts.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-15. Distribution of proceeds from acquisition  Selection and establishment of an independent foundation. (a) In the event of the approval of a conversion involving a not for profit corporation, as an acquiree, it may be required that the proceeds from the sale and any endowments, restricted, unrestricted and specific purpose funds may be transferred to a charitable foundation established in this section.  (b) The determination whether the proceeds of the conversion shall be transferred to the foundation established in this section shall be made pursuant to the common law doctrine of cy pres and chapter 4 of title 18.  (c) The board of directors shall consist of an executive director, who shall serve ex-officio, and nine (9) members, all of whom shall be citizens and residents of this state and none of whom shall be members of the general assembly, and three (3) of whom shall be appointed by the governor, three (3) of whom shall be appointed by the speaker of the house and three (3) of whom shall be appointed by the president of the senate. The board members may include one or more members with experience in matters including financial, legal, business, labor, health care delivery, investments, community purpose, grant-making, health insurance and members who represent diverse populations of the affected community and not more than three (3) members of the board may be prior board members of the acquiree.  (d) The members shall be appointed for terms of three (3) years except for the three (3) members originally appointed by each of the appointing authorities; one shall be appointed for a term of one year, one shall be appointed for a term of two (2) years and one for a term of three (3) years. The board shall annually elect a chairperson from among its members and other officers it deems necessary for the performance of its duties and board members shall not receive compensation.  (e) Control of the distribution of the proceeds of the fund is vested solely in the board provided, the investment responsibility shall be through the Rhode Island Foundation, or similar foundation.  (f) Vacancies occurring on the board may be filled by a majority vote of the remaining board members.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1; P.L. 2001, ch. 180,  58. 
 27-66-16. Powers and duties of the board. The board is vested with full power, authority, and jurisdiction over the foundation and may perform all acts necessary or convenient in the exercise of any power, authority, or jurisdiction over the foundation; including the power to intervene in any cy pres proceeding involving the transfer of proceeds from health care conversion in order to seek their transfer to the foundation, or as an amicus curiae.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-17. Personal liability excluded. The members of the board and officers or employees of the foundation are not liable personally, either jointly or severally, for any debt or obligation created or incurred by the foundation unless that conduct is deemed to be gross misconduct or reckless.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-18. Implementation. (a) The attorney general may take all steps necessary to effectuate the purposes of  27-66-15 and the board shall be appointed no more than sixty (60) days after the completion of the conversion. The board shall act promptly to appoint an executive director, hire any staff as necessary, and acquire necessary facilities and supplies to begin the operation of the foundation;  (b) The board shall conduct a public hearing to solicit comments on the proposed mission statement, program agenda, corporate structure, and strategic planning. The board shall hold a public hearing within one hundred eighty (180) days of establishment of the board and on an annual basis after this.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-19. Annual report. The board shall submit an annual report and a copy of Form 990 as required by the Internal Revenue Service to the governor, the attorney general and the legislature.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-2. Findings. The general assembly finds and declares that: (1) Rhode Island has a proud history of health insurance companies including health insurance corporations, health maintenance organizations, non-profit hospital service corporations, and non-profit medical service corporations doing business in this state;  (2) Nationally and regionally private investment is being made that results in the conversion of not-for-profit into for-profit health insurance corporations, health maintenance organizations, hospital service corporations and medical service corporations;  (3) These health insurance organizations and corporations provide an important health insurance product in the community. There are concerns that for profit health insurance organizations and corporations may engage in practices that affect the quality of the insurance coverage in the community as a whole and for more vulnerable members of society in particular;  (4) In order to protect public health and welfare, it is necessary to establish standards and procedures for health insurance organizations and corporation conversions.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-20. General powers and limitations. For the purposes of exercising the specific powers granted in this chapter and effectuating the other purposes of this chapter, the foundation:  (1) May be sued and sue;  (2) May have a seal and alter it at will;  (3) May make, amend, and repeal rules relating to the conduct of the business of the foundation;  (4) May enter into contracts relating to the administration of the foundation;  (5) May rent, lease, buy or sell property in its own name and may construct or repair buildings necessary to provide space for its operations;  (6) May hire personnel, consultants and experts and set salaries; and  (7) May perform all other functions and exercise all other powers that are necessary, appropriate or convenient to administer the foundation.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-21. Failure to comply  Penalties. If any person knowingly violates or fails to comply with any provision of this chapter or willingly or knowingly gives false or incorrect information:  (1) The director may, after notice and opportunity for a prompt and fair hearing to the applicant or licensee, deny, suspend or revoke a license, or to take corrective action necessary to secure compliance under this chapter; or  (2) The superior court, after notice and opportunity for a prompt and fair hearing, may impose a fine of not more than one hundred thousand dollars ($100,000) or impose a prison term of not more than five (5) years.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1; P.L. 2009, ch. 310,  10. 
 27-66-22. Powers of the department of business regulation. The department may adopt rules, including measurable standards, as may be necessary to accomplish the purpose of this chapter.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-23. Determination of confidentiality by the department of business regulation. The director shall have the power to decide whether any information required by this chapter of an applicant is confidential and/or proprietary. The decisions by the department of business regulation shall be made prior to any public notice of an initial application or any public review of the information.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-24. Exceptions  Rehabilitation, liquidation or conservation. No proposed conversion shall be subject to this chapter in the event that the health insurance corporation, health maintenance corporation, a nonprofit hospital service corporation, nonprofit medical service corporation or affiliate or subsidiary of them is subject to an order from the superior court directing the director to rehabilitate, liquidate or conserve, as provided in  27-19-28, 27-20-24, 27-41-18, or chapter 14.1, 14.2,14.3 or 14.4 of this title.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1; P.L. 2002, ch. 292,  95. 
 27-66-25. Applicability. The acquirors shall be subject to the provisions of chapters 17.12 and 17.13 of title 23.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-26. Conflict of law. The provisions of this chapter shall supersede the provisions of chapters 19, 20, and 41 of this title in conflict with this chapter. Except as expressly provided in this chapter, this chapter shall supersede chapter 35 of this title with respect to conversions subject to this chapter, except for conversions involving domestic insurance companies subject to chapter 1 of this title, which conversion shall be subject to chapter 35 of this title.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-27. Severability. If any provision of this chapter or its application to any person or circumstances is held invalid, that invalidity shall not affect other provisions or applications of the chapter, which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared to be severable.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-3. Applicability. This chapter shall apply to health insurance corporations subject to chapter 1 of this title, nonprofit hospital or medical service corporations subject to chapters 19 or 20 of this title, and health maintenance organizations incorporated or resident in the state of Rhode Island.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-4. Definitions. For purposes of this chapter: (1) Acquiree means the person or persons which lose(s) any ownership or control in a health insurance corporation, health maintenance organization, non-profit hospital service corporations and non-profit medical service corporations;  (2) Acquiror means the person or persons which gain(s) an ownership or control in a health insurance corporation, health maintenance organization, non-profit hospital service corporation and non-profit medical service corporation;  (3) Conversion means any transfer by a person or persons of an ownership or membership interest or authority in a health insurance corporation, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation or the assets of these corporations, whether by purchase, merger, consolidation, lease, gift, joint venture, sale, or other disposition which results in a change of ownership or control or possession of twenty percent (20%) or greater of the members or voting rights or interests of the health insurance corporation, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation or of the assets of the health insurance corporation, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation or pursuant to which, by virtue of the transfer, a person, together with all persons affiliated with that person, holds or owns, in the aggregate, twenty percent (20%) or greater of the membership or voting rights or interests of the health insurance corporations, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation or of the assets of the health insurance organization, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation or the removal, addition or substitution of a partner which results in a new partner gaining or acquiring a controlling interest in the health insurance organization, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation or any change in membership which results in a new person gaining or acquiring a controlling vote in the health insurance corporation, health maintenance organization non-profit hospital service corporation, or non-profit medical service corporation;  (4) Department means the department of business regulation;  (5) Director means the director of the department of business regulation;  (6) Existing health insurance corporation, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation means the health insurance corporation, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation as it exists prior to the acquisition;  (7) For profit corporation means a legal entity formed for the purpose of transacting business which has as any one of its purposes pecuniary profit;  (8) Health insurance corporation means any insurance company subject to chapter 1 of this title of the general laws that offers health insurance in Rhode Island except that health insurance corporation shall not include companies whose health insurance policies only cover one or more of the following: disability income, long term care, legal services, hospital confinement indemnity, specified disease indemnity, sickness or bodily injury by accident or other limited health benefits.  (9) Mutual insurance company means a corporation in which shares are held exclusively by members to whom profits are distributed as dividends and members are both the insurer and the insured.  (10) New health insurance corporations, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation means the health insurance corporations, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation as it exists after the completion of a conversion;  (11) Not-for-profit corporation means a corporation subject to chapter 6 of title 7, including any corporation organized under special provisions of the general laws or under a private act which is declared to be a charitable corporation.  (12) Person means any individual, trust or estate, partnership, joint venture, corporation, whether for profit or not for profit, (including associations, mutual insurance companies, joint stock companies and insurance companies);  (13) Subscriber means those persons or groups of persons who shall contract with a health insurance corporation, health maintenance organization, nonprofit hospital service corporation or nonprofit medical service corporation for health insurance.  (14) Transacting parties means any person or persons who seeks either to transfer or acquire ownership or a controlling interest or controlling authority in a health insurance corporation, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation which would result in a change of ownership, control or authority of twenty percent (20%) or greater.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-5. Prior approval required  Department of business regulation. A conversion shall require review and approval from the department of business regulation, after a public hearing, in accordance with the provisions of this chapter.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-6. Initial application  Conversions. (a) No person shall engage in a conversion involving the establishment, maintenance, or operation of a health insurance corporation, health maintenance organization, non-profit hospital service corporation or non-profit 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, non-profit hospital service corporation or non-profit 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 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 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 (13) 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, non-profit hospital service corporation or non-profit 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 generals report shall be considered public records and shall be available for inspection upon request.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-7.1. Certain financial incentives prohibited. It being generally contrary to the public interest to lose local control of a nonprofit health insurer providing the majority of private health insurance coverage within the state, and such payments as are herein forbidden providing inducements to do so for personal gain, no officer, director or senior management employee of a nonprofit hospital and/or medical service corporation or of any subsidiary of such corporation shall solicit, accept, receive or maintain claim of right to any financial incentive, including any pecuniary reward, based in whole or in part on the contingency of, or as a result of, the completion of a conversion. For purposes of this section, pecuniary award includes, but is not limited to, bonuses, cash payouts, deferred payments, stock options and enhanced retirement packages. Nothing in this section shall be deemed to prohibit the employment of such an officer, director or employee by a successor corporation or entity following the completion of a conversion, nor to prohibit reasonable severance payments where no conversion is involved.  History of Section.P.L. 2004, ch. 330,  3; P.L. 2004, ch. 567,  3. 
 27-66-7. Review process and review criteria by department of attorney general  Conversions. (a) The department of attorney general shall review all conversions involving a health insurance corporation, health maintenance organization non-profit hospital service corporation or non-profit medical service corporation.  (b) The department of attorney general shall, within twenty (20) days of its receipt of an initial application, inform the department of business regulation and/or the applicant of any additional information necessary to its ability to prepare the detailed report required under subsections (d) and (e) of this section.  (c) Upon receipt by the department of attorney general of the additional information requested in  27-66-7(b), the application shall be deemed complete.  (d) The department of attorney general shall transmit, within sixty (60) days of the receipt of the completed application, a detailed report of its findings to the department of business regulation.  (e) The report of the department of the attorney general shall address each of the following criteria:  (1) Whether any conflict of interest exists concerning the proposed conversion relative to the officers, directors, senior management, experts or consultants engaged in connection with the proposed conversion including, but not limited to attorneys, accountants, investment bankers, actuaries, health care experts, or industry analysts;  (2) Whether individuals described in subdivision (1) of this subsection were provided with contracts or consulting agreements or arrangements that included pecuniary rewards based in whole, or in part on the contingency of the completion of the conversion;  (3) Whether any members of the board of directors will retain any authority in the new health insurance corporation, health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation;  (4) Whether individual officers, directors, or senior management engaged legal counsel to consider their individual rights or duties in acting in their capacity as a fiduciary in connection with the proposed conversion;  (5) Whether the conversion is proper under the Rhode Island Nonprofit Corporation Act, chapter 6 of title 7;  (6) Whether the conversion is proper under applicable state tax code provisions;  (7) Whether the individuals who represented the existing health maintenance organization, non-profit hospital service corporation or non-profit medical service corporation in negotiations avoided conflicts of interest;  (8) Whether the proposed conversion results in an abandonment of the original purposes of the acquiree or whether a resulting entity will depart from the traditional purposes and mission of the acquiree such that a cy pres proceeding would be necessary; (9) Whether the proposed conversion jeopardizes the tax status of the acquiree;  (10) Whether the transacting parties are in compliance with the Charitable Trust Act, chapter 9 of title 18;  (11) Whether the proposed conversion will harm the publics interest in trust property given, devised, or bequeathed to the acquiree for charitable, educational or religious purposes located or administered in this state;  (12) Whether a trustee or trustees of any charitable trust located or administered in this state will be deemed to have exercised reasonable care, diligence, and prudence in performing as a fiduciary in connection with the proposed conversion; and  (13) Whether the proposed conversion appropriately provides for the disposition of proceeds of the conversion, which may include, but not be limited to:  (i) Whether an existing entity or a new entity will receive the proceeds;  (ii) Whether appropriate tax status implications of the entity receiving the proceeds have been considered;  (iii) Whether the mission statement and program agenda will be or should be closely related with the purposes of the mission of the acquiree;  (iv) Whether any conflicts of interest arise in the proposed handling of the conversions proceeds;  (v) Whether the bylaws and articles of incorporation have been prepared for the new entity;  (vi) Whether the board of any continuing entity will be independent from the new entity;  (vii) Whether the method for selecting board members, staff, and consultants is appropriate;  (viii)Whether the board will comprise an appropriate number of individuals with experience in pertinent areas such as foundations, health care, business, labor, community programs, financial management, legal, accounting, grant making and public members representing diverse ethnic populations of the affected community; and  (ix) Whether the size of the board and proposed length of board terms are sufficient.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-8. Review process and review criteria by department of business regulation for conversions. (a) The department shall review all proposed conversions involving a health insurance corporation, health maintenance organization, non-profit hospital service corporation or a non-profit medical service corporation.  (b) In reviewing proposed conversions in accordance with subsection (a) of this section the department shall adhere to the following process:  (1) Within ten (10) working days after receipt of two (2) copies of an initial application pursuant to  27-66-6, the department shall publish notice of the application in a newspaper of general circulation in the state and shall notify by United States mail any person who has requested notice of the filing of the application. The notice shall state: (i) that an initial application has been received, (ii) the names of the transacting parties, (iii) the date by which a person may submit written comments to the department, and (iv) shall provide notice of the date, time and place of a public hearing;  (2) Within thirty (30) days after receipt of an initial application, the department shall advise the applicant in writing whether the application is complete, and, if not, shall specify what additional information is required;  (3) The department shall, upon receipt of information requested in subdivision (2) of this subsection, notify the applicant in writing of the date of completion of the application;  (4) The department shall approve, approve with conditions directly related to the proposed conversion, or disapprove the application within ninety (90) days of the date of completion of the application;  (c) In reviewing an application for a conversion involving health insurance corporations, health maintenance organizations, non-profit hospital service corporations, or non-profit medical service corporations the department shall consider the following criteria:  (1) Whether the proposed conversion provides reasonable assurance that the entity surviving after the conversion will be financially viable and competently managed;  (2) Whether the character, commitment, competence, and standing in the community, or any other communities served by the proposed transacting parties, are satisfactory;  (3) Whether the transacting parties have made a commitment to assure the continuation of collective bargaining rights, if applicable, and retention of the workforce;  (4) Whether the transacting parties have appropriately accounted for employment needs at the facility and addressed workforce retraining needed as a consequence of any proposed restructuring;  (5) Whether the acquiror has demonstrated that it has satisfactorily met the terms and conditions of approval for any previous conversion pursuant to an application submitted under  27-66-5.  (6) Whether the acquiree established appropriate criteria in deciding to pursue a conversion in relation to carrying out its mission and purposes;  (7) Whether the acquiree formulated and issued appropriate requests for proposals in pursuing a conversion;  (8) Whether the acquiree considered the proposed conversion as the only alternative or as the best alternative in carrying out its mission and purposes;  (9) Whether the acquiree exercised due care in engaging consultants with the appropriate level of independence, education, and experience in similar conversions;  (10) Whether the acquiree exercised due care in accepting assumptions and conclusions provided by consultants engaged to assist in the proposed conversion;  (11) Whether the acquiree accepted fair consideration and value for any management contracts made part of the proposed conversion;  (12) Whether the proposed conversion contemplates the appropriate and reasonable fair market value;  (13) Whether the proposed conversion was based upon appropriate valuation methods including, but not limited to, market approach, third party report or fairness opinion;  (14) Whether officers, directors, or senior management deliberately acted or failed to act in a manner that impacted negatively on the value or purchase price;  (15) Whether the board exposed an inappropriate amount of assets by accepting in exchange for the proposed conversion future or contingent value based upon success of the new health insurance corporations, health maintenance organizations, nonprofit hospital service corporations, and nonprofit medical service corporations;  (16) Whether the formula used in determining the value of the acquiree was appropriate and reasonable which may include, but not be limited to, factors such as: the multiple factor applied to the EBITDA: earnings before interest, taxes, depreciation, and amortization; the time period of the evaluation; price/earnings multiples; the projected efficiency differences between the acquiree and the new entity and the historic value of any tax exemptions granted to the acquiree;  (17) Whether the transacting parties have made a commitment: (i) to honor existing contracts with subscribers, businesses and providers, and (ii) to satisfy outstanding liabilities to providers through a formal account reconciliation process;  (18) Whether a right of first refusal to repurchase the assets has been retained;  (19) Whether a control premium is an appropriate component of the proposed conversion;  (20) Whether the value of assets factored in the conversion is based on past performance or future potential performance;  (21) Whether the board exercised due care in assigning a value to the acquiree and its charitable assets in proceeding to negotiate the proposed conversion;  (22) Any criteria delineated in  27-35-2(d)(1) which the department deems applicable and appropriate.  (23) The detailed report submitted to the department of business regulation, by the department of the attorney general; and  (24) Any other criteria the department deems relevant to its investigation;  (25) Whether the transacting parties have made a commitment to assure access to care for insured, underinsured and uninsured members of the community;  (26) Whether the proposed conversion negatively impacts on the quality and reliability of health services.  (d) In considering the criteria in subsection (c), the department shall assign any weight and importance that it deems necessary and appropriate under the circumstances to carry out the purposes of this chapter.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-66-9. Reports, use of experts, costs. The department of business regulation and/or the department of the attorney general may, in effectuating the purposes of this chapter engage experts or consultants including, but not limited to, actuaries, investment bankers, accountants, attorneys, or industry analysts. All copies of reports prepared by experts and consultants, and costs associated with them, shall be made available to the transacting parties and to the public. All costs incurred under this provision shall be the responsibility of one or more transacting parties in an amount to be determined by the director as he or she deems appropriate. No application for a conversion made pursuant to the requirements of this chapter shall be considered complete unless an agreement has been executed with the director for the payment of costs in accordance with this section.  History of Section.P.L. 1999, ch. 215,  1; P.L. 1999, ch. 376,  1. 
 27-67-1. Short title. This chapter shall be known and may be cited as The Health Insurance Market Expansion Act.  History of Section.P.L. 2004, ch. 383,  1. 
 27-67-2. Findings. The general assembly finds and declares that: (1) Rhode Island has a proud history of health insurance companies including health insurance corporations, health maintenance organizations, nonprofit hospital service corporations, and nonprofit medical service corporations doing business in this state;  (2) Nationally and regionally, insurance corporations, health maintenance organizations, hospital service corporations and medical service corporations, are being consolidated or are departing from some state insurance markets. Rhode Island is one of twelve (12) states with three (3) or fewer health insurers active in the group insurance market;  (3) One reason cited for the departure of health insurers from the state of Rhode Island is the size of our population. States with larger populations offer a greater opportunity for competition and profit; and  (4) A regional approach to health insurance that joins Rhode Islands health insurance market with those of the other New England states may expand the opportunities for regional insurers to offer insurance in Rhode Island.  History of Section.P.L. 2004, ch. 383,  1; P.L. 2008, ch. 99,  1; P.L. 2008, ch. 160,  1. 
 27-67-3. Definitions. (1) Department means the department of business regulation;  (2) Health insurer means the health insurance corporation, health maintenance organization, nonprofit hospital service corporation or nonprofit medical service corporation as defined in chapters 1, 18, 19 and 20 of this title.  History of Section.P.L. 2004, ch. 383,  1; P.L. 2008, ch. 99,  1; P.L. 2008, ch. 160,  1. 
 27-67-4. Establishment of a regional health insurance market. The health insurance commissioner shall undertake a review of the existing laws and regulations pertaining to the business of health insurance in this state, and in other New England states. On or before March 1, 2009, the health insurance commissioner shall submit a report to the general assembly on what changes would be necessary to the laws and/or regulations of Rhode Island in order to meet the goal of enabling health insurers licensed in other New England states to do business in Rhode Island without a separate application for licensure in Rhode Island. The report shall address the policy implications of implementing the identified changes in law and regulations, and the potential advantages and disadvantages of creating a regional health insurance market.  The report shall further address the extent to which licensure is a barrier to bringing other health insurers into the Rhode Island market. The report shall further address the manner in which licensure can be automatically granted to those insurers licensed in other New England states while still requiring that such insurers otherwise remain bound by the non-licensure related laws and regulations governing the administration of health insurance benefit plans in Rhode Island. The report shall include an analysis of barriers to the creation of a regional health insurance market and a proposed timeline for implementing all changes that would be needed to establish a regional health insurance market.  History of Section.P.L. 2004, ch. 383,  1; P.L. 2008, ch. 99,  1; P.L. 2008, ch. 160,  1. 
 27-68-1. Legislative findings. The general assembly hereby finds and declares that: (1) Although Rhode Island has one of the highest rates of health insurance coverage in the nation, gaps in coverage remain and the rate of coverage dropped significantly during the past year.  (2) From 2001 to 2002, the states uninsured rate for working age adults went from eight percent (8%) to eleven percent (11%), one of eighteen (18) states in the country with a significant increase.  (3) Significant health insurance premium rate increases over the past two (2) years especially for small businesses and the self-insured are contributing to an increase in the rate of the uninsured.  (4) The largest segment of uninsured Rhode Island residents are adults with low incomes, many of whom are employed.  (5) Individuals without health coverage often resort to expensive emergency room care that ultimately drives up the overall cost of care for everyone and adds to the states uncompensated care burden.  (6) Rhode Island residents use of emergency room services is greater than that of the nation.  (7) The institute of medicine defines primary care as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.  (8) Access to primary health care should be available to every resident of the state regardless of income and whether or not they have access to health insurance.  History of Section.P.L. 2004, ch. 611,  1. 
 27-68-2. Pilot primary care program established. To increase access to primary care for those state residents who do not have access to health insurance coverage or who are unable to afford health insurance coverage, the director of the state department of human services in collaboration with the director of the department of health shall develop a plan for a pilot primary care program for uninsured residents of the state. The pilot program may include enrollee premiums and co-insurance payments that are income-based with premiums and/or co-insurance subsidized by the state. The pilot program may also include catastrophic or reinsurance coverage provided under the auspices of the state. In designing the pilot program, the director may consider a variety of service delivery and financing models including capitation payments to private physicians, a buy-in program under RIte Care and coverage arrangements purchased from qualified community health centers. In developing the pilot program the director may seek available federal grant monies, including medicaid, and private foundation grants. The director shall submit the plan for the pilot primary care program to the governor, the speaker of the house, the president of the senate, the majority leaders of the house and senate and the chairpersons of the house and senate finance committees by January 15, 2005. The plan shall include eligibility criteria for participation in the pilot program, the scope of services to be offered, the geographic area and population to be served, and cost estimates to implement the program.  History of Section.P.L. 2004, ch. 611,  1. 
 27-69-1. Purpose. The purpose of this chapter is to provide for the availability of health plans that qualify as high deductible health plans which may be purchased for use with a health savings account and all similar plans that may be tax-favored under title 26 of the United States Code, as amended from time to time, and under those laws of this state that provide for taxation. This chapter shall be liberally construed to allow employers, employees and individuals to receive maximum tax benefits provided in federal or state law through use of high deductibles and other cost-sharing by a beneficiary.  History of Section.P.L. 2005, ch. 97,  5; P.L. 2005, ch. 99,  5. 
 27-69-2. Definitions. (a) Commissioner shall mean the director of the department of business regulation or the health insurance commissioner, as appropriate.  (b) Health plan shall mean health insurance coverage as defined in subsections 27-18.5-2(8)(i) and 27-18.6-2(16)(i) or health benefit plan as defined in  27-50-3.  (c) High deductible health plan shall have the same meaning as defined in 26 U.S.C. 223.  (d) Mandated benefit law shall mean any law of this state that requires provision of health insurance coverage for a specified service or payment to a specified type of health care provider, including, but not limited to, the benefits or services mandated in  27-18-48.1, 27-18-60, 27-18-62, 27-18-64, similar provisions in title 27, chapters 19, 20 and 41, and  27-18-3(c), 27-38.2-1 et seq., and all mandated benefit laws passed subsequent to the effective date of this chapter unless applicability of this chapter is specifically excluded in such law.  History of Section.P.L. 2005, ch. 97,  5; P.L. 2005, ch. 99,  5. 
 27-69-3. Deductibles and other cost-sharing. Notwithstanding anything to the contrary in any mandated benefit law, no mandated benefit law shall be construed to forbid inclusion in any health plan of a provision for any deductible and/or other cost-sharing provisions suitable to qualify a health plan, which may be purchased for use with health savings accounts for a tax preference, as a high deductible health plan or any other similar federal or state tax preference available now or in the future; provided, however, that this section shall not exempt high deductible health plans from any other provision of applicable mandated benefit laws. The commissioner shall retain jurisdiction to approve policies, rates and forms for all high deductible health plans pursuant to the provisions of this title and title 42 of the general laws.  History of Section.P.L. 2005, ch. 97,  5; P.L. 2005, ch. 99,  5. 
 27-69-4. Rules and regulations. The commissioner shall promulgate any rules or regulations as he or she shall deem necessary for the efficient administration of this chapter.  History of Section.P.L. 2005, ch. 97,  5; P.L. 2005, ch. 99,  5. 
 27-69-5. Severability. If any provision of this chapter or its application to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application, and for this purpose the provisions of this chapter are severable.  History of Section.P.L. 2005, ch. 97,  5; P.L. 2005, ch. 99,  5. 
 27-69-6. [Repealed.] History of Section.P.L. 2005, ch. 97,  5; P.L. 2005, ch. 99,  5; P.L. 2009, ch. 180,  1; P.L. 2009, ch. 182,  1; Repealed by P.L. 2011, ch. 42,  1; P.L. 2011, ch. 51,  1, effective June 6, 2011. 
 27-69-7. Mandated benefit statement of intent. Notwithstanding any general law enacted after January 1, 2014, any legislation that would create a new state health benefit mandate, or expand upon an existing health benefit, shall contain a statement of intent that clearly provides the purpose and objectives of the health benefit mandate, including measurable goals expected to be achieved by the new or expanded benefit mandate. These goals should address both commercial insurance affordability and population health outcomes.  History of Section.P.L. 2013, ch. 341,  5; P.L. 2013, ch. 394,  5. 
 27-7.1-1.1. Definitions. The following definitions shall apply for purposes of this chapter: (1) Accepted actuarial standards means the standards adopted by the casualty actuarial society in its statement of principles regarding property and casualty insurance ratemaking, and the standards of practice adopted by the actuarial standards board.  (2) Advisory organization means any entity, including its affiliates or subsidiaries that assists insurers in ratemaking-related activities, and is licensed in accordance with the provisions of  27-9-22.  (3) Classification system means the plan, system, or arrangement for recognizing differences in exposure to hazards among industries, occupations of operations of insurance policyholders.  (4) Department means the department of business regulation.  (5) Developed losses means losses (including loss adjustment expenses) adjusted using standard actuarial techniques, to eliminate the effect of differences between current payment or reserve estimates and those which are anticipated to provide actual ultimate loss (including loss adjustment expense) payments.  (6) Director means the director of the department of business regulation.  (7) Expenses means a workers compensation insurers determination of the expenses, other than loss expenses and loss adjustment expenses, associated with writing workers compensation insurance.  (8) Experience rating means a rating procedure utilizing past insurance experience of the individual policyholder to forecast future losses by measuring the policyholders loss in the same classification to produce a prospective premium credit, debt or unity modification.  (9) Insurer means any person writing coverage under the workers compensation laws of this state.  (10) Loss trending means any procedure for projecting developed losses to the average date of loss for the period during which the policies are to be effective, including loss ratio trending.  (11) Prospective loss costs means historical aggregate losses and loss adjustment expenses, including all assessments that are loss-based, projected through development to their ultimate value and through trending to a future point in time, ascertained by accepted actuarial standards. Prospective loss costs do not include provisions for profit or expenses other than loss adjustment expenses.  (12) Pure premium rate means that portion of the rate that represents the loss cost per unit of exposure including loss adjustment expense.  (13) Rate or rates means rate of premium, policy and membership fee, or any other charge made by an insurer for or in connection with a contract or policy of workers compensation and employers liability insurance, prior to application of individual risk variations based on loss or expense considerations, and does not include minimum premiums.  (14) Special assessments means insurers insolvency fund assessments, workers compensation administration fund assessments, capital assessments for the state compensation insurance fund, and other similar assessments. Special assessments shall not be considered as either expenses or losses, but shall be treated as separate costs by insurers and shall be assessed on their policyholders in accordance with rules set forth by an advisory organization and approved by the director.  (15) Statistical plan means the plan, system, or arrangement used in collecting data.  (16) Supplementary rating information includes any manual or plan of rates, classification, rating schedule, minimum premium, policy fee, rating rule, underwriting rule, statistical plan and any other similar information needed to determine the applicable premium for an individual insured and not inconsistent with the purposes of this act, as prescribed by the director.  (17) Supporting information means (i) the experience and judgment of the filer and the experience or data of other insurers or advisory organizations relied upon by the filer; (ii) the interpretation of any other data relied upon by the filer; and (iii) descriptions of methods used in making the rates, and any other information required by the director to be filed.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-1. Applicability. The provisions set forth in this chapter shall apply to approval of insurance policies and rates by the director of the department of business regulation, referred to in this chapter as the director.  History of Section.P.L. 1985, ch. 365,  18. 
 27-7.1-10.1. Procedural rules  Rate administration  Consultation with other states. (a) Subject to the applicable requirements of the Administrative Procedures Act, chapter 35 of title 42, the director may adopt rules and regulations for:  (1) The administration of this chapter, including, but not limited to, procedures governing submission of petitions for intervenor status, prefiling of testimony and exhibits, information requests, subpoenas, prehearing conferences, and the conduct of hearings;  (2) Use by insurers to record and report to the director their rates;  (3) Use by insurers in the recording and reporting of loss and expense experience, in order that the experience of all insurers may be made available at least annually in the form and detail necessary to aid in determining whether rating systems comply with the standards set forth in  27-7.1-4. The director may designate an advisory organization or other entity to assist in gathering that experience and making compilations of it, and the compilations shall be public records;  (4) The interchange of data necessary for the application of rating plans;  (b) In order to further the administration of this chapter, the director and every insurer and advisory organization may exchange information and experience data with insurance supervisor officials, insurers, and advisory organizations in other states and may consult with them with respect to the application of rating systems.  (c) Cooperation among advisory organizations or among advisory organizations and insurers in ratemaking or in other matters within the scope of this chapter is authorized, but the filings resulting from that cooperation are subject to all the provisions of this chapter. The director may review these cooperative activities and practices and if, after a hearing, any activity or practice is found to violate the provisions of this chapter, a written order may be issued specifying that the activity or practice violates the provisions of this chapter and requiring the discontinuance of the activity.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-10. Repealed.
 27-7.1-11.1. Challenge and review of application of rating system. (a) An advisory organization and every insurer subject to this chapter that makes its own rate shall provide within this state reasonable means where any person aggrieved by the application of its rating system may upon that persons or the persons authorized representatives written request to review the manner in which the rating system has been applied in connection with the insurance afforded the aggrieved person.  (b) Any party affected by the action of an advisory organization or the insurer may, within thirty (30) days after written notice of that action, make application, in writing, for an appeal to the director, setting forth the basis for the appeal and the grounds to be relied upon by the applicant. If the advisory organization or insurer fails to grant or reject the request within thirty (30) days after it is made, the applicant may proceed in the same manner as if the application has been rejected.  (c) The director shall review the application and, if the director finds that the application is made in good faith and that it sets forth on its face grounds that reasonably justify holding a hearing, the director shall conduct a hearing held not less than ten (10) days after written notice to the applicant and to an advisory organization or insurer. The director, after a hearing, shall affirm or reverse the action of an advisory organization or insurer.  (d) If, after a hearing held under this section, it is determined that the rates charged by an insurer are in excess of the appropriate rate, the overcharge shall be refunded to the insured.  History of Section.P.L. 1998, ch. 148,  3; P.L. 2022, ch. 404,  3, effective June 30, 2022; P.L. 2022, ch. 405,  3, effective June 30, 2022. 
 27-7.1-11. Repealed.
 27-7.1-12.1. Acts reducing competition prohibited. (a) In this section, insurer includes two (2) or more affiliated insurers: (1) under common management; or (2) under common controlling ownership or under common effective legal control and in fact engaged in joint or cooperative underwriting, investment management, marketing, servicing, or administration of their business and affairs as insurers.  (b) Neither the advisory organization nor any insurer may:  (1) Monopolize, attempt to monopolize, or combine or conspire with any other person or persons to monopolize the business of insurance of any kind, subdivision, or class;  (2) Agree with any other insurer or the advisory organization to charge or adhere to any rate or rating plan other than the uniform experience rating plan or rating rule except as needed to comply with the requirements of  27-7.1-10 [Repealed];  (3) Make an agreement with any other insurer, the advisory organization, or other person to unreasonably restrain trade or substantially lessen competition in the business of insurance of any kind, subdivision, or class; or  (4) Make any agreement with any other insurer or the advisory organization to refuse to deal with any person in connection with the sale of insurance.  (c) The fact that two (2) or more insurers, whether or not members or subscribers to the advisory organization, use consistently or intermittently the same rules rating plans, rating schedules, rating rules, policy forms, rate classification, underwriting rules, surveys, inspections, or similar materials is not sufficient in itself to support a finding that an agreement exists.  (d) The advisory organization and any member or subscriber of it may not interfere with the right of any insurer to make its rates independently of the advisory organization.  (e) Except as required by  27-7.1-10 [Repealed], the advisory organization may not have or adopt any rule or exact any agreement or formulate or engage in any program which would require any member, subscriber, or other insurer to:  (1) Utilize some or all of its service;  (2) Adhere to its rates, rating plan, rating systems, or underwriting rules; or  (3) Prevent any insurer from acting independently.  History of Section.P.L. 1998, ch. 148,  3; P.L. 2008, ch. 475,  77. 
 27-7.1-12. Repealed.
 27-7.1-13.1. False or misleading information. No person, firm, corporation, association, or organization shall willfully withhold information that will affect the rates or premiums chargeable under this chapter or knowingly give false or misleading information to the director, any statistical agency or advisory organization designed by the director or any insurer.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-13.2. Group workers compensation insurance. Nothing contained in this title shall be interpreted as preventing insurance companies, authorized to do business within this state, from offering workers compensation and employers liability insurance coverage to groups of employer beneficiaries.  History of Section.P.L. 2005, ch. 175,  2. 
 27-7.1-13. Costs. For the purpose of determining whether the filing meets the requirements of this chapter, the director may employ staff personnel and outside consultants including, but not limited to, those authorized under  27-9-52. The reasonable costs related to the review of workers compensation rate filings, including the conduct of the hearing, shall be borne by the rating organizations or insurers making the filing.  History of Section.P.L. 1985, ch. 365,  18. 
 27-7.1-14  27-7.1-17. Repealed.
 27-7.1-18. Examination of rating and advisory organizations and underwriting and reinsurance groups. (a) The director may, as often as he or she may deem it necessary, make or cause to be made an examination of each rating organization licensed in this state as provided in  27-9-22 and may also examine every group, association, or other organization of insurers, including any workers compensation assigned risk servicing carrier or carriers. The officers, managers, agents, and employees of each rating organization, group, association, or other organization of insurers, including workers compensation assigned risk servicing carrier or carriers, may be examined at any time under oath and shall exhibit all books, records, accounts, documents, or agreements governing its method of operation. In lieu of any examination, the director may accept the report of any examination made by the insurance supervisory official of another state, pursuant to the laws of that state.  (b) The expenses of examinations under this section shall be assessed against the organization being examined. The total cost of the examination shall be borne by the examined organization and shall be in the same amount as provided for in  27-13-1 and shall be paid to the director to and for the use of the state. This assessment for expenses shall be in addition to any taxes and fees payable to the state. In instances where the examination is performed by outside accountants, the expenses of the examination shall be borne by the examined organization.  History of Section.P.L. 1992, ch. 31,  25. 
 27-7.1-19. Midterm notice of cancellation. Notwithstanding any general or special law to the contrary, a midterm notice of cancellation of a workers compensation policy shall be effective only if based on one or more of the following reasons: (1) nonpayment of premium; (2) fraud or material misrepresentation affecting the policy or insured; and/or (3) a substantial increase in the hazard insured against. Nothing in this section shall limit an insurers right to refuse to renew a workers compensation policy.  History of Section.P.L. 1992, ch. 31,  25. 
 27-7.1-2. Approval of policies. (a) Every insurance company issuing workers compensation insurance policies covering the payment of compensation and benefits provided for in this chapter shall file with the director:  (1) A copy of the form of the policies. A policy may not be issued until the director has approved the form; and  (2) Its classification of risks and their premium rates and any subsequent proposed classifications and premium rates, which may not take effect until the expiration of sixty (60) days from the date the director has approved them.  (b) Premium rates less than those approved may be used and filed with the director. If the director has reason to believe that the filing produces rates that are inadequate or unfairly discriminatory, the director may disapprove them.  (c) Any policy forms, subject to this chapter and filed by an insurer or rating organization on behalf of its members or subscribers with the director, shall be deemed public information at the time of the filing; and the director shall furnish the policy forms and all pertinent information as to the policy forms, upon written request, to any insured, to any authorized representative of an insured, to any insurance company trade association, or to any trade association of insurance producers.  History of Section.P.L. 1985, ch. 365,  18; P.L. 1990, ch. 500,  1; P.L. 1992, ch. 267,  1; P.L. 1998, ch. 148,  2. 
 27-7.1-20. Cost control  Insurers. The director is authorized, at his or her discretion, to conduct audits and investigations to examine the insurers utilization of adequate programs to control costs or expenses or to collect the appropriate premium charges. On the basis of information submitted in any filing made pursuant to this chapter, or obtained from the department of labor and training and/or by independent investigation, the director shall make a finding whether or not the insurer or insurers employ cost control programs and techniques that meet the standards of the rating agency, or any other standards as may, after notice and a hearing, be approved by the director, which have had or are expected to have a substantial impact on fraudulent claim costs, unnecessary health care costs, and any other unreasonable costs and expenses, and on the collection of the appropriate premium charges owed to the insurer or insurers. If the director does not find adequate utilization of cost control, the director may impose an appropriate penalty not to exceed five percent (5%) of the insurers annual premium.  History of Section.P.L. 1992, ch. 31,  25. 
 27-7.1-21. Cost control  Insured. (a) The director shall establish loss control standards for insured that meet criteria designed to identify those insured that would significantly benefit from the adoption of a program to control workers compensation costs. The criteria shall be established by the director and may include the number of persons employed by the insured, the amount of the insureds annual payroll, the amount of the insureds workers compensation insurance premium, the experience modifier of the insured, the class code of the insured, the injury and illness lost workday rate of the insured, and any other relevant criteria as the director may determine. The loss control standards may require that an insured, in cooperation with its insurer, establish and maintain a safety committee, prepare and maintain a plan for medical evaluation and treatment, including immediate post-injury offsite care, establish and maintain a written plan for providing reasonable accommodation for injured workers to return to work, and implement other cost control measures acceptable to the director. The director shall have the authority to establish a rating plan to effectuate compliance with the loss control standards established pursuant to this subsection. In establishing any rating plan, the director may create financial incentives to employees of insured to encourage the employees to assist in controlling workers compensation costs.  (b) The director may promulgate rules and regulations as necessary to carry out the provisions of this section.  History of Section.P.L. 1992, ch. 31,  25. 
 27-7.1-22. Repealed.
 27-7.1-23. Repealed.
 27-7.1-24. Transition. Insurers and an advisory organization are not required to immediately refile rates previously approved. For five (5) years after July 7, 1998, any member or subscriber of an advisory organization is authorized to continue to use all rates and deviations filed or approved for its use until the insurer makes its own filing to change its rates, either by making an independent filing and adopting an advisory organizations approved prospective loss costs, or modifications of those loss costs. No advisory organization shall file, and the department of business regulation shall not accept a filing by an advisory organization, as to proposed changes in rates previously approved unless the filing shall include relevant data through July 7, 2003.  History of Section.P.L. 1998, ch. 148,  3; P.L. 2001, ch. 18,  1; P.L. 2001, ch. 34,  1. 
 27-7.1-25. Severability. If any provision of this chapter or the application of this chapter to any person or circumstances is held invalid, the invalidity shall not affect other provisions or applications of the chapter, which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared to be severable.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-3, 27-7.1-4. Repealed.
 27-7.1-4.1. Standards for approval of rates. The director shall apply the following standards in making rates: (1) Rates shall not be excessive, inadequate, or unfairly discriminatory.  (2) Due consideration shall be given to: (i) past and prospective loss experience within and outside the state; (ii) a reasonable margin for profits and contingencies; (iii) dividends, savings, or unabsorbed premium deposits allowed or returned by insurers to their policyholders, members, or subscribers; (iv) past and prospective expenses both countrywide and those specifically applicable to this state; (v) provisions for special assessments; and (vi) all other relevant factors within and outside this state. In determining the reasonableness of the profit, consideration shall be given to investment income.  (3) Risks may be grouped by classifications for the establishment of rates and minimum premiums. Classification rates may be modified to produce rates for individual risks in accordance with rating plans that establish standards for measuring variations in hazards or expense provisions, or both. These standards may measure any differences among risks that can be demonstrated to have a probable effect upon losses or expenses.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-5.1. Rate filings. (a)(1) Every insurer shall file with the director every manual, minimum premium, class rate, rating schedule, or rating plan and every other rating rule, and every modification of any of the foregoing which it proposes to use. An insurer may file its rates either by filing its final rates or by filing a multiplier to be applied to prospective loss costs that have been filed by an advisory organization on behalf of an insurer as permitted by  27-9-8.1. Every filing shall state the proposed effective date of the filing.  (2) Every insurer shall file or incorporate by reference material which has been approved by the director, at the same time as the filing of the rate, and all supplementary rating and supporting information to be used in support of or in conjunction with a rate. The information furnished for support of a filing may include or consist of a reference to: (i) the experience or judgment of the insurer or information filed by the advisory organization on behalf of the insurer as permitted by  27-9-8.1; (ii) the interpretation of the insurer or advisory organization of any statistical data it relies upon; (iii) the experience of other insurers or advisory organizations; or (iv) any other relevant factors. A filing and any supporting information shall be open to public inspection upon receipt of the filing.  (3) When a filing is not accompanied by the information upon which the insurer supports the filing, the director may require the insurer to furnish the information upon which it supports the filing and, in that event, the waiting period shall commence as of the date the information is furnished. Until the requested information is provided, the filing shall not be deemed complete. If the requested information is not filed within a reasonable time, the filing may be returned to the insurer as not filed and not available for use.  (4) After reviewing an insurers filing, the director may require that the insurers rates be based upon the insurers own loss, special assessment, and expense information. If the insurers loss or allocated loss adjustment expense information is not actuarially credible, as determined by the director, the insurer may use or supplement its experience with information filed with the director by an advisory organization.  (5) Insurers utilizing the services of an advisory organization must provide with their rate filing, at the request of the director, a description of the rationale for that use, including its own information and method of utilization of the advisory organizations information.  (b) The director shall review filings as soon as reasonably possible after they have been made in order to determine whether they meet the requirements of this chapter.  (c) Subject to the exception specified in  27-7.1-6.2, each filing shall be on file for a waiting period of thirty (30) days before it becomes effective, which period may be extended by the director for an additional period not to exceed thirty (30) days if written notice is given within the waiting period to the insurer or advisory organization which made the filing that additional time is needed for the consideration of the filing. Upon written application by the insurer, the director may authorize a filing that has been reviewed to become effective before the expiration of the waiting period or any extension of the waiting period. A filing shall be deemed to meet the requirements of this chapter unless disapproved by the director within the waiting period or any extension of the waiting period.  (d) No insurer shall make or issue a contract or policy except in accordance with the filings which have been approved and are in effect for that insurer as provided in this chapter or in accordance with subsection (c) of this section.  (e) Nothing contained in this section shall prevent the director from holding a hearing on a rate filing pursuant to the provisions of chapter 35 of title 42 and regulations adopted by the department.  History of Section.P.L. 1998, ch. 148,  3; P.L. 1999, ch. 46,  1. 
 27-7.1-5. Repealed.
 27-7.1-6.1. Disapproval of rates. (a) If within the waiting period or any extension of the waiting period as provided in  27-7.1-5.1(c) the director finds that a filing does not meet the requirements of this chapter, a written order of disapproval shall be sent to the insurer or advisory organization, specifying in the order the reasons the filing fails to meet the requirements of this chapter and stating that the filing shall not become effective. If a filing is disapproved by the director, the insurer or advisory organization may request a hearing on the disapproval within thirty (30) days of the date of the order of disapproval and the director shall schedule the hearing within thirty (30) days of the receipt of the request. The insurer bears the burden of proving compliance with the standards established by this chapter.  (b) If at any time after a rate has been approved, the director finds that the rate no longer meets the requirements of this chapter, the director may order the discontinuance of use of that rate. The order of discontinuance may be issued after a hearing with at least thirty (30) days prior notice to all insurers affected by the order. The order must be in writing and state the grounds for the order. The order shall also specify when, within a reasonable time after this, the filing will be deemed no longer effective. The order shall not affect any contract or policy made or issued prior to the expiration of the period set forth in the order. The directors order may include a provision for a premium adjustment for contracts or policies made or issued after the effective date of the order.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-6.2. Consent to rate. Notwithstanding any other provision of this chapter, upon the written consent of the insured, filed with the director, a rate in excess of the rate determined in accordance with the other provisions of this chapter may be used on any specific risk.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-6. Repealed.
 27-7.1-7.1. Information to be furnished insureds. Every advisory organization and every insurer shall, within a reasonable time after receiving a written request, furnish to any insured affected by a rate made by the insurer, or the authorized representative of the insured, all pertinent information as to that rate.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-7.2. Repealed. History of Section.P.L. 1992, ch. 31,  25; Repealed by P.L. 2011, ch. 158,  3, effective June 30, 2011; P.L. 2011, ch. 274,  3, effective July 12, 2011. 
 27-7.1-7. Repealed.
 27-7.1-8.1. Services of advisory organizations. (a) No advisory organization shall provide any service relating to the rates subject to this chapter, and no insurer shall utilize the services of that organization for those purposes, unless the organization has obtained a license pursuant to  27-9-22.  (b) No advisory organization shall refuse to supply any services for which it is licensed in this state to any insurer authorized to do business in this state and offering to pay the fair and usual compensation for the services.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-8. Repealed.
 27-7.1-9.1. Membership in rating organization. (a) The director shall appoint one or more advisory organizations licensed in accordance with  27-9-22 to assist the director in gathering, compiling, and reporting relevant statistical information. Every workers compensation insurer shall record and report its workers compensation experience to the advisory organization as set forth in the uniform statistical plans submitted by the advisory organization to the director.  (b) Except for corporations organized under chapter 7.2 of this title, each workers compensation insurer shall be a member of an advisory organization. Each workers compensation insurer may adhere to the policy terms filed by the advisory organization.  (c) Every workers compensation insurer shall adhere to the uniform classification system and uniform experience rating plan as submitted to the director and which is presently in effect. The experience rating plan shall be the exclusive means of providing prospective premium adjustments based upon measurement of the loss-producing characteristics of an individual insured.  (d) Subject to the approval of the director, the advisory organization shall develop and file rules reasonably related to the recording and reporting of data pursuant to the uniform statistical plan, uniform experience rating plan, and the uniform classification system.  (e) The advisory organization shall not adopt any rule that would prohibit or regulate the payment of dividends, savings, or unabsorbed premium deposits allowed or returned by insurers to their policyholders, members, or subscribers. A plan for the payment of dividends, savings, or unabsorbed premium deposits allowed or returned by insurers to their policyholders is not considered a rating plan or system.  History of Section.P.L. 1998, ch. 148,  3. 
 27-7.1-9. Repealed.
 27-7.2-1  27-7.2-21. Repealed.
 27-7-1. Direct liability of insurer to person injured. Every policy written insuring against liability for property damage or personal injuries or both, and every policy written indemnifying any person by reason of that liability, other than the payment of compensation under chapters 29  38 of title 28, shall contain provisions to the effect that the insurer shall be directly liable to the injured party and, in the event of that partys death, to the party entitled to sue for that death, to pay that party the amount of damages for which the insured is liable.  History of Section.P.L. 1921, ch. 2094,  1; G.L. 1923, ch. 258,  7; P.L. 1936, ch. 2422,  1; G.L. 1938, ch. 155,  1; G.L. 1956,  27-7-1. 
 27-7-2.1. Uninsured motorist coverage. (a) No policy insuring against loss resulting from liability imposed by law for property damage caused by collision, bodily injury, or death suffered by any person arising out of the ownership, maintenance, or use of a motor vehicle shall be delivered or issued for delivery in this state with respect to any motor vehicle registered or principally garaged in this state unless coverage is provided in or supplemental to the policy, for bodily injury or death in limits set forth in each policy, but in no instance less than the limits set forth in  31-47-2(13)(i)(A) under provisions approved by the insurance commissioner, for the protection of persons insured under the policy who are legally entitled to recover damages from owners or operators of uninsured motor vehicles and hit-and-run motor vehicles because of property damage, bodily injury, sickness, or disease, including death, resulting from that injury, sickness, or disease. The insurer shall provide uninsured motorist coverage in an amount equal to the insureds bodily injury liability limits. The named insured shall have the option of selecting a limit in writing less than the bodily injury liability coverage, but in no event less than the limits set forth in  31-47-2(13)(i)(A), unless the named insured is purchasing only the minimum coverage required by compulsory insurance provisions of the general laws, in which case the limit can be reduced to zero, but only after signing an advisory notice approved by the director of business regulation concerning the hazard of uninsured and underinsured motorists. That coverage shall also apply in the case of a responsible party whose liability insurance carrier was insolvent at the time of the accident or became insolvent subsequent to the accident.  (b) Notwithstanding the provisions of subsection (a), the named insured shall have the option to reject, in writing, uninsured motorist coverage for loss resulting from damage to property. If the named insured has collision coverage for property damage to his or her vehicle, then no coverage for uninsured motorist property damage shall be required unless the insured at his or her option chooses to purchase that coverage.  (c) For the purposes of this section:  (1) Policy insuring against loss means a policy that provides primary coverage for the insured motor vehicle; and  (2) Property damage means injury to or destruction of the insured vehicle, including its loss of use and any property, excluding business property, owned by the insured while contained in the insured vehicle.  (d) After the selection of limits by the named insured or the exercise of the right to reject that portion of the coverage that applies to property damage, the insurer or any affiliated insurer shall be required to notify the policyholder, in any renewal, reinstatement, substitute, amended, altered, modified, transfer, or replacement policy, as to the availability of that coverage or optional limits. The insured may, subject to the limitations expressed in this chapter, make a written request for higher limits, newly added coverage, or coverage more extensive than that provided on a prior policy.  (e) Property damage caused by collision shall be subject to a two hundred dollar ($200) deductible per claim unless otherwise agreed. Any claim submitted under the property damage portion of this section must include the name, address, and other means of identification to establish that the at-fault operator is without insurance. The rate for this coverage will be established as a percentage of the existing base collision insurance rate as utilized by the majority of companies, to be determined by the insurance commissioner.  (f) Whenever, through subrogation, an insurance company or its insurance producer collects a casualty loss from a third party, that company or insurance producer shall, from the funds collected, first pay to the insured the deductible portion of the casualty loss less the prorated share of subrogation expense and only after this retain any funds in excess of the deductible portion of the recovery.  (g) For the purposes of this section uninsured motorist shall include an underinsured motorist. An underinsured motorist is the owner or operator of a motor vehicle who carries automobile liability insurance with coverage in an amount less than the limits or damages that persons insured pursuant to this section are legally entitled to recover because of bodily injury, sickness, or disease, including death, resulting from that injury, sickness, or disease.  (h) A person entitled to recover damages pursuant to this section shall not be required to make a claim against or bring an action against the uninsured or underinsured tortfeasor as a prerequisite to recover damages from the insurer providing coverage pursuant to this section. In the event that the person entitled to recover against an underinsured motorist recovers from the insurer providing coverage pursuant to this section, that insurer shall be entitled to subrogation rights against the underinsured motorist and his or her insurance carrier. Release of the tortfeasor with the consent of the company providing the underinsured coverage shall not extinguish or bar the claim of the insured against the underinsurance carrier regardless of whether the claim has been liquidated.  (i) Whenever an insured has paid two (2) or more separate premiums for uninsured motorists coverage in a single policy of insurance or under several policies with the same insurance company, the insured shall be permitted to collect up to the aggregate amount of coverage for all of the vehicles insured, regardless of any language in the policy to the contrary.  History of Section.P.L. 1962, ch. 161,  1; P.L. 1970, ch. 275,  1; P.L. 1978, ch. 283,  1; P.L. 1981, ch. 251,  2; P.L. 1985, ch. 197,  1; P.L. 1985, ch. 288,  1; P.L. 1986, ch. 334,  1; P.L. 1987, ch. 380,  1; P.L. 1987, ch. 435,  1; P.L. 1988, ch. 519,  1; P.L. 1989, ch. 489,  1; P.L. 1990, ch. 340,  1; P.L. 1991, ch. 167,  4; P.L. 1993, ch. 255,  2; P.L. 2021, ch. 398,  3, effective July 14, 2021; P.L. 2021, ch. 399,  3, effective July 14, 2021. 
 27-7-2.2. Interest on judgment  Payment by insurer. In any civil action in which the defendant is covered by liability insurance and in which the plaintiff makes a written offer to the defendants insurer to settle the action in an amount equal to or less than the coverage limits on the liability policy in force at the time the action accrues, and the offer is rejected by the defendants insurer, then the defendants insurer shall be liable for all interest due on the judgment entered by the court even if the payment of the judgment and interest totals a sum in excess of the policy coverage limitation. This written offer shall be presumed to have been rejected if the insurer does not respond in writing within a period of thirty (30) days.  History of Section.P.L. 1981, ch. 55,  1; P.L. 1993, ch. 255,  2. 
 27-7-2.3. Insurance rate adjustment. The insurer shall be responsible for maintaining records of all judgments entered by the court that require the insurer to pay an amount in excess of a policy coverage limitation due to the failure of the insurer to settle a civil action in accordance with the provisions of  27-7-2.2. No payments made by the insurer in excess of a policy coverage limitation shall be incorporated or used by the insurer in any subsequent rate adjustment on affected liability lines of insurance.  History of Section.P.L. 1981, ch. 55,  1. 
 27-7-2.4. Direct action against insurer upon filing for bankruptcy. Any person, having a claim because of damages of any kind caused by the tort of any other person, may file a complaint directly against the liability insurer of the alleged tortfeasor seeking compensation by way of a judgment for money damages whenever the alleged tortfeasor files for bankruptcy, involving a chapter 7 liquidation, a chapter 11 reorganization for the benefit of creditors or a chapter 13 wage earner plan, provided that the complaining party shall not recover an amount in excess of the insurance coverage available for the tort complained of.  History of Section.P.L. 1983, ch. 169,  1; P.L. 1989, ch. 542,  75; P.L. 1994, ch. 134,  11; P.L. 1998, ch. 230,  1. 
 27-7-2.5. Minimum coverage  Medical payments. (a) No policy insuring against loss resulting from liability imposed by law, or for injuries caused by a motor vehicle collision or for injuries arising out of the ownership, maintenance, or use of a motor vehicle, shall be delivered or issued in this state unless coverage is provided in the policy for medical payments in an amount of not less than twenty-five hundred dollars ($2,500) for each individual and five thousand dollars ($5,000) aggregate for the protection of persons injured regardless of the fault of the injured person; provided, that the named insured shall have the right to reject that coverage in writing.  (b) The insurer or any affiliated insurer shall be required to notify the policy holder in any renewal policy as to the availability of medical payments coverage. Unless the insured named in the policy requests medical payments coverage in writing, that coverage need not be provided in any subsequent policy issued by the same insurer or any affiliate for motor vehicles owned by the named insured, including, but not limited to, renewal, reinstatement, substitute, amended, modified, transfer, or replacement policies where the named insured has rejected the coverage in connection with the policy previously issued to the insured by the same insurer or an affiliate.  History of Section.P.L. 1985, ch. 424,  1; P.L. 1987, ch. 573,  1; P.L. 2009, ch. 303,  3; P.L. 2009, ch. 304,  3. 
 27-7-2. Remedies of injured party against insurer. An injured party, or, in the event of that partys death, the party entitled to sue for that death, in his or her suit against the insured, shall not join the insurer as a defendant. If the officer serving any process against the insured shall return that process non est inventus, or where before suit has been brought and probate proceedings have not been initiated the insured has died, or where a suit is pending against an insured in his or her own name and the insured died prior to judgment, or where a nonresident had been involved in an automobile accident in Rhode Island as an operator or owner and died before suit has been brought, the injured party, and, in the event of that partys death, the party entitled to sue for that death, may proceed directly against the insurer. The injured party, or, in the event of that partys death, the party entitled to sue for that death, after having obtained judgment against the insured alone, may proceed on that judgment in a separate action against the insurer; provided, the payment in whole or in part of the liability by either the insured or the insurer shall, to the extent of the payment, be a bar to recovery against the other of the amount paid. The time limitations for filing such actions shall be governed by the provisions of  9-1-14 as appropriate, including, but not limited to, any extension of the statute of limitations for injuries to the person provided by  9-1-14(c).  History of Section.P.L. 1921, ch. 2094,  1; G.L. 1923, ch. 258,  7; P.L. 1936, ch. 2422,  1; G.L. 1938, ch. 155,  1; G.L. 1956,  27-7-2; P.L. 1972, ch. 188,  1; P.L. 1973, ch. 205,  1; P.L. 2009, ch. 123,  2; P.L. 2009, ch. 142,  2. 
 27-7-3. Applicability. 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.  History of Section.P.L. 1921, ch. 2094,  1; G.L. 1923, ch. 258,  7; P.L. 1936, ch. 2422,  1; G.L. 1938, ch. 155,  1; G.L. 1956,  27-7-3. 
 27-7-4. Information to policyholder. Whenever an insurer pays a property damage or personal injury claim under the provisions of policies written pursuant to this chapter, the insurer upon the request of the policyholder must notify the policy holder of the amount of the claim paid.  History of Section.P.L. 1986, ch. 62,  1. 
 27-7-5. Information to injured party. Any insurance company doing business in this state shall reveal to an injured party making a claim against an insured the amount of the limits of liability coverage upon receiving a request in writing for that information from the injured party or his or her attorney. A reply shall be made within fourteen (14) days of receiving the request.  History of Section.P.L. 1989, ch. 215,  1. 
 27-7-6. Rental vehicle coverage. (a) For liability assumed under a written contract, coverage shall be provided under the property damage liability section of an insureds private passenger automobile insurance policy. Property damage coverage shall extend to a rented motor vehicle, under ten thousand pounds (10,000 lbs.), without regard to negligence for a period not to exceed sixty (60) consecutive days.  (b) Coverage pursuant to subsection (a) shall apply to all collision and comprehensive type losses.  History of Section.P.L. 2004, ch. 54,  1; P.L. 2004, ch. 59,  1; P.L. 2021, ch. 260,  1, effective July 14, 2021; P.L. 2021, ch. 265,  1, effective July 14, 2021. 
 27-7-7. Written notice to claimants of payment of claim in settlements. Upon payment of five thousand dollars ($5,000) or more in settlement of any liability claim, the insurer shall cause written notice of the payment to be mailed to the claimant, at the same time payment is made by the insurer or its representative, including the insurers attorney, to the claimants attorney or other representative of the claimant by draft, check, or otherwise.  History of Section.P.L. 2005, ch. 69,  3; P.L. 2005, ch. 79,  3. 
 27-70-1. Short title. This chapter shall be known and may be cited as The Health Insurance Tax Incentive. History of Section.P.L. 2007, ch. 125,  1; P.L. 2007, ch. 231,  1. 
 27-70-2. Definitions. As used in this chapter: (1) Employee has the meaning set forth in subsection 28-42-3(14).  (2) Employer has the meaning set forth in subsection 28-42-3(15).  History of Section.P.L. 2007, ch. 125,  1; P.L. 2007, ch. 231,  1. 
 27-70-3. Cafeteria plans. On or before July 1, 2009, each employer with annual average employment of more than twenty-five (25) employees for six (6) consecutive months of the year in the state of Rhode Island shall adopt and maintain for its employees a cafeteria plan that satisfies the Internal Revenue Code 26 U.S.C.  125 and the rules and regulations promulgated by the office of the health insurance commissioner and through which the employees and their dependents may purchase health insurance. Nothing in this section shall be construed to require an employer covered by this section to pay for, or otherwise contribute to, the cost of any health insurance purchased through the cafeteria plan.  History of Section.P.L. 2007, ch. 125,  1; P.L. 2007, ch. 231,  1. 
 27-70-4. Regulatory oversight. 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.  History of Section.P.L. 2007, ch. 125,  1; P.L. 2007, ch. 231,  1. 
 27-71-1. Short title. This chapter shall be known and may be cited as the Market Conduct Surveillance Act. History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-10. Immunity for market conduct surveillance personnel. (a) No cause of action shall arise nor shall any liability be imposed against the commissioner, the commissioners authorized representatives or an examiner appointed by the commissioner for any statements made or conduct performed in good faith while carrying out the provisions of this chapter.  (b) No cause of action shall arise, nor shall any liability be imposed against any person for the act of communicating or delivering information or data to the commissioner or the commissioners authorized representative or examiner pursuant to an examination made under this chapter, if the act of communication or delivery was performed in good faith and without fraudulent intent or the intent to deceive.  (c) A person identified in subsection(a) shall be entitled to an award of attorneys fees and costs if he or she is the prevailing party in a civil cause of action for libel, slander or any other relevant tort arising out of activities in carrying out the provisions of this chapter and the party bringing the action was not substantially justified in doing so. For purposes of this section a proceeding is substantially justified if it had a reasonable basis in law or fact at the time that it was initiated.  (d) This section does not abrogate or modify in any way any common law or statutory privilege or immunity heretofore enjoyed by any person identified in subsection (a).  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-11. Fines and penalties. (a) Fines and penalties levied pursuant to this chapter or other provisions of the general laws shall be consistent, reasonable and justified.  (b) The commissioner shall take into consideration actions taken by insurers that maintain membership in best-practice organizations that exist to promote high ethical standards of conduct in the marketplace, and insurers that self-assess, self-report and remediate problems detected to mitigate fines levied pursuant to this chapter.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-12. Data collection and participation in national market conduct databases. The commissioner shall collect and report market data to the NAICs market information systems, including the complaint database system, the examination tracking system, and the regulatory information retrieval system, or other comparable successor NAIC products as determined by the commissioner. In addition to complaint data, the accuracy of insurer-specific information reported to the NAIC to be used for market analysis purposes or as the basis for market conduct actions shall be reviewed be appropriate personnel in the department of business regulation and by the insurer.  (a) Information collected and maintained by the department of business regulation shall be compiled in a manner that meets the requirements of the NAIC.  (b) After completion of any level of market analysis, prior to further market conduct action, the state shall contact the insurer to review the analysis.  (c)(1) A company responding to a commissioners 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 commissioners 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.  (d) Whether through market analysis, market conduct action, or in response to another regulatory request, any information provided in response to a data call from the commissioner shall be treated as confidential and privileged. It shall not be subject to subpoena and shall not be subject to discovery or admissible in evidence in any private civil action. No waiver of privilege or confidentiality shall occur as a result of responding to such data call.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-13. Coordination with other states through the NAIC. The commissioner shall share information and coordinate the department of business regulations market analysis and examination efforts with other states through the NAIC.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-14. Additional duties of the commissioner. (a) At least once per year, or more frequently if deemed necessary, the commissioner shall make available in an appropriate manner to insurers and other entities subject to the scope of this chapter information on new laws and regulations, and other information the commissioner deems pertinent to ensure compliance with market conduct requirements. The failure of the commissioner to provide information shall not be a defense for an insurer that fails to comply with any insurance laws of this state.  (b) Insurers who wish to receive the information indicated in (a) above shall provide to the commissioner, in a form specified by the commissioner, contact information. The insurer is responsible for keeping that contact information up to date and informing the commissioner of any changes.  (c) The commissioner shall designate a specific person or persons whose responsibilities shall include the receipt of information from employees of insurers and licensed entities concerning violations of laws, rules or regulations by employers, as defined in this section. Such person or persons shall be provided with proper training on the handling of such information, which shall be deemed a confidential communication for the purposes of this section.  (d) For any change made by the commissioner to procedures, guidelines, handbooks or other work products of the NAIC referenced in this chapter, which materially changes the way in which market analysis, market conducted actions, or market conduct examinations are conducted, the commissioner shall give notice and provide parties with an opportunity for a public hearing pursuant to the Administrative Procedures Act, chapter 42-35.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-15. Cost of market analysis and examination. (a) The total cost of market analysis and examinations performed pursuant to this chapter shall be borne by the companies analyzed and/or examined, including the total cost of all persons contracted by the commissioner pursuant to this chapter to supplement in-house staff, in accordance with the provisions of subdivision 27-13.1-7(a)(1) or in subsection 27-13.1-4(d) as applicable.  (b) The commissioner shall maintain active management and oversight of examination costs and fees, including costs and fees associated with the use of department personnel and examiners and with retaining qualified contract examiners necessary to perform an examination. To the extent the commissioner retains outside assistance, the commissioner must have in writing protocols that:  (1) Clearly identify the types of functions to be subject to outsourcing;  (2) Provide specific timelines for completion of the outsourced review;  (3) Require disclosure of contract examiners recommendations;  (4) Establish and utilize a dispute resolution or arbitration mechanism to resolve conflicts with insurers regarding examination costs and fees; and  (5) Require disclosure of the terms of the contracts with the outside consultants that will be used specifically the costs and fees and/or hourly rates that can be charged.  (c) The commissioner shall review and affirmatively endorse detailed billings from the qualified contract examiner before summary billings are sent to the insurer.  (d) The commissioner may contract for such qualified contract examiners as the commissioner deems necessary, provided that the compensation and per diem allowances paid to such contract persons shall not exceed one hundred twenty-five percent (125%) of the compensation and per diem allowances for examiners set forth in the guidelines adopted by the National Association of Insurance Commissioners, unless the commissioner demonstrates that one hundred twenty-five percent (125%) is inadequate under the circumstances of the examination. The commissioners may make an exception to this requirement for compensation paid to contracted persons with unique expertise, however, such compensation shall be reasonable and based on market conditions.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-2. Purpose  Legislative intent. (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 42-14.5 (The Rhode Island Healthcare Reform Act of 2004  Health Insurance Oversight) or any insurer licensed only in the state of Rhode Island.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-3. Definitions. (a) Commissioner means the director of the department of business regulation or his or her designee.  (b) Complaint means a written or documented oral communication to the commissioner primarily expressing a grievance, meaning an expression of dissatisfaction. For healthcare companies, a grievance is a written complaint submitted by or on behalf of a covered person.  (c) Comprehensive market conduct examination means a review of one or more lines of business of an insurer domiciled in this state that is not conducted for cause. The term includes a review of rating, tier classification, underwriting, policyholder service, claims, marketing and sales, producer licensing, complaint handling practices, or compliance procedures and policies.  (d) Market conduct action means any of the full range of activities that the commissioner may initiate to assess the market and practices of individual insurers, beginning with market analysis and extending to targeted examinations. The commissioners activities to resolve an individual consumer complaint or other reports of a specific instance of misconduct are not market conduct actions for purposes of this chapter.  (e) Market analysis means a process whereby market conduct surveillance personnel collect and analyze information from filed schedules, surveys, required reports and other sources in order to develop a baseline and to identify patterns or practices of insurers licensed to do business in this state that deviate significantly from the norm or that may pose a potential risk to the insurance consumer.  (f) Market conduct examination means the examination of the insurance operations of an insurer licensed to do business in this state in order to evaluate compliance with the applicable laws and regulations of this state. A market conduct examination may be either a comprehensive examination or a targeted examination. A market conduct examination is separate and distinct from a financial examination of an insurer performed pursuant to the Rhode Island general laws, but may be conducted at the same time.  (g) Market conduct surveillance personnel means those individuals employed or contracted by the commissioner to collect, analyze, review or act on information on the insurance marketplace, which identifies patterns or practices of insurers.  (h) National Association of Insurance Commissioners (NAIC) means the organization of insurance regulators from the fifty (50) states, the District of Columbia, and the four U.S. territories.  (i) NAIC market regulation handbook means a handbook, developed and adopted by the NAIC, or successor product, which:  (A) outlines elements and objectives of market analysis and the process by which states can establish and implement market analysis programs; and  (B) sets up guidelines that document established practices to be used by market conduct surveillance personnel in developing and executing an examination.  (j) NAIC market conduct uniform examination procedures means the set of guidelines developed and adopted by the NAIC designed to be used by market conduct surveillance personnel in conducting an examination.  (k) NAIC standard data request means the set of field names and descriptions developed and adopted by the NAIC for use by market conduct surveillance personnel in an examination.  (l) Qualified contract examiner means a person under contract to the commissioner, who is qualified by education, experience and, where applicable, professional designations, to perform market conduct actions.  (m) Targeted examination means a focused exam conducted for cause, based on the results of market analysis indicating the need to review either a specific line of business or specific business practices, including but not limited to, underwriting and rating, marketing and sales, complaint handling operations/management, advertising materials, licensing, policyholder services, non-forfeitures, claims handling, or policy forms and filings. A targeted examination may be conducted by desk examination of by an on-site examination:  (1) Desk examination means a targeted examination that is conducted by an examiner at a location other than the insurers premises. A desk examination is usually performed at the department of business regulations offices with the insurer providing requested documents by hard copy, microfiche, discs, or other electronic media, for review; and  (2) On-site examination means a targeted examination conducted at the insurers home office or the location where the records under review are stored.  (n) Third-party model or product means a model or product provided by an entity separate from and not under directed or indirect corporate control of the insurer using the model or product.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-4. Domestic responsibility and deference to other states. (a) The commissioner is authorized to conduct market conduct examinations as deemed necessary by the commissioner for Rhode Island policyholder protection, which shall be accomplished by comprehensive or targeted examinations of domestic insurers and targeted examinations of foreign insurers, based on the results of market analysis. The commissioner may delegate responsibility for conducting an examination of a domestic insurer, foreign insurer, or an affiliate of an insurer to the insurance commissioner of another state if that insurance commissioner agrees to accept the delegated responsibility for the examination.  (b) The commissioner may delegate such responsibility to a commissioner of a state in which the domestic insurer, foreign insurer, or affiliate has a significant number of policies or significant premium volume.  (c) If the commissioner elected to delegate responsibility for examining an insurer, the commissioner shall accept a report of the examination prepared by the commissioner to whom the responsibility has been delegated.  (d) In lieu of conducting a market conduct examination of an insurer, the commissioner shall accept a report of a market conduct examination on such insurer prepared by the insurance commissioner of the insurers state of domicile or another state, unless:  (1) The laws of that state applicable to the subject of the examination are not deemed by the commissioner to be substantially similar to those of this state;  (2) The examining state does not have market conduct surveillance system that the commissioner deems comparable to the market conducted surveillance system required under this chapter; or  (3) The examination from the other states commissioner has not be conducted within the past three (3) years.  (e) If the insurance commissioner or the designee to whom the examination responsibility was delegated pursuant to paragraph (a) of this section or the report of a market conduct examination prepared by the insurance commissioner of another state pursuant to paragraph (d) of this section, did not evaluate the specific area or issue of concern to the commissioner or a specific requirement of Rhode Island law, the commissioner may pursue a targeted examination or market analysis of the unexamined area pursuant to this statute.  (f) The commissioners determination under subsection (d) is discretionary with the commissioner and is not subject to appeal.  (g) Subject to a determination under subsection (d), if a market conduct examination conducted by another state results in a finding that an insurer should modify a specific practice or procedure, the commissioner shall accept documentation that the insurer has made a similar modification in the state, in lieu of initiating a market conduct action or examination related to that practice or procedure. The commissioner may require other or additional practice or procedure modifications as are necessary to achieve compliance with specific state laws or regulations, which differ substantially from those of the state that conducted the examination.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-5. Market analysis procedures. (a)(1) The commissioner shall gather information as deemed necessary from data currently available, as well as surveys and required reporting requirements, information collected by the NAIC and a variety of other objective sources in both the public and private sectors including law enforcement inquires.  (2) Such information, when collected, shall be analyzed in order to develop a baseline understanding of the marketplace and to identify for further review insurers and/or practices that deviate significantly from the norm or that may pose a potential risk to the insurance consumer. The commissioner shall use the NAIC Market Regulation Handbook as one resource in performing this analysis (or procedures, adopted by regulation, that are substantially similar to the foregoing NAIC product).  (3) The commissioner shall perform the analysis described under this section by:  (i) Identifying key lines of business for systematic review;  (ii) Identifying companies for further analysis based on available information.  (b) If the analysis compels the commissioner to inquire further into a particular insurer or practice, the following continuum of market conduct actions may be considered prior to conducting a targeted, on-site market conduct examination. The action selected shall be made known to the insurer in writing if the action involves insurer participation or response. These actions may include, but are not limited to:  (1) Correspondence with insurer;  (2) Insurer interviews;  (3) Information gathering;  (4) Policy and procedure reviews;  (5) Interrogatories;  (6) Review of insurer self-evaluation (if not subject to a privilege of confidentiality) and compliance programs, including membership in a best-practice organization; and  (7) Desk examinations.  (c) The commissioner shall select a market conduct action that is efficient for the department of business regulation and the insurer, while still protecting the insurance consumer.  (d) The commissioner shall take those steps reasonably necessary to eliminate requests for information that duplicate information provided as part of an insurers annual financial statement, the annual market conduct statement of the National Association of Insurance Commissioners, or other required schedules, surveys, or reports that are regularly submitted to the commissioner, or with data requests made by other states if that information is available to the commissioner, unless the information is state specific, and coordinate market conduct actions and findings with other states.  (e) Causes or conditions, if identified through market analysis, that may trigger a target examination, included but are not limited to:  (1) Information obtained from a market conduct annual statement, market survey or report of financial examination indicating potential fraud, that the insurer is conducting the business of insurance without a license or is engaged in a potential pattern of violation of the general laws or law enforcement inquiry.  (2) A number of complaints against the insurer or a complaint ratio sufficient to indicate potential fraud, conducting the business of insurance without a license, or a potential pattern of unfair trade practice in violation of the general laws. For the purposes of this section, a complaint ratio shall be determined for each line of business.  (3) Information obtained from other objective sources, such as published advertising materials indicating potential fraud, conducting the business of insurance without a license, or evidencing a potential pattern of unfair trade practice in violation of the general laws.  (4) Patterns of violations of the general laws and administrative regulations promulgated thereunder that cause consumer harm.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-6. Protocols for market conduct actions. (a) Market conduct actions taken as a result of a market analysis shall focus on the general business practices and compliance activities of insurers, rather than identifying infrequent or unintentional random errors that do not cause consumer harm.  (b)(1) The commissioner is authorized to determine the frequency and timing of such market conduct actions. The timing shall depend upon the specific market conducted action to be initiated, unless extraordinary circumstances indicating a risk to consumers require immediate action.  (2) If the commissioner has information that more than one insurer is engaged in common practices that may violate statute or regulations, he or she may schedule and coordinate multiple examinations simultaneously.  (c) The insurer shall be given an opportunity to resolve such matters that arise as a result of market analysis to the satisfaction of the commissioner before any additional market conduct actions are taken against the insurer. If the insurer has modified such practice or procedure as a result of a market conduct action taken by the commissioner of another state, the commissioner shall accept appropriate documentation that the insurer has satisfactorily modified the practice or procedure and made similar modification to such practice or procedure in this state. The commissioner may require other or additional practice or procedure modifications as are necessary to achieve compliance with specific state laws or regulations, which differ substantially from those of the state conducted examination.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-7. Protocols for targeted market conduct examinations. (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 subsection 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 conducted 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 the 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 NAICs 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 requires 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 commissioners 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 commissioners 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:  (a) 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.  (b) The insurer must respond with written comments within thirty (30) days of receipt of the draft report.  (c) The department shall make a good faith effort to resolve issues and prepare a final report within thirty (30) days of receipt of the insurers written comments, unless a mutual agreement is reached to extend the deadline. The commissioner may make corrections and other changes, as appropriate.  (d) 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 insurers written response and any agreed-to corrections or changes. The response may be included either as an appendix or in 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 subsections 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 the paragraph (k)(2) of this subsection herein. 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 commissioners 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 commissioners 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 subsection 27-13.1-5(d) and the administrative procedures act, title 42, chapter 35.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-8. Confidentiality requirements. (a) Except as otherwise provided by law, market conduct surveillance personnel shall have free and full access to all books and records, employees, officers and directors, as practicable, of the insurer during regular business hours. An insurer utilizing a third-party model or product for any of the activities under examination shall cause, upon the request of market conduct surveillance personnel, the details of such models or products to be made available to such personnel. All documents, whether from a third-party or an insurer, including, but not limited to, working papers, third-party models or products, complaint logs, and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in the course of any market conduct actions made pursuant to this chapter, or in the course of market analysis by the commissioner of the market conditions of an insurer, or obtained by the NAIC as a result of any of the provisions of this chapter, shall be confidential by law and privileged, shall not be subject to subpoena and shall not be subject to discovery or admissible in evidence in any private civil action. The commissioner will work with an insurer to assure that the insurers privacy and information security procedures are not compromised as a result of or in connection with an examination.  (b) No waiver of any applicable privilege or claim of confidentiality in the documents, materials, or information shall occur as a result of disclosure to the commissioner under this section.  (c) Market conduct surveillance personnel shall be vested with the power to issue subpoenas and examine insurance company personnel under oath when such action is ordered by the commissioner.  (d) Notwithstanding the provisions of paragraph (a) of this subsection, in order to assist in the performance of the commissioners duties, the commissioner may:  (1) Share documents, materials, or other information, including the confidential and privileged documents, materials or information subject to paragraph (a), with other state, federal and international regulatory agencies and law enforcement authorities and the NAIC and its affiliates and subsidiaries, provided that the recipient agrees to and has the legal authority to maintain the confidentiality and privileged status of the document, material, communication or other information;  (2) Receive documents, materials, communications, or information, including otherwise confidential and privileged documents, materials, or information, from the NAIC and its affiliates or subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any documents, materials or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information;  (3) Enter into agreements governing the sharing and use of information consistent with this subsection; and  (4) Notwithstanding the provisions of this section, no insurer shall be compelled to waive any statutory or common law privilege, but may voluntarily disclose such document to the commissioner in response to any market analysis, market conduct action or examination as provided in this chapter.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-71-9. Market conduct surveillance personnel. (a) Market conduct surveillance personnel shall be qualified by education, experience and, where applicable, professional designations. The commissioner may supplement the in-house market conduct surveillance staff with qualified outside professional assistance if he or she determines that such assistance is necessary.  (b) Market conduct surveillance personnel have a conflict of interest, either directly or indirectly, if they are affiliated with the management, have been employed by, or own a pecuniary interest in the insurer subject to any examination under this chapter within the most recent five (5) years prior to the use of the personnel. This section shall not be construed to automatically preclude an individual from being:  (1) A policyholder or claimant under an insurance policy;  (2) A grantee of a mortgage or similar instrument on the individuals residence from a regulated entity if done under customary terms and in the ordinary course of business;  (3) An investment owner in shares of regulated diversified investment companies; or  (4) A settlor or beneficiary of a blind trust into which any otherwise permissible holdings have been placed.  History of Section.P.L. 2008, ch. 72,  1; P.L. 2008, ch. 233,  1. 
 27-72-1. Title. This chapter may be cited and shall be known as the Life Settlements Act. History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-10. Disclosure to insurer. (a) Without limiting the ability of an insurer from assessing the insurability of a policy applicant and determining whether or not to issue the policy, and in addition to other questions an insurance carrier may lawfully pose to a life insurance applicant, insurance carriers may inquire in the application for insurance whether the proposed owner intends to pay premiums with the assistance of financing from a lender that will use the policy as collateral to support the financing.  (1) If, as described in this chapter, the loan provides funds which can be used for a purpose other than paying for the premiums, costs, and expenses associated with obtaining and maintaining the life insurance policy and loan, the application shall be rejected as a violation of the prohibited practices in  27-72-13.  (2) If the financing does not violate  27-72-13, the insurance carrier:  (i) May make disclosures, including but not limited to such as the following, to the applicant and the insured, either on the application or an amendment to the application to be completed no later than the delivery of the policy:  If you have entered into a loan arrangement where the policy is used as collateral, and the policy does change ownership at some point in the future in satisfaction of the loan, the following may be true:  (A) A change of ownership could lead to a stranger owning an interest in the insureds life;  (B) A change of ownership could in the future limit your ability to purchase future insurance on the insureds life because there is a limit to how much coverage insurers will issue on one life;  (C) Should there be a change of ownership and you wish to obtain more insurance coverage on the insureds life in the future, the insureds higher issue age, a change in health status, and/or other factors may reduce the ability to obtain coverage and/or may result in significantly higher premiums;  (D) You should consult a professional advisor, since a change in ownership in satisfaction of the loan may result in tax consequences to the owner, depending on the structure of the loan; and  (b) May require certifications, such as the following, from the applicant and/or the insured:  (1) I have not entered into any agreement or arrangement providing for the future sale of this life insurance policy;  (2) My loan arrangement for this policy provides funds sufficient to pay for some or all of the premiums, costs, and expenses associated with obtaining and maintaining my life insurance policy, but I have not entered into any agreement by which I am to receive consideration in exchange for procuring this policy; and  (3) The borrower has an insurable interest in the insured.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-11. General rules. (a) A provider entering into a life settlement contract with any owner of a policy, wherein the insured is terminally or chronically ill, shall first obtain:  (1) If the owner is the insured, a written statement from a licensed attending physician that the owner is of sound mind and under no constraint or undue influence to enter into a settlement contract; and  (2) A document in which the insured consents to the release of his/her medical records to a provider, settlement broker, or insurance producer and, if the policy was issued less than two (2) years from the date of application for a settlement contract, to the insurance company that issued the policy.  (b) The insurer shall respond to a request for verification of coverage submitted by a provider, settlement broker, or life insurance producer not later than thirty (30) calendar days from the date the request is received. The request for verification of coverage must be made on a form approved by the commissioner. The insurer shall complete and issue the verification of coverage or indicate in which respects it is unable to respond. In its response, the insurer shall indicate whether, based on the medical evidence and documents provided, the insurer intends to pursue an investigation at this time regarding the validity of the insurance contract.  (c) Before or at the time of execution of the settlement contract, the provider shall obtain a witnessed document in which the owner consents to the settlement contract, represents that the owner has a full and complete understanding of the settlement contract, that the owner has a full and complete understanding of the benefits of the policy, acknowledges that the owner is entering into the settlement contract freely and voluntarily, and, for persons with a terminal or chronic illness or condition, acknowledges that the insured has a terminal or chronic illness and that the terminal or chronic illness or condition was diagnosed after the policy was issued.  (d) The insurer shall not unreasonably delay effecting change of ownership or beneficiary with any life settlement contract lawfully entered into in this state or with a resident of this state.  (e) If a settlement broker or life insurance producer performs any of these activities required of the provider, the provider is deemed to have fulfilled the requirements of this chapter.  (f) If a broker performs those verification of coverage activities required of the provider, the provider is deemed to have fulfilled the requirements of  27-72-9.  (g) Within twenty (20) days after an owner executes the life settlement contract, the provider shall give written notice to the insurer that issued that insurance policy that the policy has become subject to a life settlement contract. The notice shall be accompanied by the documents required by  27-72-10(a)(2).  (h) All medical information solicited or obtained by any licensee shall be subject to the applicable provision of state law relating to confidentiality of medical information, if not otherwise provided in this chapter.  (i) All life settlement contracts entered into in this state shall provide that the owner may rescind the contract on or before fifteen (15) days after the date it is executed by all parties thereto. Rescission, if exercised by the owner, is effective only if both notice of the rescission is given, and the owner repays all proceeds and any premiums, loans, and loan interest paid on account of the provider within the rescission period. If the insured dies during the rescission period, the contract shall be deemed to have been rescinded subject to repayment by the owner or the owners estate of all proceeds and any premiums, loans, and loan interest to the provider.  (j) Within three (3) business days after receipt from the owner of documents to effect the transfer of the insurance policy, the provider shall pay the proceeds of the settlement to an escrow or trust account managed by a trustee or escrow agent in a state or federally chartered financial institution pending acknowledgement of the transfer by the issuer of the policy. The trustee or escrow agent shall be required to transfer the proceeds due to the owner within three (3) business days of acknowledgement of the transfer from the insurer.  (k) Failure to tender the life settlement contract proceeds to the owner by the date disclosed to the owner renders the contract voidable by the owner for lack of consideration until the time the proceeds are tendered to and accepted by the owner. A failure to give written notice of the right of rescission hereunder shall toll the right of rescission until thirty (30) days after the written notice of the right of rescission has been given.  (l) Any fee paid by a provider, party, individual, or an owner to a broker in exchange for services provided to the owner pertaining to a life settlement contract shall be computed as a percentage of the offer obtained, not the face value of the policy. Nothing in this section shall be construed as prohibiting a broker from reducing such brokers fee below this percentage if the broker so chooses.  (m) The broker shall disclose to the owner anything of value paid or given to a broker, which relates to a life settlement contract.  (n) No person at any time prior to, or at the time of, the application for, or issuance of, a policy, or during a two (2) year period commencing with the date of issuance of the policy, shall enter into a life settlement regardless of the date the compensation is to be provided and regardless of the date the assignment, transfer, sale, devise, bequest or surrender of the policy is to occur. This prohibition shall not apply if the owner certifies to the provider that:  (1) The policy was issued upon the owners exercise of conversion rights arising out of a group or individual policy, provided the total of the time covered under the conversion policy plus the time covered under the prior policy is at least twenty-four (24) months. The time covered under a group policy must be calculated without regard to a change in insurance carriers, provided the coverage has been continuous and under the same group sponsorship; or  (2) The owner submits independent evidence to the provider that one or more of the following conditions have been met within the two (2) year period:  (i) The owner or insured is terminally or chronically ill;  (ii) The owner or insured disposes of his/her ownership interests in a closely held corporation, pursuant to the terms of a buyout or other similar agreement in effect at the time the insurance policy was initially issued;  (iii) The owners spouse dies;  (iv) The owner divorces his or her spouse;  (v) The owner retires from full-time employment;  (vi) The owner becomes physically or mentally disabled and a physician determines that the disability prevents the owner from maintaining full-time employment; or  (vii) A final order, judgment or decree is entered by a court of competent jurisdiction, on the application of a creditor of the owner, adjudicating the owner bankrupt or insolvent, or approving a petition seeking reorganization of the owner or appointing a receiver, trustee or liquidator to all or a substantial part of the owners assets;  (3) Copies of the independent evidence required by subdivision (n)(2) of this section shall be submitted to the insurer when the provider submits a request to the insurer for verification of coverage. The copies shall be accompanied by a letter of attestation from the provider that the copies are true and correct copies of the documents received by the provider. Nothing in this section shall prohibit an insurer from exercising its right to contest the validity of any policy;  (4) If the provider submits to the insurer a copy of independent evidence provided for in subdivision (n)(2) of this section when the provider submits a request to the insurer to effect the transfer of the policy to the provider, the copy is deemed to establish that the settlement contract satisfies the requirements of this section.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-12. Authority to promulgate regulations  Conflict of laws. (a) The Commissioner may:  (1) Promulgate regulations implementing this chapter and regulating the activities and relationships of providers, brokers, insurers and their agents, subject to statutory limitations on administrative rule making.  (2) Provide by regulation that the commissioner is authorized and may in his or her discretion recover the reasonable cost of legal services incurred by the department in enforcement actions under this chapter either from the licensee against whom the action is taken or by way of an assessment of all providers licensed pursuant to  27-72-3(a). The assessment formula shall be set by regulation based upon information provided in the prior years annual statement filed pursuant to  27-72-3(l).  (b) Conflict of laws.(1) If there is more than one owner on a single policy, and the owners are residents of different states, the life settlement contract shall be governed by the law of the state in which the owner having the largest percentage ownership resides or, if the owners hold equal ownership, the state of residence of one owner agreed upon in writing by all of the owners. The law of the state of the insured shall govern in the event that equal owners fail to agree in writing upon a state of residence for jurisdictional purposes.  (2) A provider from this state who enters into a life settlement contract with an owner who is a resident of another state that has enacted statutes or adopted regulations governing life settlement contracts, shall be governed in the effectuation of that life settlement contract by the statutes and regulations of the owners state of residence. If the state in which the owner is a resident has not enacted statutes or regulations governing life settlement contracts, the provider shall give the owner notice that neither state regulates the transaction upon which he or she is entering. For transactions in those states, however, the provider is to maintain all records required as if the transactions were executed in the state of residence. The forms used in those states need not be approved by the department.  (3) If there is a conflict in the laws that apply to an owner and a purchaser in any individual transaction, the laws of the state that apply to the owner shall take precedence and the provider shall comply with those laws.   History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-13. Prohibited practices. (a) It is unlawful for any person to:  (1) Enter into a life settlement contract if such person knows or reasonably should have known that the life insurance policy was obtained by means of a false, deceptive or misleading application for such policy;  (2) Engage in any transaction, practice or course of business if such person knows or reasonably should have known that the intent was to avoid the notice requirements of this chapter;  (3) Engage in any fraudulent act or practice in connection with any transaction relating to any settlement involving an owner who is a resident of this state;  (4) Issue, solicit, market or otherwise promote the purchase of an insurance policy for the purpose of or with an emphasis on settling the policy;  (5) Enter into a premium finance agreement with any person or agency, or any person affiliated with such person or agency, pursuant to which such person shall receive any proceeds, fees or other consideration, directly or indirectly, from the policy or owner of the policy or any other person with respect to the premium finance agreement or any settlement contract or other transaction related to such policy that are in addition to the amounts required to pay the principal, interest and service charges related to policy premiums pursuant to the premium finance agreement or subsequent sale of such agreement; provided, further, that any payments, charges, fees or other amounts in addition to the amounts required to pay the principal, interest and service charges related to policy premiums paid under the premium finance agreement shall be remitted to the original owner of the policy or to his or her estate if he or she is not living at the time of the determination of the overpayment;  (6) With respect to any settlement contract or insurance policy and a broker, knowingly solicit an offer from, effectuate a life settlement contract with or make a sale to any provider, financing entity or related provider trust that is controlling, controlled by, or under common control with such broker unless such relationship has been disclosed to the owner;  (7) With respect to any life settlement contract or insurance policy and a provider, knowingly enter into a life settlement contract with an owner, if, in connection with such life settlement contract, anything of value will be paid to a broker that is controlling, controlled by, or under common control with such provider or the financing entity or related provider trust that is involved in such settlement contract unless such relationship has been disclosed to the owner;  (8) With respect to a provider, enter into a life settlement contract unless the life settlement promotional, advertising and marketing materials, as may be prescribed by regulation, have been filed with the commissioner. In no event shall any marketing materials expressly reference that the insurance is free for any period of time. The inclusion of any reference in the marketing materials that would cause an owner to reasonably believe that the insurance is free for any period of time shall be considered a violation of this chapter; or  (9) With respect to any life insurance producer, insurance company, broker, or provider make any statement or representation to the applicant or policyholder in connection with the sale or financing of a life insurance policy to the effect that the insurance is free or without cost to the policyholder for any period of time unless provided in the policy.  (b) A violation of this section shall be deemed a fraudulent life settlement act.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-14. Fraud prevention and control. (a) Fraudulent life settlement acts, interference and participation of convicted felons prohibited.(1) A person shall not commit a fraudulent life settlement act.  (2) A person shall not knowingly and intentionally interfere with the enforcement of the provisions of this chapter or investigations of suspected or actual violations of this chapter.  (3) A person in the business of life settlements shall not knowingly or intentionally permit any person convicted of a felony involving dishonesty or breach of trust to participate in the business of life settlements.   (b) Fraud warning required.(1) Life settlement contracts and applications for life settlement contracts, regardless of the form of transmission, shall contain the following statement or a substantially similar statement:  (1) Any person who knowingly presents false information in an application for insurance or life settlement contract is guilty of a crime and may be subject to fines and confinement in prison.  (2) The lack of a statement as required in subdivision (1) of this subsection does not constitute a defense in any prosecution for a fraudulent life settlement act.   (c) Mandatory reporting of fraudulent life settlement acts.(1) Any person engaged in the business of life settlements having knowledge or a reasonable belief that a fraudulent life settlement acts is being, will be or has been committed shall provide to the commissioner the information required by, and in a manner prescribed by, the commissioner.  (2) Any other person having knowledge or a reasonable belief that a fraudulent life settlement act is being, will be or has been committed may provide to the commissioner the information required by, and in a manner prescribed by, the commissioner.   (d) Immunity from liability.(1) No civil liability shall be imposed on and no cause of action shall arise from a persons furnishing information concerning suspected, anticipated or completed fraudulent life settlement acts or suspected or completed fraudulent insurance acts, if the information is provided to or received from:  (i) The commissioner or the commissioners employees, agents or representatives;  (ii) Federal, state or local law enforcement or regulatory officials or their employees, agents or representatives;  (iii) A person involved in the prevention and detection of fraudulent life settlement acts or that persons agents, employees or representatives;  (iv) Any regulatory body or their employees, agents or representatives, overseeing life insurance, life settlements, securities or investment fraud;  (v) The life insurer that issued the life insurance policy covering the life of the insured; or  (vi) The licensee and any agents, employees or representatives.  (2) Subdivision (1) of this subsection shall not apply to statements made with actual malice. In an action brought against a person for filing a report or furnishing other information concerning a fraudulent life settlement act or a fraudulent insurance act, the party bringing the action shall plead specifically any allegation that subdivision (1) does not apply because the person filing the report or furnishing the information did so with actual malice.  (3) A person identified in subdivision (1) shall be entitled to an award of attorneys fees and costs if he or she is the prevailing party in a civil cause of action for libel, slander or any other relevant tort arising out of activities in carrying out the provisions of this chapter and the party bringing the action was not substantially justified in doing so. For purposes of this section a proceeding is substantially justified if it had a reasonable basis in law or fact at the time that it was initiated.  (4) This section does not abrogate or modify common law or statutory privileges or immunities enjoyed by a person described in subdivision (1).   (e) Confidentiality.(1) The documents and evidence provided pursuant to subsection (d) of this section or obtained by the commissioner in an investigation of suspected or actual fraudulent life settlement acts shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in a civil or criminal action.  (2) Subdivision (1) of this subsection does not prohibit release by the commissioner of documents and evidence obtained in an investigation of suspected or actual fraudulent life settlement acts:  (i) In administrative or judicial proceedings to enforce laws administered by the commissioner;  (ii) To federal, state or local law enforcement or regulatory agencies, to an organization established for the purpose of detecting and preventing fraudulent life settlement acts or to the NAIC; or  (iii) At the discretion of the commissioner, to a person in the business of life settlements that is aggrieved by a fraudulent life settlement act.  (3) Release of documents and evidence under subdivision (2) of this subsection does not abrogate or modify the privilege granted in subdivision (1).   (f) Other law enforcement or regulatory authority. This chapter shall not:  (1) Preempt the authority or relieve the duty of other law enforcement or regulatory agencies to investigate, examine and prosecute suspected violations of law;  (2) Preempt, supersede, or limit any provision of any state securities law or any rule, order, or notice issued thereunder;  (3) Prevent or prohibit a person from voluntarily disclosing information concerning life settlement fraud to a law enforcement or regulatory agency other than the insurance department; or  (4) Limit the powers granted elsewhere by the laws of this state to the commissioner or an insurance fraud unit to investigate and examine possible violations of law and to take appropriate action against wrongdoers.  (g) Life settlement antifraud initiatives.(1) Providers and brokers shall have in place antifraud initiatives reasonably calculated to detect, prosecute and prevent fraudulent life settlement acts. At the discretion of the commissioner, the commissioner may order, or a licensee may request and the commissioner may grant, such modifications of the following required initiatives as necessary to ensure an effective antifraud program. The modifications may be more or less restrictive than the required initiatives so long as the modifications may reasonably be expected to accomplish the purpose of this section. Antifraud initiatives shall include:  (i) Fraud investigators, who may be provider or broker employees or independent contractors; and  (ii) An antifraud plan, which shall be submitted to the commissioner. The antifraud plan shall include, but not be limited to:  (A) A description of the procedures for detecting and investigating possible fraudulent life settlement acts and procedures for resolving material inconsistencies between medical records and insurance applications;  (B) A description of the procedures for reporting possible fraudulent life settlement acts to the commissioner;  (C) A description of the plan for antifraud education and training of underwriters and other personnel; and  (D) A description or chart outlining the organizational arrangement of the antifraud personnel who are responsible for the investigation and reporting of possible fraudulent life settlement acts and investigating unresolved material inconsistencies between medical records and insurance applications.  (2) Antifraud plans submitted to the commissioner shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in a civil or criminal action.   History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-15. Injunctions  Civil remedies  Cease and desist. (a) In addition to the penalties and other enforcement provisions of this chapter, if any person violates this chapter or any rule implementing this chapter, the commissioner may seek an injunction in a court of competent jurisdiction in this state and may apply for temporary and permanent orders that the commissioner determines necessary to restrain the person from further committing the violation.  (b) Any person damaged by the acts of another person in violation of this chapter or any rule or regulation implementing this chapter, may bring a civil action for damages against the person committing the violation in a court of competent jurisdiction.  (c) The commissioner may issue a cease and desist order upon a person who violates any provision of this part, any rule or order adopted by the commissioner, or any written agreement entered into with the commissioner, in accordance with the chapter governing administrative procedures,  42-35-1 et seq.  (d) When the commissioner finds that such an action presents an immediate danger to the public and requires an immediate final order, he may issue an emergency cease and desist order reciting with particularity the facts underlying such findings. The emergency cease and desist order is effective immediately upon service of a copy of the order on the respondent and remains effective for ninety (90) days. If the department begins non-emergency cease and desist proceedings under subsection (a), the emergency cease and desist order remains effective, absent an order by a court of competent jurisdiction pursuant to  42-35-1 et seq. In the event of a willful violation of this chapter, the superior court may award statutory damages in addition to actual damages in an additional amount up to three (3) times the actual damage award. The provisions of this chapter may not be waived by agreement. No choice of law provision may be utilized to prevent the application of this chapter to any settlement in which a party to the settlement is a resident of this state.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-16. Penalties. (a) It is a violation of this chapter for any person, provider, broker, or any other party related to the business of life settlements, to commit a fraudulent life settlement act.  (b) For criminal liability purposes, a person that commits a fraudulent life settlement act is guilty of committing insurance fraud and shall be subject to additional penalties under  27-54-1 et seq.  (c) The commissioner shall be empowered to levy a civil penalty not exceeding one thousand dollars ($1,000) and the amount of the claim for each violation upon any person, including those persons and their employees licensed pursuant to this chapter, who is found to have committed a fraudulent life settlement act or violated any other provision of this chapter.  (d) The license of a person licensed under this chapter that commits a fraudulent life settlement act shall be revoked.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-17. Unfair trade practices. A violation of this chapter shall be considered an unfair trade practice pursuant to state law and subject to the penalties provided by state law.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-18. Effective date. (a) A provider lawfully transacting business in this state prior to the effective date of this act may continue to do so pending approval or disapproval of that persons application for a license as long as the application is filed with the commissioner not later than thirty (30) days after publication by the commissioner of an application form and instructions for licensure of providers. If the publication of the application form and instructions is prior to the effective date of this act, then the filing of the application shall not be later than thirty (30) days after the effective date of this act. During the time that such an application is pending with the commissioner, the applicant may use any form of life settlement contract that has been filed with the commissioner pending approval thereof, provided that such form is otherwise in compliance with the provisions of this chapter. Any person transacting business in this state under this provision shall be obligated to comply with all other requirements of this chapter.  (b) A person who has lawfully negotiated life settlement contracts between any owner residing in this state and one or more providers for at least one year immediately prior to the effective date of this act may continue to do so pending approval or disapproval of that persons application for a license as long as the application is filed with the commissioner not later than thirty (30) days after publication by the commissioner of an application form and instructions for licensure of brokers. If the publication of the application form and instructions is prior to the effective date of this chapter, then the filing of the application shall not be later than thirty (30) days after the effective date of this act. Any person transacting business in this state under this provision shall be obligated to comply with all other requirements of this chapter.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-2. Definitions. As used in this chapter: (1) Advertisement means any written, electronic or printed communication or any communication by means of recorded telephone messages or transmitted on radio, television, the Internet or similar communications media, including film strips, motion pictures and videos, published, disseminated, circulated or placed before the public, directly or indirectly, for the purpose of creating an interest in or inducing a person to purchase or sell, assign, devise, bequest or transfer the death benefit or ownership of a life insurance policy or an interest in a life insurance policy pursuant to a life settlement contract.  (2) Broker means a person who, on behalf of an owner and for a fee, commission or other valuable consideration, offers or attempts to negotiate life settlement contracts between an owner and provider. A broker represents only the owner and owes a fiduciary duty to the owner to act according to the owners instructions, and in the best interest of the owner, notwithstanding the manner in which the broker is compensated. A broker does not include an attorney, certified public accountant or financial planner retained in the type of practice customarily performed in their professional capacity to represent the owner whose compensation is not paid directly or indirectly by the provider or any other person, except the owner.  (3) Business of life settlements means an activity involved in, but not limited to, offering to enter into, soliciting, negotiating, procuring, effectuating, monitoring, or tracking, of life settlement contracts.  (4) Chronically ill means:  (i) Being unable to perform at least two (2) activities of daily living (i.e., eating, toileting, transferring, bathing, dressing or continence);  (ii) Requiring substantial supervision to protect the individual from threats to health and safety due to severe cognitive impairment; or  (iii) Having a level of disability similar to that described in subdivision (i) as determined by the United States Secretary of Health and Human Services.  (5) Commissioner means the director of the department of business regulation or his or her designee.  (6) Federally regulated entity means a national bank, thrift, credit union, or any entity registered or exempt from registration under 15 U.S.C.  80a-1 et seq., 15 U.S.C.  80b-1 et seq., 15 U.S.C.  77a et seq., and 15 U.S.C.  78a et seq., or any affiliate thereof.  (7) Financing entity means an underwriter, placement agent, lender, purchaser of securities, purchaser of a policy or certificate from a provider, credit enhancer, or any entity that has a direct ownership in a policy or certificate that is the subject of a life settlement contract, but:  (i) Whose principal activity related to the transaction is providing funds to effect the life settlement contract or purchase of one or more policies; and  (ii) Who has an agreement in writing with one or more providers to finance the acquisition of life settlement contracts.  Financing entity does not include a non-accredited investor or purchaser. (8) Financing transaction means a transaction in which a licensed provider obtains financing from a financing entity including, without limitation, any secured or unsecured financing, any securitization transaction, or any securities offering which either is registered or exempt from registration under federal and state securities law.  (9) Fraudulent life settlement act includes:  (i) Acts or omissions committed by any person who, knowingly and with intent to defraud, for the purpose of depriving another of property or for pecuniary gain, commits, or permits its employees or its agents to engage in acts including, but not limited to:  (A) Presenting, causing to be presented or preparing with knowledge and belief that it will be presented to or by a provider, premium finance lender, broker, insurer, insurance producer or any other person, false material information, or concealing material information, as part of, in support of, or concerning a fact material to one or more of the following:  (I) An application for the issuance of a life settlement contract or insurance policy;  (II) The underwriting of a life settlement contract or insurance policy;  (III) A claim for payment or benefit pursuant to a life settlement contract or insurance policy;  (IV) Premiums paid on an insurance policy;  (V) Payments and changes in ownership or beneficiary made in accordance with the terms of a life settlement contract or insurance policy;  (VI) The reinstatement or conversion of an insurance policy;  (VII) In the solicitation, offer to enter into, or effectuation of a life settlement contract, or insurance policy;  (VIII) The issuance of written evidence of life settlement contract or insurance;  (IX) Any application for or the existence of or any payments related to a loan secured directly or indirectly by any interest in a life insurance policy; or  (X) Enter into any practice or plan which involves stranger originated life insurance (STOLI).  (B) Failing to disclose to the insurer where the request for such disclosure has been asked for by the insurer that the prospective insured has undergone a life expectancy evaluation by any person or entity other than the insurer or its authorized representatives in connection with the issuance of the policy.  (C) Employing any device, scheme, or artifice to defraud in the business of life settlements.  (D) In the solicitation, application or issuance of a life insurance policy, employing any device, scheme or artifice in violation of state insurable interest laws.  (ii) In the furtherance of a fraud or to prevent the detection of a fraud any person commits or permits its employees or its agents to:  (A) Remove, conceal, alter, destroy or sequester from the commissioner the assets or records of a licensee or other person engaged in the business of life settlements;  (B) Misrepresent or conceal the financial condition of a licensee, financing entity, insurer or other person;  (C) Transact the business of life settlements in violation of laws requiring a license, certificate of authority or other legal authority for the transaction of the business of life settlements;  (D) File with the commissioner or the chief insurance regulatory official of another jurisdiction a document containing false information or otherwise concealing information about a material fact from the commissioner;  (E) Engage in embezzlement, theft, misappropriation or conversion of monies, funds, premiums, credits or other property of a provider, insurer, insured, owner, insurance, policy owner or any other person engaged in the business of life settlements or insurance;  (F) Knowingly and with intent to defraud, enter into, broker, or otherwise deal in a life settlement contract, the subject of which is a life insurance policy that was obtained by presenting false information concerning any fact material to the policy or by concealing, for the purpose of misleading another, information concerning any fact material to the policy, where the owner or the owners agent intended to defraud the policys issuer;  (G) Attempt to commit, assist, aid or abet in the commission of, or conspiracy to commit the acts or omissions specified in this subsection; or  (H) Misrepresent the state of residence of an owner to be a state or jurisdiction that does not have a law substantially similar to this chapter for the purpose of evading or avoiding the provisions of this chapter.  (10) Insured means the person covered under the policy being considered for sale in a life settlement contract.  (11) Life expectancy means the arithmetic mean of the number of months the insured under the life insurance policy to be settled can be expected to live as determined by a life expectancy company provider, broker, or financing entity considering medical records and appropriate experiential data.  (12) Life insurance producer means any person licensed in this state as a resident or nonresident insurance producer who has received qualification or authority for life insurance coverage or a life line of coverage pursuant to chapter 2.4 of this title.  (13) Life settlement contract means a written agreement entered into between a provider and an owner, establishing the terms under which compensation or any thing of value will be paid, which compensation or thing of value is less than the expected death benefit of the insurance policy or certificate, in return for the owners assignment, transfer, sale, devise or bequest of the death benefit or any portion of an insurance policy or certificate of insurance for compensation; provided, however, that the minimum value for a life settlement contract shall be greater than a cash surrender value or accelerated death benefit available at the time of an application for a life settlement contract. Life settlement contract also includes the transfer for compensation or value of ownership or beneficial interest in a trust or other entity that owns such policy if the trust or other entity was formed or availed of for the principal purpose of acquiring one or more life insurance contracts, which life insurance contract insures the life of a person residing in this state.  (i) Life settlement contract also includes a premium finance loan made for a policy on or before the date of issuance where:  (A) The loan proceeds are not used solely to pay premiums for the policy and any costs or expenses incurred by the lender or the borrower in connection with the financing; or  (B) The owner receives on the date of the premium finance loan a guarantee of the future life settlement value of the policy; or  (C) The owner agrees on the date of the premium finance loan to sell the policy or any portion of its death benefit on any date following the issuance of the policy.  (ii) Life settlement contract does not include:  (A) A policy loan by a life insurance company pursuant to the terms of the life insurance policy or accelerated death provisions contained in the life insurance policy, whether issued with the original policy or as a rider;  (B) A premium finance loan, as defined herein, or any loan made to an insured, a trust established by an insured, or an entity established by the insured by a bank, federally regulated entity, or other licensed financial institution or any transfer, foreclosure, option to transfer, sale of any interest in collateral of such loan subsequent thereto for the purpose of evading regulation under this chapter;  (C) A collateral assignment of a life insurance policy by an owner;  (D) A loan made by a lender that does not violate chapter 14.6 of title 19, provided such loan is not described in subdivision (i) above, and is not otherwise within the definition of life settlement contract;  (E) An agreement where all the parties:  (I) are closely related to the insured by blood or law; or  (II) have a lawful substantial economic interest in the continued life, health and bodily safety of the person insured, or are trusts established primarily for the benefit of such parties;  (F) Any designation, consent or agreement by an insured who is an employee of an employer in connection with the purchase by the employer, or trust established by the employer, of life insurance on the life of the employee;  (G) A bona fide business succession planning arrangement:  (I) Between one or more shareholders in a corporation or between a corporation and one or more of its shareholders or one or more trust established by its shareholders;  (II) Between one or more partners in a partnership or between a partnership and one or more of its partners or one or more trust established by its partners; or  (III) Between one or more members in a limited liability company or between a limited liability company and one or more of its members or one or more trust established by its members;  (H) An agreement entered into by a service recipient, or a trust established by the service recipient, and a service provider, or a trust established by the service provider, who performs significant services for the service recipients trade or business; or  (I) Any other contract, transaction or arrangement from the definition of life settlement contract that the commissioner determines is not of the type intended to be regulated by this chapter.  (14) Net death benefit means the amount of the life insurance policy or certificate to be settled less any outstanding debts or liens.  (15) Owner means the owner of a life insurance policy or a certificate holder under a group policy, with or without a terminal illness, who enters or seeks to enter into a life settlement contract. For the purposes of this article, an owner shall not be limited to an owner of a life insurance policy or a certificate holder under a group policy that insures the life of an individual with a terminal or chronic illness or condition except where specifically addressed. The term owner does not include:  (i) Any provider or other licensee under this chapter;  (ii) A qualified institutional buyer as defined in Rule 144A of the Federal Securities Act of 1933, as amended;  (iii) A financing entity;  (iv) A special purpose entity; or  (v) A related provider trust.  (16) Patient identifying information means an insureds address, telephone number, facsimile number, electronic mail address, photograph or likeness, employer, employment status, social security number, or any other information that is likely to lead to the identification of the insured.  (17) Policy means an individual or group policy, group certificate, contract or arrangement of life insurance owned by a resident of this state, regardless of whether delivered or issued for delivery in this state.  (18) Premium finance loan is a loan made primarily for the purposes of making premium payments on a life insurance policy, which loan is secured by an interest in such life insurance policy.  (19) Person means any natural person or legal entity including, but not limited to, a partnership, limited liability company, association, trust or corporation.  (20) Provider means a person, other than an owner, who enters into or effectuates a life settlement contract with an owner, a provider does not include:  (i) Any bank, savings bank, savings and loan association, credit union;  (ii) A licensed lending institution or creditor or secured party pursuant to a premium finance loan agreement which takes an assignment of a life insurance policy or certificate issued pursuant to a group life insurance policy as collateral for a loan;  (iii) The insurer of a life insurance policy or rider to the extent of providing accelerated death benefits or riders or cash surrender value;  (iv) Any natural person who enters into or effectuates no more than one agreement in a calendar year for the transfer of a life insurance policy or certificate issued pursuant to a group life insurance policy, for compensation or anything of value less than the expected death benefit payable under the policy;  (v) A purchaser;  (vi) Any authorized or eligible insurer that provides stop loss coverage to a provider; purchaser, financing entity, special purpose entity, or related provider trust;  (vii) A financing entity;  (viii) A special purpose entity;  (ix) A related provider trust;  (x) A broker; or  (xi) An accredited investor or qualified institutional buyer as defined; respectively, in regulation D, rule 501 or rule 144A of the Federal Securities Act of 1933, as amended, who purchases a life settlement policy from a provider.  (21) Purchased policy means a policy or group certificate that has been acquired by a provider pursuant to a life settlement contract.  (22) Purchaser means a person who pays compensation or anything of value as consideration for a beneficial interest in a trust which is vested with, or for the assignment, transfer or sale of, an ownership or other interest in a life insurance policy or a certificate issued pursuant to a group life insurance policy which has been the subject of a life settlement contract.  (23) Related provider trust means a titling trust or other trust established by a licensed provider or a financing entity for the sole purpose of holding the ownership or beneficial interest in purchased policies in connection with a financing transaction. In order to qualify as a related provider trust, the trust must have a written agreement with the licensed provider under which the licensed provider is responsible for ensuring compliance with all statutory and regulatory requirements and under which the trust agrees to make all records and files relating to life settlement transactions available to the commissioner as if those records and files were maintained directly by the licensed provider.  (24) Settled policy means a life insurance policy or certificate that has been acquired by a provider pursuant to a life settlement contract.  (25) Special purpose entity means a corporation, partnership, trust, limited liability company, or other legal entity formed solely to provide either directly or indirectly access to institutional capital markets:  (i) For a financing entity or provider; or  (ii) In connection with a transaction in which the securities in the special purpose entity are acquired by the owner or by a qualified institutional buyer as defined in Rule 144 promulgated under the Federal Securities Act of 1933, as amended; or  (iii) The securities pay a fixed rate of return commensurate with established asset-backed institutional capital markets.  (26) Stranger-originated life insurance or STOLI is a practice or plan to initiate a life insurance policy for the benefit of a third-party investor who, at the time of policy origination, has no insurable interest in the insured. STOLI practices include, but are not limited to, cases in which life insurance is purchased with resources or guarantees from or through a person, or entity, who, at the time of policy inception, could not lawfully initiate the policy himself/herself or itself, and where, at the time of inception, there is an arrangement or agreement, whether verbal or written, to directly or indirectly transfer the ownership of the policy and/or the policy benefits to a third party. Trusts, that are created to give the appearance of insurable interest, and are used to initiate policies for investors, violate insurable interest laws and the prohibition against wagering on life. STOLI arrangements do not include those practices set forth in this chapter.  (27) Terminally ill means having an illness or sickness that can reasonably be expected to result in death in twenty-four (24) months or less.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-3. Licensing requirements. (a) No person, wherever located, shall act as a provider or broker with an owner or multiple owners who is a resident of this state, without first having obtained a license from the commissioner. If there is more than one owner on a single policy and the owners are residents of different states, the life settlement contract shall be governed by the law of the state in which the owner having the largest percentage ownership resides or, if the owners hold equal ownership, the state of residence of one owner agreed upon in writing by all owners.  (b) Application for a provider, or broker, license shall be made to the commissioner by the applicant on a form prescribed by the commissioner, and the application shall be accompanied by a fee reasonable in an amount established by the commissioner.  (c) A life insurance producer who has been duly licensed as a resident insurance producer with a life line of authority in this state or his or her home state for at least one year and is licensed as a nonresident producer in this state shall be deemed to meet the licensing requirements of this section and shall be permitted to operate as a broker.  (d) Not later than thirty (30) days from the first day of operating as a broker, the life insurance producer shall notify the commissioner that he or she is acting as a broker on a form prescribed by the commissioner, and shall pay any applicable fee to be determined by the commissioner. Notification shall include an acknowledgement by the life insurance producer that he or she will operate as a broker in accordance with this chapter.  (e) The insurer that issued the policy that is the subject of a life settlement contract shall not be responsible for any act or omission of a broker or provider or purchaser arising out of or in connection with the life settlement transaction, unless the insurer receives compensation for the placement of a life settlement contract from the provider or purchaser or broker in connection with the life settlement contract.  (f) A person licensed as an attorney, certified public accountant or financial planner accredited by a nationally recognized accreditation agency, who is retained to represent the owner, whose compensation is not paid directly or indirectly by the provider or purchaser, may negotiate life settlement contracts on behalf of the owner without having to obtain a license as a broker.  (g) Broker licenses may be renewed on a schedule prescribed by the commissioner and upon payment of the reasonable renewal fee as prescribed by the commissioner. Failure to pay the fee within the terms prescribed shall result in the automatic revocation of the license requiring periodic renewal.  (h) The term of a provider license shall be perpetual; provided, that the provider files the annual report and pays the fee as prescribed by the commissioner. Failure to file the annual report or pay the fees on or before the due date shall result in immediate suspension of the license.  (i) The applicant shall provide such information as the commissioner may require on forms prepared by the commissioner. The commissioner shall have authority, at any time, to require such applicant to fully disclose the identity of its stockholders (except stockholders owning fewer than ten percent (10%) of the shares of an applicant whose shares are publicly traded), partners, officers and employees, and the commissioner may, in the exercise of the commissioners sole discretion, refuse to issue such a license in the name of any person if not satisfied that any officer, employee, stockholder or partner thereof who may materially influence the applicants conduct meets the standards set forth in this chapter.  (j) Upon the filing of an application and the payment of the license fee, the commissioner shall make an investigation of each applicant and may issue a license if the commissioner finds that the applicant:  (1) If a provider, has provided a detailed plan of operation;  (2) Is competent and trustworthy and intends to transact its business in good faith;  (3) Has a good business reputation and has had experience, training or education so as to be qualified in the business for which the license is applied;  (4) If the provider applicant is a legal entity, is formed or organized pursuant to the laws of this state or is a foreign legal entity authorized to transact business in this state, or provides a certificate of good standing from the state of its domicile; and  (5) Has provided to the commissioner an anti-fraud plan that meets the requirements of this chapter and includes:  (i) A description of the procedures for detecting and investigating possible fraudulent acts and procedures for resolving material inconsistencies between medical records and insurance applications;  (ii) A description of the procedures for reporting fraudulent insurance acts to the commissioner;  (iii) A description of the plan for anti-fraud education and training of its underwriters and other personnel; and  (iv) A written description or chart outlining the arrangement of the anti-fraud personnel who are responsible for the investigation and reporting of possible fraudulent insurance acts and investigating unresolved material inconsistencies between medical records and insurance applications.  (k) The commissioner shall not issue any license to any nonresident applicant, unless a written designation of an agent for service of process is filed and maintained with the commissioner or unless the applicant has filed with the commissioner the applicants written irrevocable consent that any action against the applicant may be commenced against the applicant by service of process on the commissioner.  (l) Each licensee shall file with the commissioner on or before the first day of March of each year an annual statement containing such information as the commissioner by rule may prescribe. The department may have this annual statement renewed and analyzed by outside consultant(s) and the total cost of that review shall be borne by, billed directly to and paid by the provider filing the annual statement.  (m) A provider may not use any person to perform the functions of a broker as defined in this chapter unless the person holds a current, valid license as a broker, and as provided in this section.  (n) A broker may not use any person to perform the functions of a provider as defined in this chapter unless such person holds a current, valid license as a provider, and as provided in this section.  (o) A provider, or broker shall provide to the commissioner new or revised information about officers, ten percent (10%) or more stockholders, partners, directors, members or designated employees within thirty (30) days of the change.  (p) An individual licensed as a broker shall complete, on a biennial basis, fifteen (15) hours of training related to life settlements and life settlement transactions, as required by the commissioner; provided, however, that a life insurance producer who is operating as a broker pursuant to this section shall not be subject to the requirements of this subsection. Any person failing to meet the requirements of this subsection shall be subject to the penalties imposed by the commissioner.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-4. License suspension, revocation or refusal to renew. (a) The commissioner may suspend, revoke or refuse to renew the license of any licensee if the commissioner finds that:  (1) There was any material misrepresentation in the application for the license;  (2) The licensee or any officer, partner, member or director has been guilty of fraudulent or dishonest practices, is subject to a final administrative action or is otherwise shown to be untrustworthy or incompetent to act as a licensee;  (3) The provider demonstrates a pattern of unreasonably withholding payments to policy owners;  (4) The licensee no longer meets the requirements for initial licensure;  (5) The licensee or any officer, partner, member or director has been convicted of a felony, or of any misdemeanor of which criminal fraud is an element; or the licensee has pleaded guilty or nolo contendere with respect to any felony or any misdemeanor of which criminal fraud is an element, regardless whether a judgment of conviction has been entered by the court;  (6) The provider has entered into any life settlement contract using a form that has been approved pursuant to this chapter;  (7) The provider has failed to honor contractual obligations set out in a life settlement contract;  (8) The provider has assigned, transferred or pledged a settled policy to a person other than a provider licensed in this state, a purchaser, an accredited investor or qualified institutional buyer as defined respectively in Regulation D, Rule 501 or Rule 144A of the Federal Securities Act of 1933, as amended, financing entity, special purpose entity, or related provider trust; or  (9) The licensee or any officer, partner, member or key management personnel has violated any of the provisions of this chapter.  (b) Before the commissioner denies a license application or suspends, revokes or refuses to renew the license of any licensee under this chapter, the commissioner shall conduct a hearing in accordance with this states laws governing administrative hearings.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1; P.L. 2021, ch. 400,  24, effective July 13, 2021; P.L. 2021, ch. 401,  24, effective July 13, 2021. 
 27-72-5. Contract requirements. (a) No person may use any form of life settlement contract in this state unless it has been filed with and approved, if required, by the commissioner in a manner that conforms with the filing procedures and any time restrictions or deeming provisions, if any, for life insurance forms, policies and contracts. The commissioner is authorized to contract with outside consultants to review life settlement forms and the total cost of that review shall be borne by, billed directly to, and paid by the provider filing the form(s).  (b) No insurer may, as a condition of responding to a request for verification of coverage or in connection with the transfer of a policy pursuant to a life settlement contract, require that the owner, insured, provider or broker sign any form, disclosure, consent, waiver or acknowledgment that has not been expressly approved by the commissioner for use in connection with life settlement contracts in this state.  (c) A person shall not use a life settlement contract form or provide to an owner a disclosure statement form in this state unless first filed with and approved by the commissioner. The commissioner shall disapprove a life settlement contract form or disclosure statement form if, in the commissioners opinion, the contract or provisions contained therein fail to meet the requirements of this chapter or are unreasonable, contrary to the interests of the public, or otherwise misleading or unfair to the owner. At the commissioners discretion, the commissioner may require the submission of advertising material. The commissioner is authorized to contract with outside consultants to review life settlement forms and/or advertising and the total cost of that review shall be borne by, billed directly to, and paid by the provider filing the form(s).  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-6. Reporting requirements and privacy. (a) For any policy settled within five (5) years of policy issuance, each provider shall file with the commissioner on or before March 1 of each year an annual statement containing such information as the commissioner may prescribe by regulation. In addition to any other requirements, the annual statement shall specify the total number, aggregate face amount and life settlement proceeds of policies settled during the immediately preceding calendar year, together with a breakdown of the information by policy issue year. The annual statement shall also include the names of the insurance companies whose policies have been settled and the brokers that have settled said policies.  (1) Such information shall be limited to only those transactions where the insured is a resident of this state and shall not include individual transaction data regarding the business of life settlements or information that there is a reasonable basis to believe could be used to identify the owner or the insured.  (2) Every provider that willfully fails to file an annual statement as required in this section, or willfully fails to reply within thirty (30) days to a written inquiry by the commissioner in connection therewith, shall, in addition to other penalties provided by this chapter, be subject, upon due notice and opportunity to be heard, to a penalty of up to two hundred fifty dollars ($250) per day of delay, not to exceed twenty-five thousand dollars ($25,000) in the aggregate, for each such failure.  (3) The department may have this annual report reviewed and analyzed by outside consultant(s) and the total cost of that review shall be borne by, billed directly to, and paid by the provider filing the annual statement.  (b) Except as otherwise allowed or required by law, a provider, broker, insurance company, insurance producer, information bureau, rating agency or company, or any other person with actual knowledge of an insureds identity, shall not disclose the identity of an insured or information that there is a reasonable basis to believe could be used to identify the insured or the insureds financial or medical information to any other person unless the disclosure:  (1) Is necessary to effect a life settlement contract between the owner and a provider and the owner and insured have provided prior written consent to the disclosure;  (2) Is necessary to effectuate the sale of life settlement contracts, or interests therein, as investments, provided the sale is conducted in accordance with applicable state and federal securities law and provided further that the owner and the insured have both provided prior written consent to the disclosure;  (3) Is provided in response to an investigation or examination by the commissioner or any other governmental officer or agency or pursuant to the requirements of this chapter;  (4) Is a term or condition to the transfer of a policy by one provider to another provider, in which case the receiving provider shall be required to comply with the confidentiality requirements of this chapter;  (5) Is necessary to allow the provider or its authorized representatives to make contacts for the purpose of determining health status. For the purposes of this section, the term authorized representative  shall not include any person who has or may have any financial interest in the settlement contract other than a provider, licensed broker, financing entity, related provider trust or special purpose entity; further, a provider or broker shall require its authorized representative to agree in writing to adhere to the privacy provisions of this chapter; or  (6) Is required to purchase stop loss coverage.  (c) Non-public personal information solicited or obtained in connection with a proposed or actual life settlement contract shall be subject to the provisions applicable to financial institutions under the federal Gramm Leach Bliley Act, Pub. L. No. 106-102 (1999), and all other state and federal laws relating to confidentiality of non-public personal information.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-7. Examination. (a) The commissioner may, when the commissioner deems it reasonably necessary to protect the interests of the public, examine the business and affairs of any licensee or applicant for a license. The commissioner may order any licensee or applicant to produce any records, books, files or other information reasonably necessary to ascertain whether such licensee or applicant is acting or has acted in violation of the law or otherwise contrary to the interests of the public. The expenses incurred in conducting any examination shall be paid by the licensee or applicant.  (b) In lieu of an examination under this chapter of any foreign or alien licensee licensed in this state, the commissioner may, at the commissioners discretion, accept an examination report on the licensee as prepared by the commissioner for the licensees state of domicile or port-of-entry state.  (c) Names of and individual identification data, or for all owners and insureds shall be considered private and confidential information and shall not be disclosed by the commissioner unless required by law.  (d) Records of all consummated transactions and life settlement contracts shall be maintained by the provider for three (3) years after the death of the insured and shall be available to the commissioner for inspection during reasonable business hours.  (e) Conduct of examinations.(1) Upon determining that an examination should be conducted, the commissioner shall issue an examination warrant appointing one or more examiners to perform the examination and instructing them as to the scope of the examination. In conducting the examination, the examiner shall use methods common to the examination of any life settlement licensee and should use those guidelines and procedures set forth in an examiners handbook adopted by a national organization.  (2) Every licensee or person from whom information is sought, its officers, directors and agents shall provide to the examiners timely, convenient and free access at all reasonable hours at its offices to all books, records, accounts, papers, documents, assets and computer or other recordings relating to the property, assets, business and affairs of the licensee being examined. The officers, directors, employees and agents of the licensee or person shall facilitate the examination and aid in the examination so far as it is in their power to do so. The refusal of a licensee, by its officers, directors, employees or agents, to submit to examination or to comply with any reasonable written request of the commissioner shall be grounds for suspension or refusal of, or nonrenewal of any license or authority held by the licensee to engage in the life settlement business or other business subject to the commissioners jurisdiction. Any proceedings for suspension, revocation or refusal of any license or authority shall be conducted pursuant to  42-35-1 et seq.  (3) The commissioner shall have the power to issue subpoenas, to administer oaths and to examine under oath any person as to any matter pertinent to the examination. Upon the failure or refusal of a 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.  (4) When making an examination under this chapter, the commissioner may retain attorneys, appraisers, independent actuaries, independent certified public accountants or other professionals and specialists as examiners, the reasonable cost of which shall be borne by the licensee that is the subject of the examination.  (5) Nothing contained in this chapter shall be construed to limit the commissioners authority to terminate or suspend an examination in order to pursue other legal or regulatory action pursuant to the insurance laws of this state. Findings of fact and conclusions made pursuant to any examination shall be prima facie evidence in any legal or regulatory action.  (6) Nothing contained in this chapter shall be construed to limit the commissioners authority to use and, if appropriate, to make public any final or preliminary examination report, any examiner or licensee work papers or other documents, or any other information discovered or developed during the course of any examination in the furtherance of any legal or regulatory action which the commissioner may, in his or her sole discretion, deem appropriate.   (f) Examination reports.(1) Examination reports shall be comprised of only facts appearing upon the books, from the testimony of its officers or agents or other persons examined concerning its affairs, and such conclusions and recommendations as the examiners find reasonably warranted from the facts.  (2) No later than sixty (60) days following completion of the examination, the examiner in charge shall file with the commissioner a verified written report of examination under oath. Upon receipt of the verified report, the commissioner shall transmit the report to the licensee examined, together with a notice that shall afford the licensee examined a reasonable opportunity of not more than thirty (30) days to make a written submission or rebuttal with respect to any matters contained in the examination report and which shall become part of the report or to request a hearing on any matter in dispute.  (3) In the event the commissioner determines that regulatory action is appropriate as a result of an examination, the commissioner may initiate any proceedings or actions provided by law.   (g) Confidentiality of examination information.(1) Names and individual identification data for all owners, purchasers, and insureds shall be considered private and confidential information and shall not be disclosed by the commissioner, unless the disclosure is to another regulator or is required by law.  (2) Except as otherwise provided in this chapter, all examination reports, working papers, recorded information, documents and copies thereof produced by, obtained by or disclosed to the commissioner or any other person in the course of an examination made under this chapter, or in the course of analysis or investigation by the commissioner of the financial condition or market conduct of a licensee shall be confidential by law and privileged, shall not be subject to open records, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. The commissioner is authorized to use the documents, materials or other information in the furtherance of any regulatory or legal action brought as part of the commissioners official duties. The licensee being examined may have access to all documents used to make the report.   (h) Conflict of interest.(1) An examiner may not be appointed by the commissioner if the examiner, either directly or indirectly, has a conflict of interest or is affiliated with the management of or owns a pecuniary interest in any person subject to examination under this chapter. This section shall not be construed to automatically preclude an examiner from being:  (i) An owner;  (ii) An insured in a life settlement contract or insurance policy; or  (iii) A beneficiary in an insurance policy that is proposed for a life settlement contract.  (2) Notwithstanding the requirements of this clause, the commissioner may retain from time to time, on an individual basis, qualified actuaries, certified public accountants, or other similar individuals who are independently practicing their professions, even though these persons may from time to time be similarly employed or retained by persons subject to examination under this chapter.   (i) Immunity from liability.(1) No cause of action shall arise nor shall any liability be imposed against the commissioner, the commissioners authorized representatives or any examiner appointed by the commissioner for any statements made or conduct performed in good faith while carrying out the provisions of this chapter.  (2) No cause of action shall arise, nor shall any liability be imposed against any person for the act of communicating or delivering information or data to the commissioner or the commissioners authorized representative or examiner pursuant to an examination made under this chapter, if the act of communication or delivery was performed in good faith and without fraudulent intent or the intent to deceive. This paragraph does not abrogate or modify in any way any common law or statutory privilege or immunity heretofore enjoyed by any person identified in subdivision (1).  (3) A person identified in subdivision (1) or (2) shall be entitled to an award of attorneys fees and costs if he or she is the prevailing party in a civil cause of action for libel, slander or any other relevant tort arising out of activities in carrying out the provisions of this chapter and the party bringing the action was not substantially justified in doing so. For purposes of this section a proceeding is substantially justified if it had a reasonable basis in law or fact at the time that it was initiated.   (j) Investigative authority of the commissioner.(1) The commissioner may investigate suspected fraudulent life settlement acts and persons engaged in the business of life settlements.   (k) Cost of examinations.(1) The total cost of examinations performed pursuant to this chapter shall be borne by the provider(s) or broker(s) examined companies in accordance with the provision of paragraph 27-13.1-7. The commissioner is authorized to retain contract examiners and consultants to perform the examinations. The commissioner shall review and affirmatively endorse detailed billings from the qualified contract examiner before summary billings are sent to the insurer.   History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-8. Advertising. (a) A broker, or provider licensed pursuant to this chapter may conduct or participate in advertisements within this state. Such advertisements shall comply with all Rhode Island advertising and marketing laws or rules and regulations promulgated by the commissioner that are applicable to life insurers or to brokers, and providers licensed pursuant to this chapter.  (b) Advertisements shall be accurate, truthful and not misleading in fact or by implication.  (c) No person or trust shall:  (1) Directly or indirectly, market, advertise, solicit or otherwise promote the purchase of a policy for the sole purpose of or with an emphasis on settling the policy; or  (2) Use the words free, no cost or words of similar import in the marketing, advertising, soliciting or otherwise promoting of the purchase of a policy.  (d) The commissioner is authorized to contract with outside consultants to review advertisements and the total cost of that review shall be borne by, billed directly to, and paid by the provider utilizing or proposing to utilize the advertisement.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-72-9. Disclosures to owners. (a) The provider or broker shall provide in writing, in a separate document that is signed by the owner, the following information to the owner no later than the date of application for a life settlement contract:  (1) The fact that possible alternatives to life settlement contracts exist, including, but not limited to, accelerated benefits offered by the issuer of the life insurance policy;  (2) The fact that some or all of the proceeds of a life settlement contract may be taxable and that assistance should be sought from a professional tax advisor;  (3) The fact that the proceeds from a life settlement contract could be subject to the claims of creditors;  (4) The fact that receipt of proceeds from a life settlement contract may adversely affect the recipients eligibility for public assistance or other government benefits or entitlements and that advice should be obtained from the appropriate agencies;  (5) The fact that the owner has a right to terminate a life settlement contract within fifteen (15) days of the date it is executed by all parties and the owner has received the disclosures contained herein. Rescission, if exercised by the owner, is effective only if both notice of the rescission is given, and the owner repays all proceeds and any premiums, loans, and loan interest paid on account of the provider within the rescission period. If the insured dies during the rescission period, the contract shall be deemed to have been rescinded subject to repayment by the owner or the owners estate of all proceeds and any premiums, loans, and loan interest to the provider;  (6) The fact that proceeds will be sent to the owner within three (3) business days after the provider has received the insurer or group administrators acknowledgement that ownership of the policy or interest in the certificate has been transferred and the beneficiary has been designated in accordance with the terms of the life settlement contract;  (7) The fact that entering into a life settlement contract may cause other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the policy or certificate of a group policy to be forfeited by the owner and that assistance should be sought from a professional financial advisor;  (8) The date by which the funds will be available to the owner and the transmitter of the funds;  (9) The fact that the commissioner shall require delivery of a buyers guide or a similar consumer advisory package in the form prescribed by the commissioner to owners during the solicitation process;  (10) The disclosure document shall contain the following language: all medical, financial or personal information solicited or obtained by a provider or broker about an insured, including the insureds identity or the identity of family members, a spouse or a significant other, may be disclosed as necessary to effect the life settlement contract between the owner and provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every two (2) years;  (11) The fact that the commissioner shall require providers and brokers to print separate signed fraud warnings on their applications and on their life settlement contracts is as follows:  (11) Any person who knowingly presents false information in an application for insurance or life settlement contract is guilty of a crime and may be subject to fines and confinement in prison.  (12) The fact that the insured may be contacted by either the provider or its authorized representative for the purpose of determining the insureds health status or to verify the insureds address. This contact is limited to once every three (3) months if the insured has a life expectancy of more than one year, and no more than once per month if the insured has a life expectancy of one year or less;  (13) The affiliation, if any, between the provider and the issuer of the insurance policy to be settled;  (14) That a broker represents exclusively the owner, and not the insurer or the provider or any other person, and owes a fiduciary duty to the owner, including a duty to act according to the owners instructions and in the best interest of the owner;  (15) The document shall include the name, address and telephone number of the provider;  (16) The name, business address, and telephone number of the independent third-party escrow agent, and the fact that the owner may inspect or receive copies of the relevant escrow or trust agreements or documents;  (17) The fact that a change of ownership could in the future limit the insureds ability to purchase future insurance on the insureds life because there is a limit to how much coverage insurers will issue on one life;  (b) The written disclosures shall be conspicuously displayed in any life settlement contract furnished to the owner by a provider including any affiliations or contractual arrangements between the provider and the broker.  (c) A broker shall provide the owner and the provider with at least the following disclosures no later than the date the life settlement contract is signed by all parties. The disclosures shall be conspicuously displayed in the life settlement contract or in a separate document signed by the owner and provide the following information:  (1) The name, business address and telephone number of the broker;  (2) A full, complete and accurate description of all the offers, counter-offers, acceptances and rejections relating to the proposed life settlement contract;  (3) A written disclosure of any affiliations or contractual arrangements between the broker and any person making an offer in connection with the proposed life settlement contracts;  (4) The name of each broker who receives compensation and the amount of compensation received by that broker, which compensation includes anything of value paid or given to the broker in connection with the life settlement contract;  (5) A complete reconciliation of the gross offer or bid by the provider to the net amount of proceeds or value to be received by the owner. For the purpose of this section, gross offer or bid shall mean the total amount or value offered by the provider for the purchase of one or more life insurance policies, inclusive of commissions and fees; and  (6) The failure to provide the disclosures or rights described in this section shall be deemed an unfair trade practice pursuant to  27-72-17.  History of Section.P.L. 2009, ch. 195,  1; P.L. 2009, ch. 262,  1. 
 27-73-1. Title and purpose. (a) This chapter shall be known and may be cited as the Rhode Island Public School Employee Uniform Benefit Act.  (b) The purpose of this chapter is to create uniform medical and prescription drug benefit plan designs for Rhode Island school district and charter school employees.  History of Section.P.L. 2009, ch. 374,  3; P.L. 2009, ch. 383,  3. 
 27-73-2. Program implementation. (a) Upon recommendation of the uniform healthcare benefit plan designs or at such other time as specified herein or as specified in  28-9.3-2 and 28-9.4-3, all public school districts and charter schools may implement one or more benefit plan design(s) including, but not limited to, those recommended in accordance with this chapter.  (b) Upon expiration of collective bargaining agreements, recommended benefit plan designs recommended by the board in accordance with this chapter may be specified in future collective bargaining agreements.  (c) Choice of benefit plan designs from those recommended in accordance with  27-73-4, medical insurance cost-sharing, payment for waiving medical insurance, eligibility for receiving benefits, and providing benefits for retirees shall continue to be negotiated pursuant to  28-9-3 and 28-9-4.  (d) Each municipality, district or charter school, may, at its discretion, contract for and manage benefit plans under this chapter, either directly or indirectly, through municipal, district or charter arrangements with insurance purchasing collaboratives or joint purchasing groups.  History of Section.P.L. 2009, ch. 374,  3; P.L. 2009, ch. 383,  3; P.L. 2011, ch. 124,  1; P.L. 2011, ch. 133,  1. 
 27-73-3. Board of directors established. (a) There is established the board of directors of the Rhode Island uniform public school employees health-care benefits program (board).  (b) The board shall consist of twelve (12) members, as follows:  (1) Two (2) members shall be appointed by the president of the Rhode Island Federation of Teachers and Health Professionals and may be active or retired teachers or officials from the union;  (2) Two (2) members shall be appointed by the president of the National Education Association of Rhode Island, and may be active or retired teachers or officials from the union;  (3) One member shall be appointed by the president of RI Council 94 of the American Federation of State, County and Municipal Employees;  (4) One member shall be appointed by the president of the Laborers International Union of North America;  (5) Two (2) members shall be appointed by the president of the Rhode Island Association of School Committees;  (6) Two (2) members shall be appointed by the Rhode Island School Superintendents Association;  (7) Two (2) members shall be appointed by the president of the Rhode Island Association of School Business Managers; and  (c) Each appointing authority may remove or replace any member appointed by that appointing authority at any time.  (d) Members of the board shall serve without compensation.  (e) The board shall be initially convened by the Rhode Island department of education on or before September 15, 2009.  (f) A technical advisory committee to the board shall be created concurrently with the board. The advisory committee shall receive adequate notice to be in attendance and to provide a report at each of the board meetings. The advisory committee shall be composed of one representative of each of the following: the department of elementary and secondary education, the department of administration, the League of Charter Schools and each of the municipal insurance purchasing collaboratives. The department of administration representative shall serve as chair and convener of the advisory committee.  History of Section.P.L. 2009, ch. 374,  3; P.L. 2009, ch. 383,  3. 
 27-73-4. Powers, duties, and functions of the board. (a) The board shall have the following powers, duties and functions relative to active full-time certified employees pursuant to  28-9.3-2, and active full-time school district employees pursuant to  28-9.4-3:  (1) To design and recommend, with input and recommendations from the technical advisory committee, medical benefits plan designs and prescription drug coverage plan designs in accordance with the following:  (i) To design at least six (6) uniform benefit plan designs for all Rhode Island public school employees.  (ii) Benefit plan designs shall include at least one managed care option, at least four (4) preferred provider organization (PPO) options, and at least one health savings account (HSA) compatible high deductible health plan (HDHP) option.  (iii) The actuarial value of any of the approved benefit plan designs may not be greater than the actuarial value of the state employee health plan in effect as of the date the plan designs are approved.  (iv) The PPO options shall reflect four (4) different levels of plan design, with a minimum actuarial difference between each of the plan designs of seven and one-half percent (7.5%).  (v) The actuarial value of the lowest board-recommended benefit plan design shall not be greater than the actuarial value of the public school employee benefit plan design with the lowest actuarial value in effect in the state on January 1, 2011.  (b) To monitor the implementation of the uniform benefit plan designs and to recommend modifications to such benefit plan designs as appropriate.  (c) To report to the governor and general assembly on or before January 1, 2012, with recommendations on the means, feasibility and benefits of developing a statewide health benefit purchasing arrangement for public school employees.  History of Section.P.L. 2009, ch. 374,  3; P.L. 2009, ch. 383,  3; P.L. 2010, ch. 301,  1; P.L. 2011, ch. 124,  1; P.L. 2011, ch. 133,  1. 
 27-73-5. Officers, quorum, meetings. (a) The board shall elect from its own membership such officers as it sees fit;  (b) Seven (7) members of the board in office shall constitute a quorum;  (c) Decisions of the board shall be made by a majority vote of the members present;  (d) Meetings may be called by the chair, or at the written request of four (4) members;  (e) The board shall hold regular meetings at least once every month, and those meetings shall be open to the public in accordance with chapter 46 of title 42 (Open Meetings).  History of Section.P.L. 2009, ch. 374,  3; P.L. 2009, ch. 383,  3. 
 27-74-1. Short title. This chapter shall be known as the Discount Medical Plan Organization Act. History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-10. Marketing requirements. (a) A discount medical plan organization may market directly or contract with other marketers for the distribution of its product.  (b) The discount medical plan organization shall have an executed written agreement with a marketer prior to the marketers marketing, promoting, selling or distributing the discount medical plan. The agreement between the discount medical plan organization and the marketer shall prohibit the marketer from using advertising, marketing materials, brochures and discount medical plan cards without the discount medical plan organizations approval in writing.  (c) The discount medical plan organization shall be bound by and responsible for the activities of a marketer that are within the scope of the marketers agency relationship with the organization.  (d) A discount medical plan organization shall approve in writing all advertisements, marketing materials, brochures and discount cards used by marketers to market, promote, sell or distribute the discount medical plan prior to their use.  (e) Upon request, a discount medical plan organization shall submit to the commissioner all advertising, marketing materials and brochures regarding a discount medical plan.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-11. Marketing restrictions and disclosure requirements. (a) All advertisements, marketing materials, brochures, discount medical plan cards and any other communications of a discount medical plan organization provided to prospective members and members shall be truthful and not misleading in fact or in implication. An advertisement, any marketing material, brochure, discount medical plan card or other communication is misleading in fact or in implication if it has a capacity or tendency to mislead or deceive based on the overall impression that it is reasonably expected to create within the segment of the public to which it is directed.  (b) A discount medical plan organization shall not:  (1) Except as otherwise provided in this chapter or as a disclaimer of any relationship between discount medical plan benefits and insurance, or as a description of an insurance product connected with a discount medical plan, use in its advertisements, marketing material, brochures and discount medical plan cards the term insurance;  (2) Except as otherwise provided in state law, describe or characterize the discount medical plan as being insurance whenever a discount medical plan is bundled with an insured product and the insurance benefits are incidental to the discount medical plan benefits;  (3) Use in its advertisements, marketing material, brochures and discount medical plan cards the terms health plan, coverage, copay, copayments, deductible, preexisting conditions, guaranteed issue, premium, PPO, preferred provider organization, or other terms in a manner that could reasonably mislead an individual into believing that the discount medical plan is health insurance;  (4) Use language in its advertisements, marketing material, brochures and discount medical plan cards with respect to being registered by the health insurance commissioner in a manner that could reasonably mislead an individual into believing that the discount medical plan is insurance or has been endorsed by the state;  (5) Make misleading, deceptive or fraudulent representations regarding the discount or range of discounts offered by the discount medical plan card or the access to any range of discounts offered by the discount medical plan card;  (6) Have restrictions on access to discount medical plan providers, including, except for hospital services, waiting periods and notification periods; or  (7) Pay providers any fees for medical or ancillary services or collect or accept money from a member to pay a provider for medical or ancillary services provided under the discount medical plan, unless the discount medical plan organization has an active certificate of authority to act as a third party administrator in accordance with chapter 20.7 of title 27.  (c) Each discount medical plan organization shall make the following general disclosures:  (1) In writing in not less than twelve-point font and in a manner that is clear and conspicuous and achieves a grade level score of no higher than eighth (8th) grade on the Flesch-Kincaid readability test;  (2) On the first content page of any advertisements, marketing materials or brochures made available to the public relating to a discount medical plan; and  (3) Along with any enrollment forms given to a prospective member:  (i) That the plan is a discount plan and is not insurance coverage;  (ii) That the range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received;  (iii) Unless the discount medical plan organization has an active certificate of authority to act as a third party administrator, that the plan does not make payments to providers for the medical or ancillary services received under the discount medical plan;  (iv) That the plan member is obligated to pay for all medical or ancillary services, but will receive a discount from those providers that have contracted with the discount medical plan organization; and  (v) The toll-free telephone number and Internet website address for the registered discount medical plan organization for prospective members and members to obtain additional information about and assistance on the discount medical plan and up-to-date lists of providers participating in the discount medical plan.  (d) If the initial contact with a prospective member is by telephone, the disclosures required under subsection (c) of this section shall be made orally and shall be included in the initial written materials that describe the benefits under the discount medical plan provided to the prospective or new member.  (e) In addition to the general disclosures required under this section, each discount medical plan organization shall provide to:  (1) Each prospective member, at the time of enrollment, information in writing in not less than twelve (12) point font and in a manner that is clear and conspicuous and achieves a grade level score of no higher than eighth (8th) grade on the Flesch-Kincaid readability test that describes the terms and conditions of the discount medical plan, including any limitations or restrictions on the refund of any processing fees or periodic charges associated with the discount medical plan;  (2) Each new member a document in writing in not less than twelve (12) point font and written in a manner that is clear and conspicuous and achieves a grade level score of no higher than eighth (8th) grade on the Flesch-Kincaid readability test that contains the terms and conditions of the discount medical plan and includes information on:  (i) The name of the member;  (ii) The benefits to be provided under the discount medical plan;  (iii) Any processing fees and periodic charges associated with the discount medical plan, including any limitations or restrictions on the refund of any processing fees and periodic charges;  (iv) The mode of payment of any processing fees and periodic charges, such as monthly, quarterly, etc., and procedures for changing the mode of payment;  (v) Any limitations, exclusions or exceptions regarding the receipt of discount medical plan benefits;  (vi) Any waiting periods for certain medical or ancillary services under the discount medical plan;  (vii) Procedures for obtaining discounts under the discount medical plan, such as requiring members to contact the discount medical plan organization to make an appointment with a provider on the members behalf;  (viii) Cancellation procedures, including information on the members thirty (30) day cancellation rights and refund requirements and procedures for obtaining refunds;  (ix) Renewal, termination and cancellation terms and conditions;  (x) Procedures for adding new members to a family discount medical plan, if applicable;  (xi) Procedures for filing complaints under the discount medical plan organizations complaint system and information that, if the member remains dissatisfied after completing the organizations complaint system, the plan member may contact his or her local state insurance department; and  (xii) The name and mailing address of the registered discount medical plan organization or other entity where the member can make inquiries about the plan, send cancellation notices and file complaints.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-12. Notice of change in name or address. Each discount medical plan organization shall provide the commissioner at least thirty (30) days advance notice of any change in the discount medical plan organizations name, address, principal business address or mailing address or Internet website address.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-13. Annual reports. (a) If the information required in subsection (b) of this section is not provided at the time of renewal of a certificate of registration under  27-74-5, a discount medical plan organization shall file an annual report with the commissioner in the form prescribed by the commissioner, within three (3) months after the end of each fiscal year.  (b) The report shall include:  (1) If different from the initial application for a certificate of registration or at the time of renewal of a certificate of registration or the last annual report, as appropriate, a list of the names and residence addresses of all persons responsible for the conduct of the organizations affairs, together with a disclosure of the extent and nature of any contracts or arrangements with these persons and the discount medical plan organization, including any possible conflicts of interest;  (2) The number of discount medical plan members in the state; and  (3) Any other information relating to the performance of the discount medical plan organization that may be required by the commissioner.  (c) Any discount medical plan organization that fails to file an annual report in the form and within the time required by this section shall:  (1) Forfeit:  (i) Up to five hundred dollars ($500) each day for the first ten (10) days during which the violation continues; and  (ii) Up to one thousand dollars ($1,000) each day after the first ten (10) days during which the violation continues; and  (2) Upon notice by the commissioner, lose its authority to enroll new members or to do business in this state while the violation continues.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1; P.L. 2021, ch. 395,  7, effective July 14, 2021. 
 27-74-14. Penalties. (a) In addition to the penalties and other enforcement provisions of this chapter or under pursuant to  42-14-16, any person who willfully violates this chapter is subject to civil penalties of up to ten thousand dollars ($10,000) per violation.  (b) A person that willfully operates as or aids and abets another operating as a discount medical plan organization in violation of this chapter shall, upon conviction, be fined not more than fifty thousand dollars ($50,000) or be imprisoned for not more than one year, or both.  (c) A person that collects fees for purported membership in a discount medical plan, but purposefully fails to provide the promised benefits shall be deemed guilty of larceny and upon conviction is subject to penalties provided for in  11-41-5. In addition, upon conviction, the person shall be ordered to pay restitution to persons aggrieved by the violation of this chapter. Restitution shall be ordered in addition to a fine or imprisonment, but not in lieu of a fine or imprisonment.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-15. Injunctions. (a) In addition to the penalties and other enforcement provisions of this act, the commissioner or the department of the attorney general may seek both temporary and permanent injunctive relief when:  (1) A discount medical plan is being operated by a person or entity that is not registered pursuant to this chapter; or  (2) Any person, entity or discount medical plan organization has engaged in any activity prohibited by this chapter or any regulation adopted pursuant to this chapter.  (b) The superior court shall have jurisdiction over any proceeding brought pursuant to this section.  (c) The authority to seek injunctive relief is not conditioned on the commissioner having conducted any proceeding pursuant to the provisions of the Administrative Procedures act, chapter 35 of title 42.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-16. Regulations. The commissioner shall adopt regulations to carry out the provisions of this chapter, including standards for readability of advertisements, marketing materials, brochures, discount medical plan cards and any other communications by discount medical plan organizations to members and prospective members.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-17. Severability. If any provision of this act, or the application of the provision to any person or circumstance shall be held invalid, the remainder of the act, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-18. Effective date. Any discount medical plan organization doing business in or from this state on or after March 1, 2011, shall comply with the requirements of this chapter.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-2. Purpose. The purpose of this chapter is to promote the public interest by establishing standards for discount medical plan organizations, protect consumers from unfair or deceptive marketing, sales or enrollment practices, and facilitate consumer understanding of the role and function of discount medical plan organizations in providing access to medical or ancillary services.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-3. Definitions. As used in this chapter: (1) Affiliate means a person that directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the person specified.  (2) Ancillary services includes, but is not limited to, audiology, dental, vision, mental health, substance abuse, chiropractic, and podiatry services.  (3) Commissioner means the health insurance commissioner.  (4) Control or controlled by or under common control with means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control shall be presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing ten percent (10%) or more of the voting securities of any other person. This presumption may be rebutted by a showing made in the manner provided by  27-35-3(i) that control does not exist in fact. The commissioner may determine, after furnishing all persons in interest notice and opportunity to be heard and making specific findings of fact to support the determination, that control exists in fact, notwithstanding the absence of a presumption to that effect.  (5) Discount medical plan means a business arrangement or contract in which a person, in exchange for fees, dues, charges or other consideration, offers access for its members to providers of medical or ancillary services and the right to receive discounts on medical or ancillary services provided under the discount medical plan from those providers.  (6) Discount medical plan does not include a plan that does not charge a membership or other fee to use the plans discount medical card.  (7) Discount medical plan organization means an entity that, in exchange for fees, dues, charges or other consideration, provides access for discount medical plan members to providers of medical or ancillary services and the right to receive medical or ancillary services from those providers at a discount. It is the organization that contracts with providers, provider networks or other discount medical plan organizations to offer access to medical or ancillary services at a discount and determines the charge to discount medical plan members.  (8) Facility means an institution providing medical or ancillary services or a healthcare setting.  (9) Facility includes, but is not limited to:  (i) A hospital or other licensed inpatient center;  (ii) An ambulatory surgical or treatment center;  (iii) A skilled nursing center;  (iv) A residential treatment center;  (v) A rehabilitation center; and  (vi) A diagnostic, laboratory or imaging center.  (10) Healthcare professional means a physician or other healthcare practitioner who is licensed, accredited or certified to perform specified medical or ancillary services within the scope of his or her license, accreditation, certification or other appropriate authority and consistent with state law.  (11) Health carrier means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and medical service corporation, or any other entity providing a plan of health insurance, health benefits or medical or ancillary services.  (12) Marketer means a person or entity that markets, promotes, sells or distributes a discount medical plan, including a private label entity that places its name on and markets or distributes a discount medical plan pursuant to a marketing agreement with a discount medical plan organization.  (13) Medical services means any maintenance care of, or preventive care for, the human body or care, service or treatment of an illness or dysfunction of, or injury to, the human body.  (14) Medical services includes, but is not limited to, physician care, inpatient care, hospital surgical services, emergency services, ambulance services, laboratory services and medical equipment and supplies.  (15) Medical services does not include pharmacy services or ancillary services.  (16) Member means any individual who pays fees, dues, charges or other consideration for the right to receive the benefits of a discount medical plan.  (17) Person means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity or any combination of the foregoing.  (18) Provider means any healthcare professional or facility that has contracted, directly or indirectly, with a discount medical plan organization to provide medical or ancillary services to members.  (19) Provider network means an entity that negotiates directly or indirectly with a discount medical plan organization on behalf of more than one provider to provide medical or ancillary services to members.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-4. Applicability and scope. (a) This chapter applies to all discount medical plan organizations doing business in or from this state.  (b) A discount medical plan organization that is a licensed health insurer or health maintenance organization or a nonprofit hospital and medical service corporation is not required to obtain a certificate of registration under  27-74-5, except that any of its affiliates that operate as a discount medical plan organization in this state shall obtain a certificate of registration under  27-74-5 and comply with all other provisions of this act; but such health insurer, health maintenance organization or nonprofit hospital and medical service corporation is required to comply with  27-74-8, 27-74-9, 27-74-10, and 27-74-11 and report, in the form and manner as the commissioner may require, any of the information described in  27-74-13 that is not otherwise already reported.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1; P.L. 2021, ch. 395,  7, effective July 14, 2021. 
 27-74-5. Registration requirements. (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 organizations 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 exists, 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 organizations 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 organizations 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.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1; P.L. 2021, ch. 395,  7, effective July 14, 2021. 
 27-74-6. Surety bond or deposit requirements. (a) Each registered discount medical plan organization shall maintain in force a surety bond in its own name in an amount not less than fifty thousand dollars ($50,000) to be used in the discretion of the commissioner to protect the financial interest of members, including, but not limited to, making refunds of fees and costs to consumers if the registered discount medical plan organizations registration is revoked. The bond shall be issued by an insurance company licensed to do business in this state.  (b) In lieu of the bond specified in this section, a registered discount medical plan organization may deposit and maintain deposited with the commissioner, or at the discretion of the commissioner, with any organization or trustee acceptable to the commissioner through which a custodial or controlled account is utilized, cash, securities or any combination of these or other measures that are acceptable to the commissioner with at all times have a market value of not less than fifty thousand dollars ($50,000).  (c) All income from a deposit made under section shall be an asset of the discount medical plan organization.  (d) Except for the commissioner, the assets or securities held in this state as a deposit under this section shall not be subject to levy by a judgment creditor or other claimant of the discount medical plan organization.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-7. Examinations and investigations. (a) The commissioner may examine or investigate the business and affairs of any discount medical plan organization to protect the interests of the residents of this state based on the following reasons, including, but not limited to, complaint indices, recent complaints, information from other states, or as the commissioner deems necessary.  (b) An examination or investigation conducted as provided this section shall be performed in accordance with the provisions of chapter 13.1 of title 27.  (c) In additional to the examination powers provided for in subsection (b) of this section, the commissioner may:  (1) Order any discount medical plan organization or applicant that operates a discount medical plan organization to produce any records, books, files, advertising and solicitation materials or other information; and  (2) Take statements under oath to determine whether the discount medical plan organization or applicant is in violation of the law or is acting contrary to the public interest.  (d) The discount medical plan organization or applicant that is the subject of the examination or investigation shall pay the expenses incurred in conducting the examination or investigation, including but not limited to the expenses of attorneys, consultants and other experts. Failure by the discount medical plan organization or applicant to promptly pay the expenses is grounds for denial of a certificate of registration to operate as a discount medical plan organization or revocation of a certificate of registration to operate as a discount medical plan organization. Such expenses, if not paid, may be recovered through a civil action filed in the superior court.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-74-8. Charges and fees  Refund requirements  Bundling of services. (a) A discount medical plan organization may charge a periodic charge as well as a reasonable one-time processing fee for a discount medical plan.  (b) If a member cancels his or her membership in the discount medical plan organization within the first thirty (30) days after the date of receipt of the written document for the discount medical plan described in  27-74-11(e), the member shall receive a reimbursement of all periodic charges and the amount of any one-time processing fee that exceeds twenty dollars ($20.00) upon return of the discount medical plan card to the discount medical plan organization.  (c) Cancellation occurs when notice of cancellation is given to the discount medical plan organization. Notice of cancellation is deemed given when delivered by hand or deposited in a mailbox, properly addressed and postage prepaid to the mailing address of the discount medical plan organization or emailed to the email address of the discount medical plan organization.  (d) A discount medical plan organization shall return any periodic charge charged or collected after the member has returned the discount medical plan card or given the discount medical plan organization notice of cancellation.  (e) If the discount medical plan organization cancels a membership for any reason other than nonpayment of charges by the member, the discount medical plan organization shall make a pro rata reimbursement of all periodic charges to the member.  (f) When a marketer or discount medical plan organization sells a discount medical plan in conjunction with any other products, the marketer or discount medical plan organization shall:  (1) Provide the charges for each discount medical plan in writing to the member; or  (2) Reimburse the member for all periodic charges for the discount medical plan and all periodic charges for any other product if the member cancels his or her membership in accordance with this section.  (g) Any discount medical plan organization that is a health carrier that provides a discount medical plan product that is incidental to the insured product is not subject to this section.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1; P.L. 2021, ch. 395,  7, effective July 14, 2021. 
 27-74-9. Provider agreements  Provider listing requirements. (a) A discount medical plan organization shall have a written provider agreement with all providers offering medical or ancillary services to its members. The written provider agreement may be entered into directly with the provider or indirectly with a provider network to which the provider belongs.  (b) A provider agreement between a discount medical plan organization and a provider shall provide the following:  (1) A list of the medical or ancillary services and products to be provided at a discount;  (2) The amount or amounts of the discounts or, alternatively, a fee schedule that reflects the providers discounted rates; and  (3) That the provider will not charge members more than the discounted rates.  (c) A provider agreement between a discount medical plan organization and a provider network shall require that the provider network have written agreements with its providers that:  (1) Contain the provisions described in subsection (b) of this section;  (2) Authorize the provider network to contract with the discount medical plan organization on behalf of the provider; and  (3) Require the provider network to maintain an up-to-date list of its contracted providers and to provide the list on a monthly basis to the discount medical plan organization.  (d) A provider agreement between a discount medical plan organization and an entity that contracts with a provider network shall require that the entity, in its contract with the provider network, require the provider network to have written agreements with its providers that comply with subsection (c) of this section.  (e) The discount medical plan organization shall maintain a copy of each active provider agreement into which it has entered.  (f) Each discount medical plan organization shall maintain on an Internet website page an up-to-date list of the names and addresses of the providers with which it has contracted directly or through a provider network. The Internet website address shall be prominently displayed on all of its advertisements, marketing materials, brochures and discount medical plan cards.  (g) This subsection applies to those providers with which the discount medical plan organization has contracted with directly as well as those providers that are members of a provider network with which the discount medical plan organization has contracted.  History of Section.P.L. 2010, ch. 156,  1; P.L. 2010, ch. 158,  1. 
 27-75-1. Repealed. History of Section.P.L. 2011, ch. 20,  1; P.L. 2011, ch. 29,  1; Repealed by P.L. 2017, ch. 195,  2, effective July 18, 2017; P.L. 2017, ch. 372,  2, effective October 4, 2017. 
 27-75-2. Repealed. History of Section.P.L. 2011, ch. 20,  1; P.L. 2011, ch. 29,  1; Repealed by P.L. 2017, ch. 195,  2, effective July 18, 2017; P.L. 2017, ch. 372,  2, effective October 4, 2017. 
 27-75-3. Repealed. History of Section.P.L. 2011, ch. 20,  1; P.L. 2011, ch. 29,  1; Repealed by P.L. 2017, ch. 195,  2, effective July 18, 2017; P.L. 2017, ch. 372,  2, effective October 4, 2017. 
 27-76-1. Applicability. Except for the provisions of  27-76-6, the provisions of this chapter shall be applicable only to personal lines residential property insurance on dwelling houses.  History of Section.P.L. 2012, ch. 64,  2; P.L. 2012, ch. 83,  2; P.L. 2013, ch. 100,  1; P.L. 2013, ch. 113,  1. 
 27-76-2. Hurricane deductibles, triggers and policyholder notice. (a) The provisions of this section shall be applicable to policies issuing or renewing on or after July 1, 2008.  (b) In all instances where an insurance company licensed to do business in this state offers or includes any deductible and/or mitigation measure related to such deductible for any type of personal lines residential property insurance on dwelling houses, the insurance company shall provide prominent and clear notice to insureds that shall be included in the policy issuance or renewal package and shall fully disclose all details pertaining to any such deductible and/or mitigation measure.  (c) The insurer may apply a deductible specific to windstorm coverage where:  (1) The deductible is specifically approved by the director and shall not exceed five percent (5%) of the insured value.  (2) The deductible shall be applicable to losses due to a hurricane during the period commencing with the issuance of a hurricane-warning bulletin for any part of the state by the National Hurricane Center and concluding twenty-four (24) hours after the termination of the last hurricane warning bulletin for any part of the state.  (3) The deductible, whether it is a flat dollar deductible or a percentage deductible shall be presented by at least two (2) examples that illustrate the application of the deductible to the insured. Nothing herein shall prohibit the insurer from providing any additional information to the insured to assist in the insureds understanding of the deductible to be applied to the insureds policy.  (4) The deductible set forth above shall not be applied to any insured, if the insured has installed approved mitigation measures to protect against windstorm damage and the insurer has either inspected the property or the insured has submitted satisfactory proof of installation of the approved mitigation measures. The insurance commissioner, in consultation with the state building code commissioner, shall adopt and may amend or revise a list of mitigation measures, based so far as reasonably feasible on national standards for such measures and practices in other comparable states. The list of mitigation measures adopted by the insurance commissioner shall be considered approved mitigation measures for purposes of this subdivision.  (5) For the application of the hurricane deductible on Block Island, losses are due to a hurricane when a hurricane results in hurricane force sustained winds as reported by the national weather service for Block Island. For the application of the hurricane deductible in the remainder of the state, losses are due to a hurricane when a hurricane results in hurricane force sustained winds as reported by the national weather service for any other location in the state. All terms are as defined by the national weather service.  (d) Premium credits shall be applied to policies with deductibles as set forth in subsection (c) of this section.  (e)(1) An insurer may require mitigation measures to protect against windstorm damage only after specific approval of the substance of such mitigation measures by the director;  (2) Mitigation measures to be taken by an insured are clearly explained, including a complete illustration of the dollar impact upon the premiums to be charged to insureds if the requested mitigation activities are undertaken;  (3) No mandatory deductible for windstorm damage shall be included in the policy;  (4) An insurer shall write the requested coverage at the premium rate that includes the premium credit to be realized with the completion of the mitigation efforts;  (5) The insurer shall affirmatively state the length of time during which discount given for the mitigation efforts will apply; and  (6) No insurer shall subsequently nonrenew an insured who has taken the mitigation steps requested by the insurer for reasons of the insurers exposure to catastrophe loss, unless for non-payment of premium, fraud, breach by the insured of a provision of the policy, reversal or a lack of maintenance of the mitigation steps, or insurer solvency concerns or adverse loss history.  (f) Penalties for failure to comply with the provisions of this section shall be administered by the director in accordance with the provisions of  42-14-16.  (g) The department of business regulation shall have authority to adopt such rules, including emergency rules, as may be necessary or desirable to effectuate the purposes of this section.  History of Section.P.L. 2012, ch. 64,  2; P.L. 2012, ch. 83,  2. 
 27-76-3. Residential property insurance hurricane deductible application. (a) For all deductibles as provided for in  27-76-2, such deductible may only be applied once to all hurricane losses that are subject to the hurricane deductible during the calendar year.  (b) If an insured incurs a hurricane loss from more than one hurricane during a calendar year that are subject to the separate deductible referred to in subsection (a), the insurer may apply the deductible to the succeeding hurricane that is equal to the remaining amount of the separate deductible or the amount of the deductible that applies to all perils other than a hurricane, whichever is greater. Insurers may require policyholders to produce receipts or other records of such losses in order to apply such losses to subsequent hurricane claims.  History of Section.P.L. 2012, ch. 64,  3; P.L. 2012, ch. 83,  3. 
 27-76-4. Notice of property loss. No insurance policy or contract covering damages to personal lines residential property may be cancelled or nonrenewed, nor may the premium for such a policy be increased solely as a result of inquiries or claims made under the policy which resulted in no loss payout or resulted in a loss payout of less than five hundred dollars ($500). The provisions of this section shall not apply where more than one non-catastrophic claim is made under the policy in a three (3) year period which resulted in any loss payout.  History of Section.P.L. 2012, ch. 64,  3; P.L. 2012, ch. 83,  3. 
 27-76-5. Hurricane mediation. The department of business regulation is hereby authorized to establish by regulation a non-adversarial non-binding alternative dispute resolution procedure for the effective, fair, and timely handling of personal lines insurance claims arising out of damages to residential property caused by hurricanes. The provisions of this section shall not apply to disputes of coverage under the insurance policy.  History of Section.P.L. 2012, ch. 64,  2; P.L. 2012, ch. 83,  2. 
 27-76-6. State of emergency  Effect upon insurance policies  Rules. (a) The department of business regulation may promulgate regulations to take effect upon the declaration of a catastrophe, as declared by a nationally recognized catastrophe loss index provider, that address any of the following or other matters related to the catastrophe for insurance policies issued in this state:  (1) Reporting requirements for claims related to the emergency;  (2) Grace periods for payment of insurance premiums and performance of other duties by insureds (other than the duty to mitigate); and/or  (3) Temporary postponement of cancellations and nonrenewals of insurance policies.  (b) Subdivisions (a)(2) and (3) above apply to all insurance policies, regardless of the line of insurance, issued to residents of this state displaced as a result of the catastrophe. The regulations shall require the insurer to make reasonable efforts to contact the policyholder and provide the accommodations requested by the policyholder, within the limits of accommodations detailed in the regulation, upon confirmation that the policyholder has been displaced by the catastrophe.  History of Section.P.L. 2012, ch. 64,  2; P.L. 2012, ch. 83,  2; P.L. 2013, ch. 100,  1; P.L. 2013, ch. 113,  1. 
 27-76-7. Use of prior claim experience of insured property. No insurer may refuse to insure, cancel, nonrenew or surcharge an insurance policy covering damages to personal lines residential property based solely upon prior claim experience for property damage claims at the insured property while under the ownership of someone other than the current insured unless the risk from which the claim originated has not been mitigated.  History of Section.P.L. 2012, ch. 64,  3; P.L. 2012, ch. 83,  3. 
 27-76-8. Use of claim experience resulting from catastrophic events. No insurer may refuse to insure, cancel, nonrenew or surcharge a policy or contract covering damages to personal lines residential property solely as a result of damages sustained in a catastrophic event.  History of Section.P.L. 2012, ch. 64,  3; P.L. 2012, ch. 83,  3. 
 27-76-9. Severability. If a court holds any section or portion of a section of this chapter or the applicability thereof to any person or circumstance invalid, the remainder of the chapter shall not be affected thereby.  History of Section.P.L. 2012, ch. 64,  2; P.L. 2012, ch. 83,  2. 
 27-77-1. Purpose and scope. 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 groups 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.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-77-10. Severability clause. If any provision of this chapter, or the application thereof to any person or circumstance, is held invalid, such determination shall not affect the provisions or applications of this chapter which can be given effect without the invalid provision or application, and to that end the provisions of this chapter are severable.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-77-2. Definitions. (a) Commissioner means the director of the department of business regulation or his or her designee.  (b) Insurance group. For the purpose of conducting an ORSA, the term insurance group means those insurers and affiliates included within an insurance holding company system as defined in chapter 27-35.  (c) Insurer. The term insurer shall not include agencies, authorities or instrumentalities of the United States, its possessions and territories, the commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state.  (d) NAIC means the National Association of Insurance Commissioners.  (e) Own Risk and Solvency Assessment or ORSA. An Own Risk and Solvency Assessment or ORSA means a confidential internal assessment, appropriate to the nature, scale and complexity of an insurer or insurance group, conducted by that insurer or insurance group of the material and relevant risks associated with the insurer or insurance groups current business plan, and the sufficiency of capital resources to support those risks.  (f) ORSA Guidance Manual means the current version of the Own Risk and Solvency Assessment Guidance Manual developed and adopted by the NAIC and as amended from time to time. A change in the ORSA guidance manual shall be effective on January 1 following the calendar year in which the changes have been adopted by the NAIC.  (g) ORSA Summary Report means a confidential high-level summary of an insurer or insurance groups ORSA.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-77-3. Risk management framework. An insurer shall maintain a risk management framework to assist the insurer with identifying, assessing, monitoring, managing and reporting on its material and relevant risks. This requirement may be satisfied if the insurance group of which the insurer is a member maintains a risk management framework applicable to the operations of the insurer.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-77-4. ORSA requirement. Subject to  27-77-6, an insurer, or the insurance group of which the insurer is a member, shall regularly conduct an ORSA consistent with a process comparable to the ORSA guidance manual. The ORSA shall be conducted no less than annually but also at any time when there are significant changes to the risk profile of the insurer or the insurance group of which the insurer is a member.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-77-5. ORSA summary report. (a) Upon the commissioners 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 groups chief risk officer or other executive having responsibility for the oversight of the insurers enterprise risk management process attesting to the best of his/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 insurers 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.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-77-6. Exemption. (a) An insurer shall be exempt from the requirements of this chapter, if:  (1) The insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than five hundred million dollars ($500,000,000); and,  (2) The insurance group of which the insurer is a member has annual direct written and unaffiliated assumed premium, including international direct and assumed premium, but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than one billion dollars ($1,000,000,000).  (b) If an insurer qualifies for exemption pursuant to subdivision (a)(1) of this section, but the insurance group of which the insurer is a member does not qualify for exemption pursuant to subdivision (a)(2), then the ORSA summary report that may be required pursuant to  27-77-5 shall include every insurer within the insurance group. This requirement may be satisfied by the submission of more than one ORSA summary report for any combination of insurers provided any combination of reports includes every insurer within the insurance group.  (c) If an insurer does not qualify for exemption pursuant to subdivision (a)(1) of this section, but the insurance group of which it is a member qualifies for exemption pursuant to subdivision (a)(2), then the only ORSA summary report that may be required pursuant to  27-77-5 shall be the report applicable to that insurer.  (d) An insurer that does not qualify for exemption pursuant to subsection (a) may apply to the commissioner for a waiver from the requirements of this chapter based upon unique circumstances. In deciding whether to grant the insurers request for waiver, the commissioner may consider the type and volume of business written, ownership and organizational structure, and any other factor the commissioner considers relevant to the insurer or insurance group of which the insurer is a member. If the insurer is part of an insurance group with insurers domiciled in more than one state, the commissioner shall coordinate with the lead state commissioner and with the other domiciliary commissioners in considering whether to grant the insurers request for a waiver.  (e) Notwithstanding the exemptions stated in this section:  (1) The commissioner may require that an insurer maintain a risk management framework, conduct an ORSA and file an ORSA summary report based on unique circumstances including, but not limited to, the type and volume of business written, ownership and organizational structure, federal agency requests, and international supervisor requests; and  (2) The commissioner may require that an insurer maintain a risk management framework, conduct an ORSA and file an ORSA summary report if the insurer has risk-based capital for company action level event as defined and governed by chapter 4.6 of this title, meets one or more of the standards of an insurer deemed to be in hazardous financial condition as defined in chapter 14.2 of this title, or otherwise exhibits qualities of a troubled insurer as determined by the commissioner.  (f) If an insurer that qualifies for an exemption pursuant to subsection (a) subsequently no longer qualifies for that exemption due to changes in premium as reflected in the insurers most recent annual statement or in the most recent annual statements of the insurers within the insurance group of which the insurer is a member, the insurer shall have one year following the year the threshold is exceeded to comply with the requirements of this chapter.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-77-7. Contents of ORSA summary report. (a) The ORSA summary report shall be prepared consistent with the ORSA guidance manual, subject to the requirements of subsection (b) of this section. Documentation and supporting information shall be maintained and made available upon examination or upon request of the commissioner.  (b) The review of the ORSA summary report, and any additional requests for information, shall be made using similar procedures currently used in the analysis and examination of multistate or global insurers and insurance groups.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-77-8. Confidentiality. (a) Documents, materials or other information, including the ORSA summary report, in the possession of or control of the department of business regulation that are obtained by, created by or disclosed to the commissioner or any other person under this chapter, is recognized by this state as being proprietary and to contain trade secrets. All such documents, materials or other information shall be confidential by law and privileged, shall not be subject to chapter 2 of title 38 (Access to Public Records), shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. However, the commissioner is authorized to use the documents, materials or other information in the furtherance of any regulatory or legal action brought as a part of the commissioners official duties. The commissioner shall not otherwise make the documents, materials or other information public without the prior written consent of the insurer.  (b) Neither the commissioner nor any person who received documents, materials or other ORSA-related information, through examination or otherwise, while acting under the authority of the commissioner or with whom such documents, materials or other information are shared pursuant to this chapter shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subsection (a).  (c) In order to assist in the performance of the commissioners regulatory duties, the commissioner:  (1) May, upon request, share documents, materials or other ORSA-related information, including the confidential and privileged documents, materials or information subject to subsection (a), including proprietary and trade secret documents and materials with other state, federal and international financial regulatory agencies, including members of any supervisory college as defined in chapter 35 of this title, with the NAIC and with any third-party consultants designated by the commissioner, provided that the recipient agrees in writing to maintain the confidentiality and privileged status of the ORSA-related documents, materials or other information and has verified in writing the legal authority to maintain confidentiality; and  (2) May receive documents, materials or other ORSA-related information, including otherwise confidential and privileged documents, materials or information, including proprietary and trade-secret information or documents, from regulatory officials of other foreign or domestic jurisdictions, including members of any supervisory college as defined in chapter 35 of this title, and from the NAIC, and shall maintain as confidential or privileged any documents, materials or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information.  (3) Shall enter into a written agreement with the NAIC or a third-party consultant governing sharing and use of information provided pursuant to this chapter, consistent with this subsection that shall:  (i) Specify procedures and protocols regarding the confidentiality and security of information shared with the NAIC or a third-party consultant pursuant to this chapter, including procedures and protocols for sharing by the NAIC with other state regulators from states in which the insurance group has domiciled insurers. The agreement shall provide that the recipient agrees in writing to maintain the confidentiality and privileged status of the ORSA-related documents, materials or other information and has verified in writing the legal authority to maintain confidentiality;  (ii) Specify that ownership of information shared with the NAIC or a third-party consultant pursuant to this chapter remains with the commissioner and the NAICs or a third-party consultants use of the information is subject to the direction of the commissioner;  (iii) Prohibit the NAIC or third-party consultant from storing the information shared pursuant to this chapter in a permanent database after the underlying analysis is completed;  (iv) Require prompt notice to be given to an insurer whose confidential information in the possession of the NAIC or a third-party consultant pursuant to this chapter is subject to a request or subpoena to the NAIC or a third-party consultant for disclosure or production;  (v) Require the NAIC or a third-party consultant to consent to intervention by an insurer in any judicial or administrative action in which the NAIC or a third-party consultant may be required to disclose confidential information about the insurer shared with the NAIC or a third-party consultant pursuant to this chapter; and  (vi) In the case of an agreement involving a third-party consultant, provide for the insurers written consent.  (d) The sharing of information and documents by the commissioner pursuant to this chapter shall not constitute a delegation of regulatory authority or rulemaking, and the commissioner is solely responsible for the administration, execution and enforcement of the provisions of this chapter.  (e) No waiver of any applicable privilege or claim of confidentiality in the documents, proprietary and trade-secret materials or other ORSA-related information shall occur as a result of disclosure of such ORSA-related information or documents to the commissioner under this section or as a result of sharing as authorized in this chapter.  (f) Documents, materials or other information in the possession or control of the NAIC or third-party consultants pursuant to this chapter shall be confidential by law and privileged, shall not be subject to chapter 2 of title 38, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-77-9. Sanctions. Any insurer failing, without just cause, to timely file the ORSA summary report as required in this chapter shall be required, after notice and hearing, to pay a penalty of one thousand dollars ($1,000) for each days delay, to be recovered by the commissioner and the penalty so recovered shall be paid into the general fund. The maximum penalty under this section is three hundred sixty-five thousand dollars ($365,000). The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.  History of Section.P.L. 2013, ch. 53,  1; P.L. 2013, ch. 59,  1. 
 27-78-1. Short title. This chapter shall be known and may be cited as the Certificates of Insurance Model Act.  History of Section.P.L. 2013, ch. 299,  1; P.L. 2013, ch. 408,  1. 
 27-78-2. Definitions. For purposes of this chapter: (1) Certificate of insurance means a document or instrument, regardless of how titled or described, that is prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage. The term does not include a policy of insurance, insurance binder, policy endorsement, or automobile insurance identification or information card.  (2) Insurance producer means a person required to be licensed under the laws of this state to sell, solicit, or negotiate property or casualty insurance.  (3) Insurer means any organization that issues property or casualty insurance.  (4) Person means any individual, partnership, corporation, association, or other legal entity, including any government or governmental subdivision or agency.  History of Section.P.L. 2013, ch. 299,  1; P.L. 2013, ch. 408,  1. 
 27-78-3. Certificate forms. (a) The commissioner of insurance shall prohibit the use of a certificate of insurance form if the form:  (1) Is unfair, misleading, or deceptive, or violates public policy; or  (2) Violates any law, including any regulation promulgated by the commissioner of insurance.  (b) A certificate of insurance is not a policy of insurance and does not affirmatively or negatively amend, extend, or alter the coverage afforded by the policy to which the certificate of insurance makes reference. A certificate of insurance shall not confer to any person new or additional rights beyond what the referenced policy of insurance expressly provides.  History of Section.P.L. 2013, ch. 299,  1; P.L. 2013, ch. 408,  1. 
 27-78-4. Limitations on use. (a) A person may not:  (1) Alter or modify a certificate of insurance after issuance by a producer or insurer;  (2) Prepare, issue, or request or require the issuance of a certificate of insurance that contains any false or misleading information concerning the policy of insurance to which the certificate of insurance makes reference; or  (3) Prepare, issue, or request or require the issuance of a certificate of insurance that purports to affirmatively or negatively alter, amend, or extend the coverage provided by the policy of insurance to which the certificate of insurance makes reference.  (b) A certificate of insurance may not warrant that the policy of insurance referenced in the certificate comply with the insurance or indemnification requirements of a contract and the inclusion of a contract number or description within a certificate of insurance may not be interpreted as doing such.  History of Section.P.L. 2013, ch. 299,  1; P.L. 2013, ch. 408,  1. 
 27-78-5. Notice requirements. A person is entitled to notice of cancellation, nonrenewal, or any material change, and to any similar notice concerning a policy of insurance only if the person has such notice rights under the terms of the policy of insurance or any endorsement to the policy. The terms and conditions of the notice are governed by the policy of insurance or endorsement and may not be altered by a certificate of insurance.  History of Section.P.L. 2013, ch. 299,  1; P.L. 2013, ch. 408,  1. 
 27-78-6. Applicability. (a) The provisions of this chapter shall apply to all certificates of insurance issued in connection with property, operations, or risks located in this state, regardless of where the policyholder, insurer, insurance producer, or person requesting or requiring the issuance of a certificate of insurance is located.  (b) A certificate of insurance or any other document or correspondence prepared, issued, requested, or required in violation of this chapter shall be null and void.  History of Section.P.L. 2013, ch. 299,  1; P.L. 2013, ch. 408,  1. 
 27-78-7. Enforcement and penalties. (a) The commissioner of insurance shall have the power to examine and investigate the activities of any person that the commissioner reasonably believes has been or is engaged in an act or practice prohibited by this chapter.  (b) The commissioner of insurance shall have the power to enforce the provisions of this chapter in accordance with  42-14-16.  (c) The commissioner of insurance may adopt reasonable rules and regulations as are necessary or proper to carry out the provisions of this chapter.  History of Section.P.L. 2013, ch. 299,  1; P.L. 2013, ch. 408,  1. 
 27-79.1-1. Short title. This chapter shall be known and may be cited as the Travel Insurance Act. History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2. 
 27-79.1-10. Policy. (a) Notwithstanding any other provision of this title, travel insurance; shall be classified, and filed for purposes of rates and forms under an inland marine line of insurance provided, however, that travel insurance that provides coverage for sickness, accident, disability, or death occurring during travel, either exclusively or in conjunction with related coverages of emergency evacuation or repatriation of remains, or incidental limited property and casualty benefits such as baggage or trip cancellation, may be filed by an authorized insurer under either an accident and health line of insurance or an inland marine line of insurance.  (b) Travel insurance may be in the form of an individual, group, or blanket policy.  (c) Eligibility and underwriting standards for travel insurance may be developed and provided based on travel protection plans designed for individual or identified marketing or distribution channels, provided those standards also meet the states underwriting standards for inland marine.  History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2. 
 27-79.1-11. Responsibility. As the insurer designee, the limited lines travel insurance producer is responsible for the acts of the travel retailer and shall use reasonable means to ensure compliance by the travel retailer with this chapter.  History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2. 
 27-79.1-12. Enforcement. Violations of this chapter shall be subject to penalties pursuant to  42-14-16. History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2. 
 27-79.1-13. Regulations. The commissioner may promulgate regulations to implement the provisions of this chapter. History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2. 
 27-79.1-2. Scope and purposes. (a) The purpose of this chapter is to promote the public welfare by creating a comprehensive legal framework within which travel insurance may be sold in this state.  (b) The requirements of this chapter shall apply to travel insurance policies and certificates that are delivered or issued for delivery in this state. It shall not apply to cancellation fee waivers and travel assistance services, except as expressly provided herein.  (c) All other applicable provisions of the states insurance laws shall continue to apply to travel insurance; provided that the specific provisions of this chapter shall supersede any other provisions of the general or public laws that would otherwise be applicable to travel insurance.  History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2. 
 27-79.1-3. Definitions. As used in this chapter, the following terms shall have the following meanings: (1) Aggregator site means a website that provides access to information regarding insurance products from more than one insurer, including product and insurer information, for use in comparison shopping.  (2) Blanket travel insurance means a policy of travel insurance issued to any eligible group providing coverage for specific classes of persons defined in the policy, with coverage provided to all members of the eligible group without a separate charge to individual members of the eligible group.  (3) Cancellation fee waiver means a contractual agreement between a supplier of travel services and its customer to waive some or all of the non-refundable cancellation fee provisions of the suppliers underlying travel contract, with or without regard to the reason for the cancellation or form of reimbursement. A cancellation fee waiver is not insurance.  (4) Eligible group, for the purposes of travel insurance, means two (2) or more persons who are engaged in a common enterprise, or have an economic, educational, or social affinity or relationship, including, but not limited to, any of the following:  (i) Any entity engaged in the business of providing travel or travel services, including, but not limited to, tour operators, lodging providers, vacation property owners, hotels and resorts, travel clubs, travel agencies, property managers, cultural exchange programs, and common carriers or the operator, owner, or lessor of a means of transportation of passengers, including, but not limited to, airlines, cruise lines, railroads, steamship companies, and public bus carriers, wherein, with regard to any particular travel or type of travel or travelers, all members or customers of the group must have a common exposure to risk attendant to the travel;  (ii) Any college, school, or other institution of learning covering students, teachers, or employees or volunteers;  (iii) Any employer covering any group of employees, volunteers, contractors, board of directors, dependents, or guests;  (iv) Any sports team, camp, or sponsor thereof covering participants, members, campers, employees, officials, supervisors, or volunteers;  (v) Any religious, charitable, recreational, educational, or civic organization or branch thereof covering any group of members, participants, or volunteers;  (vi) Any financial institution or financial institution vendor, or parent holding company, trustee, or agent of, or designated by, one or more financial institutions or financial institution vendors, including accountholders, credit card holders, debtors, guarantors, or purchasers;  (vii) Any incorporated or unincorporated association, including labor unions, having a common interest, constitution, and bylaws, and organized and maintained in good faith for purposes other than obtaining insurance for members or participants of the association covering its members;  (viii) Any trust or the trustees of a fund established, created, or maintained for the benefit of and covering members, employees, or customers, subject to the insurance commissioner permitting the use of a trust and the states premium tax provisions in  27-79.1-6 of one or more associations meeting the requirements of subsection (4)(vii) of this section;  (ix) Any entertainment production company covering any group of participants, volunteers, audience members, contestants, or workers;  (x) Any volunteer fire department, ambulance, rescue, police, court or any first aid, civil defense, or other such volunteer group;  (xi) Preschools, daycare institutions for children or adults, and senior citizen clubs;  (xii) Any automobile or truck rental or leasing company covering a group of individuals who may become renters, lessees, or passengers defined by their travel status on the rented or leased vehicles. The common carrier, the operator, owner, or lessor of a means of transportation, or the automobile or truck rental or leasing company, is the policyholder under a policy to which this section applies; or  (xiii) Any other group where the commissioner has determined that the members are engaged in a common enterprise, or have an economic, educational, or social affinity or relationship, and that issuance of the policy would not be contrary to the public interest.  (5) Fulfillment materials means documentation sent to the purchaser of a travel protection plan confirming the purchase and providing the travel protection plans coverage and assistance details.  (6) Group travel insurance means travel insurance issued to any eligible group.  (7) Limited lines travel insurance producer means:  (i) Licensed managing general agent or third-party administrator;  (ii) Licensed insurance producer, including a limited lines producer; or  (iii) Travel administrator.  (8) Offer and disseminate means providing general information, including a description of the coverage and price, as well as processing the application and collecting premiums.  (9) Primary certificate holder means an individual person who elects and purchases travel insurance under a group policy.  (10) Primary policyholder means an individual person who elects and purchases individual travel insurance.  (11) Travel administrator means a person who directly or indirectly underwrites, collects charges, collateral, or premiums from, or adjusts or settles claims on residents of this state, in connection with travel insurance, except that a person shall not be considered a travel administrator if that persons only actions that would otherwise cause it to be considered a travel administrator are among the following:  (i) A person working for a travel administrator to the extent that the persons activities are subject to the supervision and control of the travel administrator;  (ii) An insurance producer selling insurance or engaged in administrative and claims-related activities within the scope of the producers license;  (iii) A travel retailer offering and disseminating travel insurance and registered under the license of a limited lines travel insurance producer in accordance with this chapter;  (iv) An individual adjusting or settling claims in the normal course of that individuals practice or employment as an attorney at law and who does not collect charges or premiums in connection with insurance coverage; or  (v) A business entity that is affiliated with a licensed insurer while acting as a travel administrator for the direct and assumed insurance business of an affiliated insurer.  (12) Travel assistance services means non-insurance services for which the consumer is not indemnified based on a fortuitous event, and where providing the service does not result in transfer or shifting of risk that would constitute the business of insurance. Travel assistance services include, but are not limited to: security advisories; destination information; vaccination and immunization information services; travel reservation services; entertainment; activity and event planning; translation assistance; emergency messaging; international legal and medical referrals; medical case monitoring; coordination of transportation arrangements; emergency cash transfer assistance; medical prescription replacement assistance; passport and travel document replacement assistance; lost luggage assistance; concierge services; and any other service that is furnished in connection with planned travel. Travel assistance services are not insurance and not related to insurance.  (13) Travel insurance means insurance coverage for personal risks incident to planned travel, including:  (i) Interruption or cancellation of trip or event;  (ii) Loss of baggage or personal effects;  (iii) Damages to accommodations or rental vehicles;  (iv) Sickness, accident, disability, or death occurring during travel;  (v) Emergency evacuation;  (vi) Repatriation of remains; or  (vii) Any other contractual obligations to indemnify or pay a specified amount to the traveler upon determinable contingencies related to travel as approved by the commissioner.  Travel insurance does not include major medical plans that provide comprehensive medical protection for travelers with trips lasting longer than six (6) months, including, for example, those working or residing overseas as an expatriate, or any other product that requires a specific insurance producer license.  (14) Travel protection plans means plans that provide one or more of the following:  (i) Travel insurance;  (ii) Travel assistance services; and  (iii) Cancellation fee waivers.  (15) Travel retailer means a business entity that makes, arranges, or offers planned travel services, and may offer and disseminate travel insurance as a service to its customers on behalf of, and under the direction of, a limited lines travel insurance producer.  History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2; P.L. 2020, ch. 79, art. 2,  16. 
  27-79.1-4. Licensing and registration requirements.(a) The commissioner may issue to an individual or business entity that has filed with the commissioner an application for a limited lines travel insurance producer license in a form and manner prescribed by the commissioner, a limited lines travel insurance producer license that authorizes the limited lines travel insurance producer to sell, solicit, or negotiate travel insurance through a licensed insurer. No person may act as a limited lines travel insurance producer or travel insurance retailer unless properly licensed or registered.(b) A travel retailer may offer and disseminate travel insurance under a limited lines travel insurance producer business entity license only if the following conditions are met:(1) The limited lines travel insurance producer or travel retailer provides to purchasers of travel insurance:(i) A description of the material terms or the actual material terms of the insurance coverage;(ii) A description of the process for filing a claim;(iii) A description of the review or cancellation process for the travel insurance policy; and(iv) The identity and contact information of the insurer and limited lines travel insurance producer;(2) At the time of licensure, the limited lines travel insurance producer shall establish and maintain a register, on a form prescribed by the commissioner, of each travel retailer that offers travel insurance on the limited lines travel insurance producer's behalf. The register shall be maintained and updated by the limited lines travel insurance producer, and shall include the name, address, and contact information of the travel retailer, and an officer or person who directs or controls the travel retailer's operations, and the travel retailer's federal tax identification number. The limited lines travel insurance producer shall submit the register to the commissioner upon reasonable request. The limited lines travel insurance producer shall also certify that the travel retailer registered complies with 18 U.S.C.  1033. The grounds for the suspension, revocation, and the penalties applicable to resident insurance producers shall be applicable to the limited lines travel insurance producers and travel retailers;(3) The limited lines travel insurance producer has designated one of its employees who is a licensed individual producer as the person (a "designated responsible producer" or "DRP") responsible for the compliance with the travel insurance laws and regulations applicable to the limited lines travel insurance producer and its registrants;(4) The DRP, president, secretary, treasurer, and any other officer or person who directs or controls the limited lines travel insurance producer's insurance operations shall comply with the fingerprinting requirements applicable to insurance producers in the resident state of the limited lines travel insurance producer;(5) The limited lines travel insurance producer has paid all applicable licensing fees as set forth in applicable state law;(6) The limited lines travel insurance producer must require each employee and authorized representative of the travel retailer whose duties include offering and disseminating travel insurance to receive a program of instruction or training, which is subject at the discretion of the commissioner for review and approval. The training material shall, at a minimum, contain adequate instructions on the types of insurance offered, ethical sales practices, and required disclosures to prospective customers.(c) Any travel retailer offering or disseminating travel insurance shall make available to prospective purchasers brochures or other written materials that have been approved by the travel insurer. Such materials shall include information which, at a minimum:(1) Provides the identity and contact information of the insurer and the limited lines travel insurance producer;(2) Explains that the purchase of travel insurance is not required in order to purchase any other product or service from the travel retailer; and(3) Explains that an unlicensed travel retailer is permitted to provide only general information about the insurance offered by the travel retailer, including a description of the coverage and price, but is not qualified or authorized to answer technical questions about the terms and conditions of the insurance offered by the travel retailer or to evaluate the adequacy of the customer's existing insurance coverage.(d) A travel retailer employee or authorized representative, who is not licensed as an insurance producer, may not:(1) Evaluate or interpret the technical terms, benefits, and conditions of the offered travel insurance coverage;(2) Evaluate or provide advice concerning a prospective purchaser's existing insurance coverage; or(3) Hold themselves out as a licensed insurer, licensed producer, or insurance expert.(e) Any person licensed in a major line of authority as an insurance producer is authorized to sell, solicit, and negotiate travel insurance. A property and casualty insurance producer is not required to become appointed by an insurer in order to sell, solicit, or negotiate travel insurance.History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2.
  27-79.1-5. Compensation.A travel retailer whose insurance-related activities, and those of its employees, are limited to offering and disseminating travel insurance on behalf of and under the direction of a limited lines travel insurance producer meeting the conditions stated in this chapter, is authorized to do so and receive related compensation.History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2.
  27-79.1-6. Premium tax.(a) A travel insurer shall pay a gross premiums tax, as provided in  44-17-2, on travel insurance premiums paid by any of the following:(1) An individual primary policyholder who is a resident of this state;(2) A primary certificate holder who is a resident of this state who elects coverage under a group travel insurance policy; or(3) A blanket travel insurance policyholder that is resident in, or has its principal place of business or the principal place of an affiliate or subsidiary that has purchased blanket travel insurance in this state for eligible blanket group members, subject to any apportionment rules that apply to the insurer across multiple taxing jurisdictions, or that permits the insurer to allocate premiums on an apportioned basis in a reasonable and equitable manner in those jurisdictions.(b) A travel insurer shall:(1) Document the state of residence or principal place of business of the policyholder or certificate holder, as required in this chapter; and(2) Report as premium only the amount allocable to travel insurance, and not any amounts received for travel assistance services or cancellation fee waivers.History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2.
  27-79.1-7. Travel protection plans.(a) Travel protection plans may be offered for one price for the combined features that the travel protection plan offers in this state if:(1) The travel protection plan clearly discloses to the consumer at, or prior to the time of purchase, that it includes travel insurance, travel assistance services, and cancellation fee waivers, as applicable, and provides information and an opportunity at, or prior to the time of purchase, for the consumer to obtain additional information regarding the features and pricing of each; and(2) The fulfillment materials:(i) Describe and delineate the travel insurance, travel assistance services, and cancellation fee waivers in the travel protection plan; and(ii) Include the travel insurance disclosures and the contact information for persons providing travel assistance services and cancellation fee waivers, as applicable.History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2.
  27-79.1-8. Sales practices.(a) All persons offering travel insurance to residents of this state are subject to the unfair trade practices provided in chapter 29 of title 27, except as otherwise provided in this section. In the event of a conflict between this chapter, and other provisions of this title regarding the sale and marketing of travel insurance and travel protection plans, the provisions of this chapter shall control.(b) Offering or selling a travel insurance policy that could never result in the payment of any claims for any insured under the policy is an unfair trade practice under chapter 29 of title 27.(c) (1) All documents provided to consumers prior to the purchase of travel insurance, including, but not limited to, sales materials, advertising materials, and marketing materials, shall be consistent with the travel insurance policy itself, including, but not limited to, forms, endorsements, policies, rate filings, and certificates of insurance.(2) For travel insurance policies or certificates that contain pre-existing condition exclusions, information and an opportunity to learn more about the pre-existing condition exclusions shall be provided any time prior to the time of purchase, and in the coverage's fulfillment materials.(3) The fulfillment materials and the information described in  27-79.1-4(b)(1)(i)-(iv) shall be provided to a policyholder or certificate holder as soon as practicable following the purchase of a travel protection plan. Unless the insured has either started a covered trip or filed a claim under the travel insurance coverage, a policyholder or certificate holder may cancel a policy or certificate for a full refund of the travel protection plan price from the date of purchase of a travel protection plan until at least:(i) Fifteen (15) days following the date of delivery of the travel protection plan's fulfillment materials by postal mail; or(ii) Ten (10) days following the date of delivery of the travel protection plan's fulfillment materials by means other than postal mail. For the purposes of this section, "delivery" means handing fulfillment materials to the policyholder or certificate holder, or sending fulfillment materials by postal or electronic means to the policyholder or certificate holder.(4) The company shall disclose in the policy documentation and fulfillment materials whether the travel insurance is primary or secondary to other applicable coverage.(5) When travel insurance is marketed directly to a consumer through an insurer's website or by others through an aggregator site, it shall not be an unfair trade practice or other violation of law where an accurate summary or short description of coverage is provided on the website, so long as the consumer has access to the full provisions of the policy through electronic means.(d) No person offering, soliciting, or negotiating travel insurance or travel protection plans on an individual or group basis may do so by using a negative option or opt out, which would require a consumer to take an affirmative action to deselect coverage such as unchecking a box on an electronic form when they purchase a trip.(e) It shall be an unfair trade practice to market blanket travel insurance coverage as free.(f) When a consumer's destination jurisdiction requires insurance coverage, it shall not be an unfair trade practice to require that a consumer choose between the following options as a condition of purchasing a trip or travel package:(1) Purchasing the coverage required by the destination jurisdiction through the travel retailer or limited lines travel insurance producer supplying the trip or travel package; or(2) Agreeing to obtain and provide proof of coverage that meets the destination jurisdiction's requirements prior to departure.History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2.
  27-79.1-9. Travel administrators.(a) Notwithstanding any other provisions of this title, no person shall act or represent himself, herself, or itself as a travel administrator for travel insurance in this state unless that person:(1) Is a licensed property and casualty insurance producer in this state for activities permitted under that producer license; or(2) Holds a valid managing general agent license in this state.(b) A travel administrator and its employees are exempt from the licensing requirements of chapter 10 of title 27 for travel insurance it administers.(c) An insurer is responsible for the acts of a travel administrator administering travel insurance underwritten by the insurer, and is responsible for ensuring that the travel administrator maintains all books and records relevant to the insurer to be made available by the travel administrator to the commissioner upon request.History of Section.P.L. 2019, ch. 44,  2; P.L. 2019, ch. 51,  2.
 27-79-1. [Repealed.] History of Section.P.L. 2013, ch. 315,  1; P.L. 2013, ch. 410,  1; Repealed by P.L. 2019, ch. 44,  1, effective October 1, 2019; P.L. 2019, ch. 51,  1, effective October 1, 2019. 
 27-79-2. [Repealed.] History of Section.P.L. 2013, ch. 315,  1; P.L. 2013, ch. 410,  1; Repealed by P.L. 2019, ch. 44,  1, effective October 1, 2019; P.L. 2019, ch. 51,  1, effective October 1, 2019. 
 27-79-3. [Repealed.] History of Section.P.L. 2013, ch. 315,  1; P.L. 2013, ch. 410,  1; Repealed by P.L. 2019, ch. 44,  1, effective October 1, 2019; P.L. 2019, ch. 51,  1, effective October 1, 2019. 
 27-79-4. [Repealed.] History of Section.P.L. 2013, ch. 315,  1; P.L. 2013, ch. 410,  1; Repealed by P.L. 2019, ch. 44,  1, effective October 1, 2019; P.L. 2019, ch. 51,  1, effective October 1, 2019. 
 27-79-5. [Repealed.] History of Section.P.L. 2013, ch. 315,  1; P.L. 2013, ch. 410,  1; Repealed by P.L. 2019, ch. 44,  1, effective October 1, 2019; P.L. 2019, ch. 51,  1, effective October 1, 2019. 
 27-79-6. [Repealed.] History of Section.P.L. 2013, ch. 315,  1; P.L. 2013, ch. 410,  1; Repealed by P.L. 2019, ch. 44,  1, effective October 1, 2019; P.L. 2019, ch. 51,  1, effective October 1, 2019. 
 27-79-7. [Repealed.] History of Section.P.L. 2013, ch. 315,  1; P.L. 2013, ch. 410,  1; Repealed by P.L. 2019, ch. 44,  1, effective October 1, 2019; P.L. 2019, ch. 51,  1, effective October 1, 2019. 
  27-8.1-1. Short title.This chapter shall be known as the "Arson Information Reporting  Immunity Act".History of Section.P.L. 1978, ch. 328,  1.
  27-8.1-2.1. Statement to fire department concerning burned motor vehicle.(a) Whenever a motor vehicle as defined in  31-1-3(s) is burned, the owner of record of the vehicle shall submit to the fire department for the city or town in which the vehicle is located a statement signed under the penalties of perjury containing any information concerning the burning of the vehicle that the state fire marshal or his or her designee shall require.(b) The state fire marshal or his or her designee is empowered and directed to develop and adopt an appropriate form upon which to enter the owner's statement, which form shall contain the requisite information as provided in  27-8.1-3.History of Section.P.L. 1993, ch. 332,  2; P.L. 2004, ch. 6,  12; P.L. 2005, ch. 410,  12.
  27-8.1-2. Definitions.(a) "Action" includes nonaction, inaction, or failure to take action.(b) "Authorized agency" means:(1) The state fire marshal, deputy fire marshal, or assistant deputy fire marshals;(2) The superintendent of state police, or principal investigating officer of the state police;(3) The attorney general or assistant attorneys general;(4) The chief, deputy chief, or principal investigating officer of the police department of the city or town where a fire occurs;(5) The chief, deputy chief, or principal investigating officer of the fire department of the city or town or fire district where a fire occurs;(6) The federal bureau of investigation or any comparable federal investigatory agency; or(7) The United States attorney or assistant district attorneys for the district where a fire occurs.(c) "Deemed crucial" means determined by an authorized agency acting within its sole discretion to be decisive or critical to an investigation and/or prosecution by that agency.(d) "Immune" means that neither a civil action nor a criminal prosecution may be maintained or instituted by virtue of any action taken pursuant to  27-8.1-3, 27-8.1-4, or 27-8.1-5, or any other provision of this chapter, in the absence of actual malice on the part of the insurer, lending institution, party in interest, or authorized agency, against the insured.(e) "Insurer" means any insurance company incorporated by or under the laws of this state, and any foreign insurance company admitted to do business in this state, which issues fire insurance coverage on real or personal property risks located within the state.(f) "Lending institution" means any corporation incorporated by or under the law of this state and any foreign corporation admitted to do business in this state which makes any loan which is secured in whole or in part by a mortgage upon any interest in real property located in this state.(g) "Party in interest" means any person, firm, association, corporation, or other association of persons engaged:(1) In any phase of the business of fire coverage which is subject to the regulatory authority of the department of business regulation or the appropriate regulatory division of the department; or(2) In any phase of the business of making loans in association with, on behalf of, or in conjunction with a lending institution.(h) "Relevant" means having a propensity or tendency to make the existence of any fact, which is of consequence to the investigation or determination of an issue, more probable or less probable than in the absence of that information.History of Section.P.L. 1978, ch. 328,  1; P.L. 1979, ch. 392,  1; P.L. 1988, ch. 309,  2; P.L. 1989, ch. 542,  77.
  27-8.1-3. Disclosure of information relating to fire losses.(a) Whenever any authorized agency empowered to investigate the cause of, or circumstances attendant upon, a fire loss involving real or personal property within this state, and/or empowered to institute prosecution for criminal acts, actions, or missions causing, or related to, a fire loss, has reason to suspect that a fire loss is of incendiary or other suspicious origin, or results from other than accidental cause, that authorized agency may present a request in the manner and form and containing the requisites as provided in this section to an insurer, lending institution, and/or other party in interest for release to that agency of any and/or all relevant information deemed crucial to an investigation and/or prosecution by that agency, which the insurer, lending institution, or party in interest may have in its possession, relating to a fire loss; that relevant information shall include, but not be limited to:(1) Pertinent insurance policy information relevant to the fire loss under investigation and the application for that policy;(2) Available policy premium payment records;(3) The history of previous claims by the insured for fire loss;(4) Documentary materials relating to the investigation of the loss, including statements of any person, proof of loss, and any other materials or information relevant to the investigation;(5) Any loan agreement regarding the fire loss under investigation;(6) The mortgage document regarding the fire loss under investigation;(7) Documentary materials relating to the names of all persons or entities having any ownership interest in the property involved in the fire loss under investigation;(8) Documentary materials relating to any interest in other real property held by any of the persons or entities having any ownership interest in the property involved in the fire loss under investigation;(9) The history of other fire losses regarding any other real property in which any person or entity having an interest in the property involved in the fire loss under investigation has any ownership interest; and(10) Pertinent insurance policy information regarding any mortgage insurance or title insurance covering the property involved in the fire loss under investigation.(b) This request shall consist of a written statement, under oath, by the chief administrative officer of the authorized agency, that he or she has reason to believe:(1) That the fire loss is of suspicious origin;(2) That a certain insurer, lending institution, and/or party in interest, named in the statement, has relevant information concerning the fire loss; and(3) That this information is deemed crucial to an investigation and/or prosecution by the agency.(c) Upon receipt of a request in the manner and form and containing the requisites as provided in subsection (b), the insurer, lending institution, and/or party in interest shall proceed as soon as possible to provide the authorized agency with any relevant information that the insurer or party may have.(d) (1) When an insurer, lending institution, or party in interest has reason to suspect that a fire loss involving property insured by it, or its principal, is of incendiary or other suspicious origin, or results from other than accidental cause, the insurer or the party in interest shall, in writing to be sent by registered mail, return receipt requested, notify the chief of the fire department of the city, town, or fire district where the fire occurred, and shall forward a copy to the state fire marshal for the purpose of enabling him or her to investigate the loss;(2) When an insurer, lending institution, or party in interest provides any authorized agency with notice of a fire loss, that notice shall be deemed sufficient for the purpose of this chapter;(3) Nothing in this subsection shall be construed to abrogate or impair the rights or powers created under subsection (a).(e) An authorized agency which has secured any information furnished pursuant to subsection (a) may, in furtherance of its own purposes, release or provide that information, or any part of the information, to any other authorized agency, upon request by that agency.(f) An insurer, lending institution, or party in interest providing information to an authorized agency or agencies pursuant to subsections (a), (b), (c), or (d), shall have the right to request and receive relevant information from that agency on a reciprocal basis. The procedure to be followed in that case shall be in accord with that prescribed in subsections (a), (b), and (c), except to the extent that interchangeability of terminology is necessitated by the circumstances.(g) Any insurer, lending institution, party in interest, or authorized agency, or any person acting in behalf of or in conjunction with any of these, which or who releases information, whether oral or written, pursuant to a request and order, or otherwise, under subsection (a), (b), (c), (d), (e), or (f), shall be immune from any civil liability, criminal prosecution, or penalty.History of Section.P.L. 1978, ch. 328,  1; P.L. 1979, ch. 392,  1; P.L. 1984, ch. 55,  1; P.L. 1988, ch. 309,  1; P.L. 1989, ch. 542,  77.
  27-8.1-4. Confidentiality of evidence  Testimony by agency.(a) Any authorized agency, insurer, lending institution, or party in interest, or any person acting on behalf of or in conjunction with any of these, which or who has secured any information furnished or received pursuant to this chapter, shall retain that information in its strict confidence, possession, and custody until release of that information is required pursuant to a criminal or civil proceeding.(b) Any authorized agency, or the personnel of that agency, may be required to testify in any litigation in which an insurer and/or party in interest is named as a party or parties.History of Section.P.L. 1978, ch. 328,  1; P.L. 1988, ch. 309,  1.
  27-8.1-5. Enforcement  Penalty.(a) No insurer, lending institution, party in interest, or authorized agency, or any person acting in behalf of, or in conjunction with, any of these, shall:(1) Intentionally or knowingly refuse to release any information requested and/or ordered pursuant to  27-8.1-3(a), (b), (e), or (f);(2) Intentionally or knowingly refuse to provide authorized relevant information pursuant to  27-8.1-3(d)(1); and(3) Fail to hold in strict confidence, possession, and custody, information required to be so held under  27-8.1-4(a).(b) Whoever shall violate subsection (a) of this section shall be guilty of a misdemeanor and, upon conviction, shall be punished by a fine not to exceed one hundred dollars ($100).History of Section.P.L. 1978, ch. 328,  1; P.L. 1988, ch. 309,  1.
  27-8.1-6. Construction of chapter.With the exception of  27-8.1-2(a), no provision of this chapter shall be construed to impair any existing statutory or common law rights or powers.History of Section.P.L. 1978, ch. 328,  1.
  27-8.2-1. Purpose and intent.This chapter shall be known as the "Stop-Loss Insurance Act." The purpose of this chapter is to establish criteria for the issuance of stop-loss insurance policies. Nothing in this chapter shall be construed as imposing any requirement or duty on any person other than an insurer, or as treating any stop-loss policy as a direct policy of health insurance.History of Section.P.L. 2013, ch. 86,  1; P.L. 2013, ch. 92,  1.
  27-8.2-2. Definitions.(a) "Actuarial certification" means a written statement by a member of the American Academy of Actuaries, or other individual acceptable to the commissioner, that an insurer is in compliance with the provisions of this chapter. The written statement shall be based upon the individual's examination, and include a review of the appropriate records and the actuarial assumptions and methods used by the insurer in establishing attachment points and other applicable determinations in conjunction with the provision of stop-loss insurance coverage.(b) "Attachment point" means the claims amount incurred by an insured group beyond which the insurer incurs a liability for payment.(c) "Expected claims" means the amount of claims that, in the absence of a stop-loss policy or other insurance, are projected to be incurred by an insured group through its health plan.History of Section.P.L. 2013, ch. 86,  1; P.L. 2013, ch. 92,  1.
  27-8.2-3. Stop-loss insurance coverage standards.(a) An insurer shall not issue a stop-loss insurance policy that:(1) Has an annual attachment point for claims incurred per individual that is lower than twenty thousand dollars ($20,000);(2) Has an annual aggregate attachment point that is lower than one hundred twenty percent (120%) of expected claim; and(3) Provides direct coverage of healthcare expenses of an individual.(b) The commissioner may adopt rules that carry out the requirements of this chapter.History of Section.P.L. 2013, ch. 86,  1; P.L. 2013, ch. 92,  1.
  27-8.2-4. Actuarial certification.An insurer shall file with the commissioner annually on or before March 15, an actuarial certification certifying that the insurer is in compliance with this chapter. The certification shall be in a form and manner, and shall contain information, specified by the commissioner. A copy of the certification shall be retained by the insurer at its principal place of business.History of Section.P.L. 2013, ch. 86,  1; P.L. 2013, ch. 92,  1.
  27-8.2-5. Effective date.This chapter shall become effective with respect to stop-loss insurance policies issued or renewed on or after January 1, 2014.History of Section.P.L. 2013, ch. 86,  1; P.L. 2013, ch. 92,  1.
 27-8.3-1. Short title. [Effective April 1, 2023.] This act shall be known and may be cited as the Peer-to-Peer Car Sharing Program. History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-10. Insurable interest. [Effective April 1, 2023.] (a) Notwithstanding any other law, statute, rule, or regulation to the contrary, a peer-to-peer car sharing program shall have an insurable interest in a shared vehicle during the car sharing period.  (b) Nothing in this section creates liability on a peer-to-peer car sharing program to maintain the coverage mandated by  27-8.3-4.  (c) A peer-to-peer car sharing program may own and maintain as the named insured one or more policies of motor vehicle liability insurance that provides coverage for:  (1) Liabilities assumed by the peer-to-peer car sharing program under a peer-to-peer car sharing program agreement;  (2) Any liability of the shared vehicle owner; or  (3) Damage or loss to the shared motor vehicle; or any liability of the shared vehicle driver.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-11. Consumer protections disclosures. [Effective April 1, 2023.] Each car sharing program agreement made in this state shall disclose to the shared vehicle owner and the shared vehicle driver:  (1) Any right of the peer-to-peer car sharing program to seek indemnification from the shared vehicle owner or the shared vehicle driver for economic loss sustained by the peer-to-peer car sharing program resulting from a breach of the terms and conditions of the car sharing program agreement;  (2) That a motor vehicle liability insurance policy issued to the shared vehicle owner for the shared vehicle or to the shared vehicle driver does not provide a defense or indemnification for any claim asserted by the peer-to-peer car sharing program;  (3) That the peer-to-peer car sharing programs insurance coverage on the shared vehicle owner and the shared vehicle driver is in effect only during each car sharing period and that, for any use of the shared vehicle by the shared vehicle driver after the car sharing termination time, the shared vehicle driver and the shared vehicle owner may not have insurance coverage;  (4) The daily rate, fees, and if applicable, any insurance or protection package costs that are charged to the shared vehicle owner or the shared vehicle driver;  (5) That the shared vehicle owners motor vehicle liability insurance may not provide coverage for a shared vehicle;  (6) An emergency telephone number to personnel capable of fielding roadside assistance and other customer service inquiries; and  (7) If there are conditions under which a shared vehicle driver must maintain a personal automobile insurance policy with certain applicable coverage limits on a primary basis in order to book a shared motor vehicle.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-12. Drivers license verification and data retention. [Effective April 1, 2023.] (a) A peer-to-peer car sharing program may not enter into a peer-to-peer car sharing program agreement with a driver unless the driver who will operate the shared vehicle:  (1) Holds a drivers license issued under chapter 10 of title 31 that authorizes the driver to operate vehicles of the class of the shared vehicle; or  (2) Is a nonresident who:  (i) Has a drivers license issued by the state or country of the drivers residence that authorizes the driver in that state or country to drive vehicles of the class of the shared vehicle; and  (ii) Is at least the same age as that required of a resident to drive; or  (3) Otherwise is specifically authorized by  31-10-2 to drive vehicles of the class of the shared vehicle.  (b) A peer-to-peer car sharing program shall keep a record of:  (1) The name and address of the shared vehicle driver;  (2) The number of the drivers license of the shared vehicle driver and each other person, if any, who will operate the shared vehicle; and  (3) The place of issuance of the drivers license.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-13. Responsibility for equipment. [Effective April 1, 2023.] A peer-to-peer car sharing program shall have sole responsibility for any equipment, such as a GPS system or other special equipment that is put in or on the vehicle to monitor or facilitate the car sharing transaction, and shall agree to indemnify and hold harmless the vehicle owner for any damage to or theft of such equipment during the sharing period not caused by the vehicle owner. The peer-to-peer car sharing program has the right to seek indemnity from the shared vehicle driver for any loss or damage to such equipment that occurs during the sharing period.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-14. Automobile safety recalls. [Effective April 1, 2023.] (a) At the time when a vehicle owner registers as a shared vehicle owner on a peer-to-peer car sharing program and prior to the time when the shared vehicle owner makes a shared vehicle available for car sharing on the peer-to-peer car sharing program, the peer-to-peer car sharing program shall:  (1) Verify that the shared vehicle does not have any safety recalls on the vehicle for which the repairs have not been made; and  (2) Notify the shared vehicle owner of the requirements under subsection (b) of this section.  (b)(1) If the shared vehicle owner has received an actual notice of a safety recall on the vehicle, a shared vehicle owner may not make a vehicle available as a shared vehicle on a peer-to-peer car sharing program until the safety recall repair has been made.  (2) If a shared vehicle owner receives an actual notice of a safety recall on a shared vehicle while the shared vehicle is made available on the peer-to-peer car sharing program, the shared vehicle owner shall remove the shared vehicle as available on the peer-to-peer car sharing program, as soon as practicably possible after receiving the notice of the safety recall and until the safety recall repair has been made.  (3) If a shared vehicle owner receives an actual notice of a safety recall while the shared vehicle is being used in the possession of a shared vehicle driver, as soon as practicably possible after receiving the notice of the safety recall, the shared vehicle owner shall notify the peer-to-peer car sharing program about the safety recall in order that the shared vehicle owner may address the safety recall repair.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-2. Applicability. [Effective April 1, 2023.] The provisions of this chapter apply notwithstanding any law, rule, or regulation to the contrary. Where any provision of this chapter conflicts with any other provision of law, the provisions of this chapter shall supersede any such conflicting or contradictory provision.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-3. Definitions. [Effective April 1, 2023.] Except as otherwise provided, the following definitions apply throughout this chapter: (1) Car sharing delivery period means the period of time during which a shared vehicle is being delivered to the location of the car sharing start time, if applicable, as documented by the governing car sharing program agreement.  (2) Car sharing period means the period of time that commences with the car sharing delivery period or, if there is no car sharing delivery period, that commences with the car sharing start time and in either case ends at the car sharing termination time.  (3) Car sharing program agreement means the terms and conditions applicable to a shared vehicle owner and a shared vehicle driver that govern the use of a shared vehicle through a peer-to-peer car sharing program. Car sharing program agreement does not mean a rental car agreement, issued by a motor vehicle rental company as defined in  31-34.1-1.  (4) Car sharing start time means the time when the shared vehicle becomes subject to the control of the shared vehicle driver at or after the time the reservation of a shared vehicle is scheduled to begin as documented in the records of a peer-to-peer car sharing program.  (5) Car sharing termination time means the earliest of the following events:  (i) The expiration of the agreed upon period of time established for the use of a shared vehicle according to the terms of the car sharing program agreement if the shared vehicle is delivered to the location agreed upon in the car sharing program agreement;  (ii) When the shared vehicle is returned to a location as alternatively agreed upon by the shared vehicle owner and shared vehicle driver as communicated through a peer-to-peer car sharing program, which alternatively agreed upon location shall be incorporated into the car sharing program agreement; or  (iii) When the shared vehicle owner or the shared vehicle owners authorized designee, takes possession and control of the shared vehicle.  (6) Peer-to-peer car sharing means the authorized use of a vehicle by an individual other than the vehicles owner through a peer-to-peer car sharing program. Peer-to-peer car sharing does not mean rental car or rental activity as described in chapter 34.1 of title 31.  (7) Peer-to-peer car sharing program means a business platform that connects vehicle owners with drivers to enable the sharing of vehicles for financial consideration. Peer-to-peer car sharing program does not mean a rental car company as defined in  31-34.1-1.  (8) Shared vehicle means a vehicle that is available for sharing through a peer-to-peer car sharing program. Shared vehicle does not mean a rental car or rental vehicle as described in  31-34.1-1(4).  (9) Shared vehicle driver means an individual who has been authorized to drive the shared vehicle by the shared vehicle owner under a car sharing program agreement.  (10) Shared vehicle owner means the registered owner, or a person or entity designated by the registered owner, of a vehicle made available for sharing to shared vehicle drivers through a peer-to-peer car sharing program. Shared vehicle owner does not mean rental company as defined in  31-34.1-1(4).  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-4. Insurance coverage during car sharing period. [Effective April 1, 2023.] (a) A peer-to-peer car sharing program shall assume liability, except as provided in subsection (b) of this section, of a shared vehicle owner for bodily injury or property damage to third parties or uninsured and underinsured motorist or personal injury protection losses during the car sharing period in an amount stated in the peer-to-peer car sharing program agreement which amount may not be less than those set forth in  31-32-2.  (b) Notwithstanding the definition of car sharing termination time as set forth in  27-8.3-3, the assumption of liability under subsection (a) of this section does not apply to any shared vehicle owner when:  (1) A shared vehicle owner makes an intentional or fraudulent material misrepresentation or omission to the peer-to-peer car sharing program before the car sharing period in which the loss occurred; or  (2) Acting in concert with a shared vehicle driver who fails to return the shared vehicle pursuant to the terms of a car sharing program agreement.  (c) Notwithstanding the definition of car sharing termination time as set forth in  27-8.3-3, the assumption of liability under subsection (a) of this section would apply to bodily injury, property damage, uninsured and underinsured motorist or personal injury protection losses by damaged third parties required by  31-32-2.  (d) A peer-to-peer car sharing program shall ensure that, during each car sharing period, the shared vehicle owner and the shared vehicle driver are insured under a motor vehicle liability insurance policy that provides insurance coverage in amounts no less than the minimum amounts set forth in  31-32-2, and:  (1) Recognizes that the shared vehicle insured under the policy is made available and used through a peer-to-peer car sharing program; or  (2) Does not exclude use of a shared vehicle by a shared vehicle driver.  (e) The insurance described under subsection (d) of this section may be satisfied by motor vehicle liability insurance maintained by:  (1) A shared vehicle owner;  (2) A shared vehicle driver;  (3) A peer-to-peer car sharing program; or  (4) Both a shared vehicle owner, a shared vehicle driver, and a peer-to-peer car sharing program.  (f) The insurance described in subsection (e) of this section that is satisfying the insurance requirement of subsection (d) of this section shall be primary during each car sharing period and in the event that a claim occurs in another state with minimum financial responsibility limits higher than the limits contained in  31-32-2, during the car sharing period, the coverage maintained under subsection (e) of this section shall satisfy the difference in minimum coverage amounts, up to the applicable policy limits.  (g) The insurer, insurers, or peer-to-peer car sharing program providing coverage under subsection (d) or (e) of this section shall assume primary liability for a claim when:  (1) A dispute exists as to who was in control of the shared motor vehicle at the time of the loss and the peer-to-peer car sharing program does not have available, did not retain, or fails to provide the information required by this section; or  (2) A dispute exists as to whether the shared vehicle was returned to the alternatively agreed upon location as required under  27-8.3-3(5).  (h) If insurance maintained by a shared vehicle owner or shared vehicle driver in accordance with subsection (e) of this section has lapsed or does not provide the required coverage, insurance maintained by a peer-to-peer car sharing program shall provide the coverage required by subsection (d) of this section beginning with the first dollar of a claim and have the duty to defend such claim except under circumstances as set forth in subsection (b) of this section.  (i) Coverage under an automobile insurance policy maintained by the peer-to-peer car sharing program shall not be dependent on another automobile insurer first denying a claim nor shall another automobile insurance policy be required to first deny a claim.  (j) Nothing in this chapter:  (1) Limits the liability of the peer-to-peer car sharing program for any act or omission of the peer-to-peer car sharing program itself that results in injury to any person as a result of the use of a shared vehicle through a peer-to-peer car sharing program; or  (2) Limits the ability of the peer-to-peer car sharing program to, by contract, seek indemnification from the shared vehicle owner or the shared vehicle driver for economic loss sustained by the peer-to-peer car sharing program resulting from a breach of the terms and conditions of the car sharing program agreement.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-5. Notification of implications of lien. [Effective April 1, 2023.] At the time when a vehicle owner registers as a shared vehicle owner on a peer-to-peer car sharing program and prior to the time when the shared vehicle owner makes a shared vehicle available for car sharing on the peer-to-peer car sharing program, the peer-to-peer car sharing program shall notify the shared vehicle owner that, if the shared vehicle has a lien against it, the use of the shared vehicle through a peer-to-peer car sharing program, including use without physical damage coverage, may violate the terms of the contract with the lienholder.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-6. Exclusions in motor vehicle liability insurance policies. [Effective April 1, 2023.] (a) An authorized insurer that writes motor vehicle liability insurance in this state may exclude any and all coverage and the duty to defend or indemnify for any claim afforded under a shared vehicle owners motor vehicle liability insurance policy, including, but not limited to:  (1) Liability coverage for bodily injury and property damage;  (2) Uninsured and underinsured motorist coverage;  (3) Medical payments coverage;  (4) Comprehensive physical damage coverage; and  (5) Collision physical damage coverage.  (b) Nothing in this chapter invalidates or limits an exclusion contained in a motor vehicle liability insurance policy, including any insurance policy in use or approved for use that excludes coverage for motor vehicles made available for rent, sharing, or hire or for any business use.  (c) Nothing in this chapter invalidates, limits, or restricts an insurers ability under existing law to underwrite any insurance policy. Nothing in this chapter invalidates, limits, or restricts an insurers ability under existing law to cancel and non-renew policies.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-7. Recordkeeping  Use of vehicle in car sharing. [Effective April 1, 2023.] A peer-to-peer car sharing program shall collect and verify records pertaining to the use of a vehicle, including, but not limited to, times used, car sharing period pick up and drop off locations, fees paid by the shared vehicle driver, and revenues received by the shared vehicle owner and provide that information upon request to the shared vehicle owner, the shared vehicle owners insurer, or the shared vehicle drivers insurer to facilitate a claim coverage investigation, settlement, negotiation, or litigation. The peer-to-peer car sharing program shall retain the records for a time period not less than four (4) years.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-8. Exemptions. [Effective April 1, 2023.] (a) Vicarious liability.  A peer-to-peer car sharing program and a shared vehicle owner shall be exempt from vicarious liability consistent with 49 U.S.C.  30106 and under any state or local law that imposes liability solely based on vehicle ownership.  (b) Rental vehicle surcharge. The receipts of the peer-to-peer car sharing program and the receipts of the shared vehicle owner from peer-to-peer car sharing shall be exempt from the eight percent (8%) rental vehicle surcharge as set forth in  31-34.1-2.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
 27-8.3-9. Contribution against indemnification. [Effective April 1, 2023.] A motor vehicle insurer that defends or indemnifies a claim against a shared vehicle that is excluded under the terms of its policy shall have the right to seek recovery against the motor vehicle insurer of the peer-to-peer car sharing program if the claim is:  (1) Made against the shared vehicle owner or the shared vehicle driver for loss or injury that occurs during the car sharing period; and  (2) Excluded under the terms of its policy.  History of Section.P.L. 2022, ch. 427,  1, effective April 1, 2023; P.L. 2022, ch. 428,  1, effective April 1, 2023. 
  27-8-1. Types of insurance authorized for domestic fire and marine insurance companies.Every insurance company incorporated by or under the laws of this state, and now or after this authorized to transact the business of fire or marine insurance, or both, may, in addition to the business that it is now authorized by the provisions of its act of incorporation to do, make insurance:(1) On dwelling houses, stores, and all kinds of buildings, and on household furniture and other property, against direct and indirect loss or damage including loss of use or occupancy by fire, heat, smoke and smudge, lightning, windstorm, tornado, cyclone, earthquake, volcanic eruption, hail, frost or snow, weather or climatic conditions including an excess or deficiency of moisture, flood, rain, or drought, the rising of the waters of the ocean or its tributaries, bombardment, invasion, insurrection, riot, civil war or commotion, military or usurped power, vandalism, malicious mischief, sabotage, sit down and other strikes, acts of destruction by order of any military or civil authority done to prevent the spread of a conflagration, epidemic or catastrophe, or short circuits of electrical current or static electricity or any other electrical disturbance, and by explosion, whether fire ensues or not, except risks pertaining to employer's liability and worker's compensation; also against the legal liability of the insured, and against the loss, damage, or expense, incident to a claim of that liability, arising out of the loss or destruction of, or damage to, the property of any other person; also against loss or damage caused by burglary, robbery, theft, pillage, looting, larceny, or any attempt at this, whether caused or arising at the time of or in connection with fire, windstorm, or any other casualty insured against or otherwise;(2) Against loss or damage, by water or other fluid or substance, to goods or premises of any kind arising from the breakage or leakage of sprinklers, pumps, or other apparatus erected for extinguishing fires, or of other conduits or containers, or by water entering through leaks or openings in buildings, and from the breakage or leakage of water pipes, and against accidental injury to sprinklers, pumps, apparatus, conduits, containers, or water pipes, and against the legal liability of the insured, and against the loss, damage, or expense, incident to a claim of that liability, arising out of the loss or destruction of, or damage to, the property of any other person;(3) On vessels, boats, craft, aircraft, cars, automobiles and vehicles of every kind, cargoes, goods, merchandise, freights, and other property against loss or damage by all or any of the risks of lake, river, canal, and inland navigation and transportation and all goods, freights, cargoes, merchandise, effects, disbursements, profits, moneys, bullion, precious stones, securities, chose in action, evidences of debt, valuable papers, bottomry and respondentia interests, and all other kinds of property and interests in them, in respect to, appertaining to, or in connection with any and all risks or perils of navigation, transit, or transportation including war risks, on or under any seas or other waters, on land or in the air, or while being assembled, packed, crated, baled, compressed, or similarly prepared for shipment or while awaiting shipment, or during any delays, storage, transshipment, or reshipment, including marine builder's risks and all personal property floater risks;(4) On persons or to property in connection with or appertaining to a marine, inland marine, transit, or transportation insurance, including the liability for the loss of or damage to either, arising out of or in connection with the construction, repair, operation, maintenance, or use of the subject matter of that insurance, but not including life insurance; but, except as specified in this section, this shall not mean insurances against loss by reason of bodily injury to the person;(5) On precious stones, jewels, jewelry, gold, silver, and other precious metals, whether used in business or trade or otherwise and whether those stones and metals are in the course of transportation or otherwise;(6) On automobiles and other vehicles whether operated on rails or otherwise, airplanes, seaplanes, dirigibles, or other aircraft, and elevators and other conveyors, and the breakage of glass in them, whether stationary or being operated under their own power, which shall include all or any part of the hazards of fire, explosion, transportation, collision, and the loss by legal liability for damage to property resulting from the maintenance and use of automobiles and other vehicles, airplanes, seaplanes, dirigibles, and other aircraft, and elevators and other conveyors;(7) On or against loss or damage to property resulting from the maintenance and use of automobiles and other vehicles whether operated on rails or otherwise, vessels, elevators and other conveyors, and aircraft, and on or against loss by burglary, larceny or theft, vandalism, or malicious mischief, or by the wrongful conversion, disposal, or concealment of automobiles, and other vehicles, whether held under conditional sales contracts or subject to chattel mortgages, or any one or more of those hazards, but shall not include insurance against loss by reason of bodily injury to the person; and(8) Against loss of or damage to any property resulting from any cause which is a proper subject of insurance; provided, that before any company shall assume risks other than those enumerated in this section it shall first obtain the approval of the insurance commissioner; and(9) [Deleted by P.L. 2004, ch. 54,  2, and by P.L. 2004, ch. 59,  2.]History of Section.P.L. 1901, ch. 837,  1; G.L. 1909, ch. 219,  37; P.L. 1917, ch. 1526,  1; G.L. 1923, ch. 255,  37; P.L. 1934, ch. 2111,  1; G.L. 1938, ch. 150,  36; P.L. 1940, ch. 855,  1; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-8-1; P.L. 1980, ch. 37,  1; P.L. 1988, ch. 400,  1; P.L. 2004, ch. 54,  2; P.L. 2004, ch. 59,  2.
  27-8-10. Life insurance and preexisting contracts.Sections 27-8-7 to 27-8-9 shall not apply to any contract of life insurance nor shall it affect any contract existing on April 22, 1927.History of Section.P.L. 1927, ch. 1051,  3; G.L. 1938, ch. 157,  3; G.L. 1956,  27-8-10.
  27-8-11. Regulations on cancellation and renewal.(a) In addition to, and not in lieu of, any other power the commissioner has to issue rules and regulations, the commissioner of insurance may promulgate, in accordance with the procedure established in chapter 35 of title 42, reasonable rules and regulations concerning cancellation and renewal of liability and property damage insurance for automobiles rated as private passenger automobiles, homeowners insurance, residential fire insurance, or any components thereof. Those regulations may require that the insurer shall furnish to the named insured the reason, or reasons, for cancellation or nonrenewal. Those regulations shall also require that the insurer furnish, at least thirty (30) days prior to renewal, written notice of any coverage reductions, elimination, or increased deductibles not made at the request of the insured. The notice shall itemize and describe the policy coverage reductions, elimination, or increased deductibles and shall be captioned "NOTICE OF REDUCTION IN COVERAGE". The policyholder shall be notified that the policy renewal contains the "NOTICE OF REDUCTION IN COVERAGE" by one of the following manners:(1) By mailing the "NOTICE OF REDUCTION IN COVERAGE" separate from the renewal policy package mailing; or(2) By printing "NOTICE OF REDUCTION IN COVERAGE ENCLOSED" on the renewal policy package envelope and including said reductions in the first few pages of the renewal policy package; or(3) By printing "NOTICE OF REDUCTION IN COVERAGE ENCLOSED" on the first page of the renewal policy package; or(4) If the renewal policy package is made available by email, the email notifying the policyholder of the renewal shall contain a statement that the policy contains a "NOTICE OF REDUCTION IN COVERAGE" and said reductions shall be in the first few pages of the renewal policy package.These coverage changes must be approved by the insurance division with respect to those types of insurance defined in  27-8-1(1)  (8), issued to non-business insured and bodily injury and property damage liability coverage issued to non-business insured. There shall be no liability on the part of, and no cause of action of any nature shall arise against, the commissioner of insurance or any insurer, their authorized representatives, agents, or employees, or any firm, person, or corporation furnishing to the insurer or commissioner information as to the reasons for cancellation or nonrenewal; for any statement made by any of them in any written notice of cancellation or nonrenewal; or in any other communication, oral or written, specifying the reasons for cancellation or nonrenewal; or for the providing of information pertaining to the cancellation or nonrenewal; or for statements made, or evidence submitted, at any hearing conducted in connection with the cancellation or nonrenewal.(b) The commissioner shall promulgate regulations with respect to personal motor vehicle insurance, homeowners insurance, and residential fire insurance, or any components of that insurance requiring notification to policyholders upon renewal of any coverage reductions, elimination, or increased deductibles not at the request of the insured.History of Section.P.L. 1968, ch. 292,  1; P.L. 1994, ch. 129,  1; P.L. 1996, ch. 169,  1; P.L. 2008, ch. 475,  78; P.L. 2014, ch. 361,  1; P.L. 2014, ch. 396,  1.
  27-8-12. Subrogation  Payment to insured of deductible.Whenever, through subrogation, an insurance company or its agent collects a casualty loss from a third party, that company or agent shall, from the funds collected, first pay to the insured the deductible portion of the casualty loss less the prorated share of subrogation expenses and only after this retain any funds in excess of the deductible portion of the recovery.History of Section.P.L. 1981, ch. 251,  1.
  27-8-13. Repealed.
  27-8-14. Lost and salvage vehicle reporting.All casualty insurers licensed to do business in Rhode Island shall report all vehicle thefts within thirty (30) days of the theft and all salvage declarations to the National Insurance Crime Bureau (NICB), or a similar organization acceptable to the department, that maintains a central database of automobile theft and salvage.History of Section.P.L. 1983, ch. 221,  11; P.L. 1992, ch. 258,  1; P.L. 2001, ch. 122,  6.
  27-8-15. Insurance inspections.The furnishing of, or failure to furnish, insurance inspections or advisory services in connection with or incidental to the issuance or renewal of a policy of property, casualty or boiler and machinery insurance shall not subject the insurer, whether domestic or foreign, its agents, employees, or service contractors, to liability for damages from injury, death, or loss occurring as a result of any act or omission in the course of those services. This section shall not apply in the event the active negligence of the insurer, its agent, employee, or service contractor, created the condition that was the proximate cause of injury, death or loss.History of Section.P.L. 1988, ch. 68,  1; P.L. 1988, ch. 300,  1; P.L. 1996, ch. 391,  1.
  27-8-16. Repealed.
  27-8-17. Payment on claim for fire coverage of motor vehicle  Statement required.No payment shall be made by the insurer of loss or damage to an insured vehicle on a claim for fire coverage as provided in  27-8-1(6), until the insured has filed a statement in conformity with the provisions of  27-8.1-2.1, and the insurer has, within a reasonable time, reviewed the statement and determined that no fraud was involved. If the insurer denies the fire coverage claim, then the insurer shall provide appropriate notice within a reasonable period of time of the denial of coverage to all lien holders, if any, of the insured motor vehicle.History of Section.P.L. 1993, ch. 332,  1.
  27-8-18. Debtor's right to deductible election.Any debtor receiving financing for the purchase of a motor vehicle from any institution or person or other entity shall have an absolute election to choose a deductible of up to five hundred ($500) dollars for collision or limited collision coverage, and any and all contrary provisions in an insurance policy or financing agreement shall be null and void.History of Section.P.L. 1994, ch. 189,  1.
  27-8-2. Reinsurance by domestic companies.Domestic fire and marine insurance companies may affect reinsurance of any risks taken by them.History of Section.G.L. 1923, ch. 255,  37; P.L. 1934, ch. 2111,  1; G.L. 1938, ch. 150,  36; P.L. 1940, ch. 855,  1; G.L. 1956,  27-8-2.
  27-8-3. Reciprocal powers of foreign companies.Any insurance company of another state or country authorized to transact the business of fire or marine insurance, or both, in this state may, if, by the provisions of its charter or act of incorporation or articles of association, it has the power, and if similar companies of this state may transact the classes of insurance enumerated in  27-8-1 and this section in the state or country of that company's domicile, be authorized by the insurance commissioner to transact in this state the like classes of insurance.History of Section.G.L. 1938, ch. 150,  36; P.L. 1940, ch. 855,  1; impl. am. P.L. 1953, ch. 3174,  5; G.L. 1956,  27-8-3.
  27-8-4. Classification of risks by mutual companies.Any mutual insurance company incorporated by this state and any mutual insurance company incorporated by any other state or country authorized to transact business in this state may classify the property and risks insured in it at the time of issuing policies on the property, and may issue policies upon that property and those risks under different rates of premium or premium deposit, corresponding as nearly as may be to the greater or lesser risk from the causes insured against and the loss which may attach to the several assumed risks, and the directors of any mutual insurance company may, by vote, fix and determine the percentage of dividend or unused or unabsorbed premium or premium deposit return to be paid or credited on expiring policies, which percentages may differ, following the different loss experience of different classes of risks of the same term. But all policies insuring risks in the same classification shall have an equal rate of dividend or return of unused or unabsorbed premium or premium deposit upon expiration, and in case of an assessment, the rate may be different for each different class of risks.History of Section.G.L. 1923, ch. 256,  32; P.L. 1927, ch. 983,  1; G.L. 1938, ch. 151,  27; P.L. 1953, ch. 3174,  4; G.L. 1956,  27-8-4.
  27-8-5. Nonassessable insurance by mutual companies.A mutual company incorporated by this or any other state may also issue policies insuring property and risks in this state without the contingent mutual liability of the policyholders for assessment; provided, that it shall have at all times net assets over all liabilities of not less than one hundred thousand dollars ($100,000) and, if incorporated by this state, shall maintain a deposit with the general treasurer for the benefit and protection of all of its policyholders of at least one hundred thousand dollars ($100,000), or, if incorporated by any other state, it shall maintain that deposit in its home state, which deposit in each case shall be in cash or securities that are legal investments by that company in its home state.History of Section.G.L. 1938, ch. 151,  27; P.L. 1953, ch. 3174,  4; G.L. 1956,  27-8-5.
  27-8-6. Notice to mutual policyholders of dividend or unused premium.Every policyholder of a mutual fire insurance company incorporated by this state, and every policyholder of a mutual fire insurance company incorporated by any other state or country and authorized to transact business in this state, shall be notified at his or her last known address within six (6) months after the expiration of his or her policy of the amount of dividend or unused or unabsorbed premium or premium deposit return declared and payable on it, unless that dividend or unused or unabsorbed premium or premium deposit return has been paid in cash or credited to the policyholder or applied in payment of the premium or premium deposit on the renewal of his or her policy.History of Section.G.L. 1923, ch. 256,  32; P.L. 1927, ch. 983,  1; G.L. 1938, ch. 151,  27; P.L. 1953, ch. 3174,  4; G.L. 1956,  27-8-6.
  27-8-7. Terms to be stated in policy  Rebates prohibited.No insurance corporation authorized to do any insurance business within this state, or any officer, insurance producer, or their representative, shall make any contract for insurance, on property or risks located within this state, or against any liability, casualty, accident, or hazard that may arise or occur in this state, or any agreement as to that contract, other than as plainly expressed in the policy issued or to be issued; nor shall any corporation, or officer, insurance producer, or their representative, directly or indirectly, in any manner, pay or allow or offer to pay or allow to the insured named in the policy or to any employee of the insured as an inducement to the insurance, or after the insurance has been effected, any rebate from the premium which is specified in the policy or any special favor or advantage in the dividends or other benefit to accrue on the policy; or any valuable consideration or inducement, not specified in the policy or contract of insurance, or give, sell, or purchase, as an inducement to the insurance, or in connection with it, any stock, bonds, or other securities of any insurance or other corporation or association, or any dividends or profits accrued on the stock, bonds, or securities, or anything of value, not specified in the policy; nor shall any insurance producer or representative, or any other person, directly or indirectly, either by sharing commissions or in any manner, pay or allow or offer to pay or allow to the insured named in the policy, or to any employee of the insured, as an inducement to the insurance, or after the insurance has been effected, any rebate from the premium which is specified in the policy. Nothing in this chapter shall prevent any corporation lawfully doing insurance business in this state from the distribution of surplus and dividends to policyholders, nor shall this chapter prevent any corporation, or its agent, from paying commissions to a licensed insurance producer who has negotiated for the insurance, nor shall it prevent any licensed insurance producer from sharing or dividing a commission earned or received by the insurance producer with any other licensed insurance producer, who has aided the insurance producer in respect to the insurance for the negotiation of which the commission has been earned or paid.History of Section.P.L. 1927, ch. 1051,  1; G.L. 1938, ch. 157,  1; G.L. 1956,  27-8-7.
  27-8-8. Privilege against self-incrimination.No person shall be excused from attending and testifying or producing any books, papers, or other documents before any court upon any investigation, proceeding, or trial for a violation of any of the provisions of  27-8-7, upon the ground or for the reason that the testimony or evidence, documentary or otherwise, required of that person may tend to convict him or her of a crime or subject him or her to a penalty of forfeiture; but 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 given or produced testimony shall be received against that person upon any criminal investigation or proceeding.History of Section.P.L. 1927, ch. 1051,  2; G.L. 1938, ch. 157,  2; G.L. 1956,  27-8-8.
  27-8-9. Penalty for violations.Any person or corporation violating any provision of  27-8-7 and 27-8-8 shall, upon conviction, be punished by a fine not exceeding five hundred dollars ($500) or by imprisonment not exceeding one year, or both.History of Section.P.L. 1927, ch. 1051,  4; G.L. 1938, ch. 157,  4; G.L. 1956,  27-8-9.
  27-80-1. Short title.This chapter shall be known and may be cited as the "Unclaimed Life Insurance Benefits Act."History of Section.P.L. 2014, ch. 183,  1; P.L. 2014, ch. 209,  1.
  27-80-2. Purpose.By enacting this chapter, it is the intent of the general assembly to require the complete and proper disclosure, transparency, and accountability relating to any method of payment for life insurance death benefits regulated by the state.History of Section.P.L. 2014, ch. 183,  1; P.L. 2014, ch. 209,  1.
  27-80-3. Definitions.As used in this chapter:(1) "Death master file" means the United States Social Security Administration's death master file or any other database or service that is at least as comprehensive as the United States Social Security Administration's death master file for determining that a person has reportedly died.(2) "Death master file match" means a search of the death master file that results in a match of the Social Security number or the name and date of birth of an insured, annuity owner, or retained asset account holder.(3) "Policy" means any policy or certificate of life insurance that provides a death benefit. The term "policy" shall not include:(i) Any policy of certificate of life insurance that provides a death benefit under an employee benefit plan:(A) Subject to the Employee Retirement Income Security Act of 1974 (Pub. L. 93-406), 29 U.S.C.  1002, as periodically amended; or(B) Under any federal employee benefit program; or(ii) Any policy or certificate of life insurance that is used to fund a pre-need funeral contract or pre-arrangement; or(iii) Any policy or certificate of credit life or accidental death insurance.(4) "Contract" means an annuity contract. The term "contract" shall not include an annuity used to fund an employment-based retirement plan or program where the insurer is not committed by terms of the annuity contract to pay death benefits to the beneficiaries of specific plan participants.History of Section.P.L. 2014, ch. 183,  1; P.L. 2014, ch. 209,  1.
  27-80-4. Insurer conduct.(a) An insurer shall perform a comparison of its insureds' in-force life insurance policies and retained asset accounts issued for delivery in this state against a death master file, on at least a semi-annual basis, to identify potential matches of its insureds. After the initial comparison, an insurer shall perform a comparison of the insurer's in-force life insurance policies against the revised death master file, on at least a semi-annual basis, to identify the potential matches of the insurer's insureds. For those potential matches identified as a result of a death master file match, the insurer shall:(1) Within ninety (90) days of a death master file match:(i) Complete a good-faith effort, which shall be documented by the insurer, to confirm the death of the insured or retained-asset account holder against other available records and information;(ii) Review its records to determine whether the deceased insured or retained-asset account holder had purchased any other products with the insurer; and(iii) Determine whether benefits are due in accordance with the applicable policy or contract. If the insurer determines that benefits are due in accordance with the applicable policy or contract, the insurer shall:(A) Use good-faith efforts, which shall be documented by the insurer, to locate the beneficiary or beneficiaries; and(B) Provide the appropriate claims forms or instructions to the beneficiary or beneficiaries to make a claim, including the need to provide an official death certificate, if applicable, under the policy or contract.(b) An insurer shall implement procedures to account for:(1) Common nicknames, initials used in lieu of a first or middle name, use of a middle name, compound first and middle names, and interchanged first and middle names;(2) Compound last names, maiden or married names, and hyphens, blank spaces, or apostrophes in last names;(3) Transposition of the "month" and "date" portions of the date of birth; and(4) Incomplete social security numbers.(c) With respect to group life insurance, insurers are required to confirm the possible death of an insured when the insurers maintain at least the following information of those covered under a policy or certificate:(1) Social Security number or name and date of birth;(2) Beneficiary designation information;(3) Coverage eligibility;(4) Benefit amount; and(5) Premium payment status.(d) To the extent permitted by law, the insurer may disclose minimum necessary personal information about the insured or beneficiary to a person who the insurer reasonably believes may be able to assist the insurer locate the beneficiary or a person otherwise entitled to payment of the claims proceeds.(e) An insurer or its service provider shall not charge insureds, account holders, or beneficiaries for any fees or costs associated with a search or verification conducted pursuant to this section.(f) The benefits from a life insurance policy or a retained asset account, plus any applicable accrued interest, shall first be payable to the designated beneficiaries or owners, and in the event said beneficiaries or owners cannot be found, shall escheat to the state as unclaimed property pursuant to the applicable state law, including, but not limited to, chapter 21.1 of title 33 ("Unclaimed tangible and intangible property").(g) Nothing in this chapter shall be construed to limit the responsibility of an insurer with respect to requirements of  33-21.1-7 ("Funds owing under life insurance policies") or absolve the insurer of penalties enumerated in  33-21.1-34 ("Interest and penalties") for failure to comply.(h) In the event that any resolution agreement or a voluntary disclosure agreement between an insurer and the state's unclaimed property administrator conflicts with this chapter, the terms of the agreement shall supersede this chapter.(i) The commissioner may, in his or her reasonable discretion, make an order:(1) Limiting an insurer's death master file comparisons required under this section to the insurer's electronically searchable files or approving a plan and timeline for conversion of the insurer's files to electronic searchable files;(2) Exempting an insurer from the death master file comparisons required under this section or permitting an insurer to perform such comparisons less frequently than semi-annually upon a demonstration of financial hardship by the insurer; or(3) Phasing-in compliance with this section according to a plan and timeline approved by the commissioner.History of Section.P.L. 2014, ch. 183,  1; P.L. 2014, ch. 209,  1.
  27-80-5. Penalties.A violation of this chapter shall subject the insurer to penalties as determined appropriate in accordance with  42-14-16 ("Insurance Administrative Penalties").History of Section.P.L. 2014, ch. 183,  1; P.L. 2014, ch. 209,  1.
  27-81-1. Title.This act shall be known as, and may be cited as, the "Telemedicine Coverage Act."History of Section.P.L. 2016, ch. 177,  1; P.L. 2016, ch. 188,  1.
  27-81-2. Purpose.The general assembly hereby finds and declares that:(1) The advancements and continued development of medical and communications technology have had a profound impact on the practice of medicine and offer opportunities for improving the delivery, cost, and accessibility of health care, particularly in the area of telemedicine.(2) Geography, weather, availability of specialists, transportation, and other factors can create barriers to accessing the appropriate health care, including behavioral health care, and one way to provide, ensure, or enhance access to health care given these barriers is through the appropriate use of technology to allow healthcare consumers access to qualified healthcare providers.(3) There is a need in this state to embrace efforts that will encourage health insurers and healthcare providers to support the use of telemedicine, and that will also encourage all state agencies to evaluate and amend their policies and rules to remove any regulatory barriers prohibiting the use of telemedicine services.History of Section.P.L. 2016, ch. 177,  1; P.L. 2016, ch. 188,  1.
  27-81-3. Definitions.As used in this chapter:(1) "Clinically appropriate" means care that is delivered in the appropriate medical setting.(2) "Distant site" means a site at which a healthcare provider is located while providing healthcare services by means of telemedicine.(3) "Healthcare facility" means an institution providing healthcare services or a healthcare setting, including, but not limited to: hospitals and other licensed, inpatient centers; ambulatory surgical or treatment centers; skilled nursing centers; residential treatment centers; diagnostic, laboratory and imaging centers; and rehabilitation and other therapeutic health settings.(4) "Healthcare professional" means a physician or other healthcare practitioner licensed, accredited, or certified to perform specified healthcare services consistent with state law.(5) "Healthcare provider" means a healthcare professional or a healthcare facility.(6) "Healthcare services" means any services included in the furnishing to any individual of medical, podiatric, or dental care, or hospitalization, or incident to the furnishing of that care or hospitalization, and the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability.(7) "Health insurer" means any person, firm, or corporation offering and/or insuring healthcare services on a prepaid basis, including, but not limited to, a nonprofit service corporation, a health maintenance organization, the Rhode Island Medicaid program, including its contracted managed care entities, or an entity offering a policy of accident and sickness insurance.(8) "Health maintenance organization" means a health maintenance organization as defined in chapter 41 of this title.(9) "Medically necessary" means medical, surgical, or other services required for the prevention, diagnosis, cure, or treatment of a health-related condition, including services necessary to prevent a decremental change in either medical or mental health status. (10) "Nonprofit service corporation" means a nonprofit hospital service corporation as defined in chapter 19 of this title, or a nonprofit medical service corporation as defined in chapter 20 of this title.(11) "Originating site" means a site at which a patient is located at the time healthcare services are provided to them by means of telemedicine, which can include a patient's home where medically necessary and clinically appropriate.(12) "Policy of accident and sickness insurance" means a policy of accident and sickness insurance as defined in chapter 18 of this title.(13) "Rhode Island Medicaid program" means a state-administered, medical assistance program that is funded by the state and federal governments under Title XIX and Title XXI of the U.S. Social Security Act and any general or public laws and administered by the executive office of health and human services.(14) "Store-and-forward technology" means the technology used to enable the transmission of a patient's medical information from an originating site to the healthcare provider at the distant site without the patient being present.(15) "Telemedicine" means the delivery of clinical healthcare services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate the assessment, diagnosis, counseling and prescribing treatment, and care management of a patient's health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. "Telemedicine" does not include an email message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.History of Section.P.L. 2016, ch. 177,  1; P.L. 2016, ch. 188,  1; P.L. 2021, ch. 184,  1, effective July 6, 2021; P.L. 2021, ch. 199,  1, effective July 6, 2021.
  27-81-4. Coverage of telemedicine services.(a) Each health insurer that issues individual or group accident and sickness insurance policies for healthcare services and/or provides a healthcare plan for healthcare services shall provide coverage for the cost of such covered healthcare services provided through telemedicine services, as provided in this section.(b) (1) A health insurer shall not exclude a healthcare service for coverage solely because the healthcare service is provided through telemedicine and is not provided through in-person consultation or contact, so long as such healthcare services are medically necessary and clinically appropriate to be provided through telemedicine services.(2) All medically necessary and clinically appropriate telemedicine services delivered by in-network primary care providers, registered dietitian nutritionists, and behavioral health providers shall be reimbursed at rates not lower than services delivered by the same provider through in-person methods. (c) Benefit plans offered by a health insurer shall not impose a deductible, copayment, or coinsurance requirement for a healthcare service delivered through telemedicine in excess of what would normally be charged for the same healthcare service when performed in person. (d) Prior authorization requirements for medically necessary and clinically appropriate telemedicine services shall not be more stringent than prior authorization requirements for in-person care. No more stringent medical or benefit determination and utilization review requirements shall be imposed on any telemedicine service than is imposed upon the same service when performed in person. (e) Except for requiring compliance with applicable state and federal laws, regulations and/or guidance, no health insurer shall impose any specific requirements as to the technologies used to deliver medically necessary and clinically appropriate telemedicine services.(f) The requirements of this section shall apply to all policies and health plans issued, reissued, or delivered in the state of Rhode Island on and after January 1, 2018.(g) This chapter shall not apply to: short-term travel, accident-only, limited or specified disease; or individual conversion policies or health plans; nor to policies or health plans designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare; or any other similar coverage under state or federal governmental plans.History of Section.P.L. 2016, ch. 177,  1; P.L. 2016, ch. 188,  1; P.L. 2021, ch. 184,  1, effective July 6, 2021; P.L. 2021, ch. 199,  1, effective July 6, 2021.
  27-81-5. Severability.If any provision of this chapter or of any rule or regulation made under this chapter, or its application to any person or circumstance is held invalid by a court of competent jurisdiction, the remainder of the chapter, rule, or regulation and the application of the provision to other persons or circumstances shall not be affected by this invalidity. The invalidity of any section or sections or parts of any section or sections shall not affect the validity of the remainder of the chapter.History of Section.P.L. 2016, ch. 177,  1; P.L. 2016, ch. 188,  1.
  27-81-6. Rules and regulations. The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.History of Section.P.L. 2021, ch. 184,  2, effective July 6, 2021; P.L. 2021, ch. 199,  2, effective July 6, 2021.
  27-81-7. Telemedicine data reporting. 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.History of Section.P.L. 2021, ch. 184,  2, effective July 6, 2021; P.L. 2021, ch. 199,  2, effective July 6, 2021.
  27-9.1-1. Purpose.The purpose of this chapter is to set forth standards for the investigation and disposition of claims arising under policies or certificates of insurance issued to residents of Rhode Island. It is not intended to cover claims involving workers' compensation, fidelity, suretyship or boiler and machinery insurance. Nothing contained in this chapter shall be construed to create or imply a private cause of action for violation of this chapter.History of Section.P.L. 1993, ch. 37,  1; P.L. 1993, ch. 227,  1.
  27-9.1-2. Definitions.When used in this chapter:(1) "Director" means the director of business regulation;(2) "Insured" means the party named on a policy or certificate as the individual with legal rights to the benefits provided by the policy;(3) "Insurer" means any person, reciprocal exchange, inter-insurer, Lloyds insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance, including insurance producers, adjusters and third party administrators. Insurer shall also mean a nonprofit hospital and/or medical service corporation, a nonprofit dental service corporation, a nonprofit optometric service corporation, a nonprofit legal service corporation, a health maintenance organization as defined in chapter 41 of this title or as defined in chapter 62 of title 42, or any other entity providing a plan of health benefits subject to state insurance regulation. Notwithstanding  27-19-2, 27-20-2, 27-20.1-2, 27-20.2-2, 27-20.3-2, and 27-41-22, for purposes of this chapter, these entities shall be deemed to be engaged in the business of insurance;(4) "Person" means any natural or artificial entity, including, but not limited to, individuals, partnerships, associations, trusts, or corporations; and(5) "Policy" or "certificate" means any contract of insurance, indemnity, medical, health or hospital service, or annuity issued. "Policy" or "certificate" for the purposes of this chapter shall not mean contracts or workers' compensation, fidelity, suretyship or boiler and machinery insurance.History of Section.P.L. 1993, ch. 37,  1; P.L. 1993, ch. 227,  1.
  27-9.1-3. Unfair claims settlement practices prohibited.It is an improper claims practice for any domestic, foreign, or alien insurer transacting business in this state to commit any act defined in  27-9.1-4 of this chapter if:(1) It is committed flagrantly and in conscious disregard of this chapter or any rules promulgated pursuant to this chapter; or(2) It has been committed with a frequency as to indicate a general business practice to engage in that type of conduct.History of Section.P.L. 1993, ch. 37,  1; P.L. 1993, ch. 227,  1.
  27-9.1-4.1. Amounts received in settlement of claims retained for unpaid premiums.(a) Any insurance company or insurance producer may retain an amount equal to any unpaid premiums due on the policy under which a claim is being presented when settling any presented claim for an insured; provided, that:(1) The unpaid premium remains unpaid sixty (60) days after the effective date of the policy or the date of the original billing of the premium, whichever occurs later;(2) The insurance company shall pay to the insurance producer, upon written documentation submitted by the insurance agent or broker of the unpaid premium due, the amount equal to the unpaid premium due the insurance producer from the amount of the claim being presented and the balance of the claim be paid to the insured and/or loss payee or mortgagee named in the policy.(b) This section shall not apply to any health insurance policy within the state.History of Section.P.L. 2005, ch. 69,  4; P.L. 2005, ch. 79,  4.
  27-9.1-4. "Unfair claims practices" defined.(a) Any of the following acts by an insurer, if committed in violation of  27-9.1-3, constitutes an unfair claims practice:(1) Misrepresenting to claimants and insured relevant facts or policy provisions relating to coverage at issue;(2) Failing to acknowledge and act with reasonable promptness upon pertinent communications with respect to claims arising under its policies;(3) Failing to adopt and implement reasonable standards for the prompt investigation and settlement of claims arising under its policies;(4) Not attempting in good faith to effectuate prompt, fair, and equitable settlement of claims submitted in which liability has become reasonably clear;(5) Compelling insured, beneficiaries, or claimants to institute suits to recover amounts due under its policies by offering substantially less than the amounts ultimately recovered in suits brought by them;(6) Refusing to pay claims without conducting a reasonable investigation;(7) Failing to affirm or deny coverage of claims within a reasonable time after having completed its investigation related to the claim or claims;(8) Attempting to settle or settling claims for less than the amount that a reasonable person would believe the insured or beneficiary was entitled by reference to written or printed advertising material accompanying or made part of an application;(9) Attempting to settle or settling claims on the basis of an application that was materially altered without notice to, or knowledge or consent of, the insured;(10) Making claims payments to an insured or beneficiary without indicating the coverage under which each payment is being made;(11) Unreasonably delaying the investigation or payment of claims by requiring both a formal proof of loss form and subsequent verification that would result in duplication of information and verification appearing in the formal proof of loss form;(12) Failing in the case of claims denials or offers of compromise settlement to promptly provide a reasonable and accurate explanation of the basis of those actions;(13) Failing to provide forms necessary to present claims within ten (10) calendar days of a request with reasonable explanations regarding their use;(14) Failing to adopt and implement reasonable standards to assure that the repairs of a repairer owned by or required to be used by the insurer are performed in a workmanlike manner;(15) Misleading a claimant as to the applicable statute of limitations;(16) Failing to respond to a claim within thirty (30) days, unless the insured shall agree to a longer period;(17) Engaging in any act or practice of intimidation, coercion, threat, or misrepresentation of consumers rights, for or against any insured person, claimant, or entity to use a particular rental car company for motor vehicle replacement services or products; provided, however, nothing shall prohibit any insurance company, agent, or adjuster from providing to such insured person, claimant, or entity the names of a rental car company with which arrangements have been made with respect to motor vehicle replacement services; provided, that the rental car company is licensed pursuant to  31-5-33;(18) Refusing to honor a "direction to pay" executed by an insured, claimant, indicating that the insured or claimant wishes to have the insurance company directly pay his or her motor vehicle replacement vehicle rental benefit to the rental car company of the consumer's choice; provided, that the rental car company is licensed pursuant to  31-5-33. Nothing in this section shall be construed to prevent the insurance company's ability to question or challenge the amount charged, in accordance with its policy provisions, and the requirements of the department of business regulation;(19) Modifying any published manual, i.e., Motor's Auto Repair Manual, Mitchells, or any automated appraisal system, relating to auto body repair without prior agreement between the parties;(20) Failing to use a manual or system in its entirety in the appraisal of a motor vehicle;(21) Refusing to compensate an auto body shop for its documented charges as identified through the most current version of automotive industry-recognized software programs or systems for paint, body, and refinishing materials in auto body repair claims, including, but not limited to, programs such as Mitchell's RMC, PMC Logic, Paint, Micromix, or a paint manufacturer's programs. An insurer shall not discount documented charges by failing to use a system in its entirety, including an automotive industry standard markup;(22) Failing to comply with the requirements of  31-47-12.1;(23) Failure to have an appraisal performed by a licensed appraiser where the motor vehicle has sustained damage estimated to exceed two thousand five hundred dollars ($2,500). The licensed appraiser referred to herein must be unaffiliated with the repair facility repairing the subject motor vehicle; must perform a physical inspection of the damaged motor vehicle; and may not perform an appraisal based upon pictures of the damaged motor vehicle;(24) Failure to perform an initial appraisal within three (3) business days after a request is received from an auto body repair shop, provided the damaged motor vehicle is on the premises of the repair shop when the request is made, and failure to perform a supplemental appraisal inspection of a vehicle within four (4) business days after a request is received from an auto body repair shop. The time limitations set forth in this subsection may be extended by mutual agreement between the auto body repair shop and the insurer;(25) Designating a motor vehicle a total loss if the cost to rebuild or reconstruct the motor vehicle to its pre-accident condition is less than seventy-five percent (75%) of the "fair market value" of the motor vehicle immediately preceding the time it was damaged:(i) For the purposes of this subdivision, "fair market value" means the retail value of a motor vehicle as set forth in a current edition of a nationally recognized compilation of retail values commonly used by the automotive industry to establish values of motor vehicles;(ii) Nothing herein shall be construed to require a vehicle be deemed a total loss if the total cost to rebuild or reconstruct the motor vehicle to its pre-accident condition is greater than seventy-five percent (75%) of the fair market value of the motor vehicle immediately preceding the time it was damaged;(iii) Nothing herein shall prohibit an insurance company from agreeing to deem a vehicle a total loss at the vehicle owner's request and with the vehicle owner's express written authorization if the cost to rebuild or reconstruct the motor vehicle to its pre-accident condition is less than seventy-five percent (75%) of the "fair market value" of the motor vehicle immediately preceding the time it was damaged;(iv) If condition adjustments are made to the retail value of a motor vehicle designated a total loss, all such adjustments must be in accordance with the standards set forth in the current edition of a nationally recognized compilation of retail values, commonly used by the automotive industry, used by the insurer to determine the retail value of the vehicle; and all such adjustments, including prior damage deductions, must be itemized, fair, and reasonable; and(v) When a vehicle is deemed a total loss, if the insurer is not retaining the salvage, the insurer must notify the owner of the vehicle in writing of the requirements of obtaining both a salvage title and a reconstructed title from the department of motor vehicles pursuant to chapter 1 of title 31, and must obtain, in writing, the owner's consent and acknowledgement that the insurer is not retaining the salvage and include a statement of the owner's obligation and potential costs to dispose of or otherwise retain the salvage;(26) Negotiating, or effecting the settlement of, a claim for loss or damage covered by an insurance contract with an unlicensed public adjuster acting on behalf of an insured. Nothing contained in this section shall be construed to preclude an insurer from dealing with any individual or entity that is not required to be licensed under chapter 10 of title 27;(27) Refusing to pay an auto body repair shop for documented necessary sublet services paid out to vendors or incurred by the auto body repair shop, for specialty or unique services performed in the overall repair process, including costs and labor incurred to research, coordinate, administrate, or facilitate the necessary sublet service, and an automotive industry standard markup. Examples of sublet services include, but are not limited to, towing, transportation, suspension, alignments, electronic calibrations, diagnostic work, mechanical work, and paid charges to release a vehicle.(b) (1) Nothing contained in subsections (a)(19), (a)(20), and (a)(21) of this section shall be construed to interfere with an auto body repair facility's contract with an insurance company.(2) If an insurance company and auto body repair facility have contracted under a direct repair program or any similar program thereto, the provisions of subsections (a)(19), (a)(20), and (a)(21) of this section shall not apply.(3) If the insured or claimant elects to have the vehicle repaired at a shop of his or her choice, the insurer shall not limit or discount the reasonable repair costs based upon the charges that would have been incurred had the vehicle been repaired by the insurer's chosen shop(s).History of Section.P.L. 1993, ch. 37,  1; P.L. 1993, ch. 227,  1; P.L. 2005, ch. 279,  1; P.L. 2007, ch. 526,  1; P.L. 2007, ch. 527,  1; P.L. 2010, ch. 219,  1; P.L. 2013, ch. 504,  1; P.L. 2013, ch. 509,  1; P.L. 2017, ch. 196,  3; P.L. 2017, ch. 322,  3; P.L. 2019, ch. 84,  1; P.L. 2019, ch. 85,  1; P.L. 2021, ch. 426,  1, effective January 4, 2022; P.L. 2021, ch. 427,  1, effective January 4, 2022.
  27-9.1-5. Response and statement of charges.The director shall provide an initial response within two (2) weeks to any written consumer complaint containing specific and credible allegation of an unfair claims settlement practice punishable pursuant to this chapter. Whenever the director has reasonable cause to believe that any insurer doing business in this state is engaging in any unfair claims practice and that a proceeding in respect to the practice would be in the public interest, the director shall issue and serve upon the insurer a statement of the charges in that respect and a notice of hearing, which notice shall set a hearing date not less than thirty (30) days from the date of the notice.History of Section.P.L. 1993, ch. 37,  1; P.L. 1993, ch. 227,  1.
  27-9.1-6. Cease and desist and penalty orders.If, after a hearing, the director finds an insurer has engaged in an unfair claims practice, the director shall reduce the findings to writing and shall issue and cause to be served upon the insurer charged with the violation a copy of the findings and an order requiring the insurer to cease and desist from engaging in the act or practice and the director may, at the director's discretion, order:(1) Payment of a monetary penalty of not more than ten thousand dollars ($10,000) for each violation, but not to exceed an aggregate penalty of one hundred thousand dollars ($100,000), unless the violation was committed flagrantly and in conscious disregard of this chapter, in which case the penalty shall not be more than twenty-five thousand dollars ($25,000) for each violation, but not to exceed an aggregate penalty of two hundred fifty thousand dollars ($250,000) pursuant to any hearing; and/or(2) Suspension or revocation of the insurer's license if the insurer knew or reasonably should have known it was in violation of this chapter.History of Section.P.L. 1993, ch. 37,  1; P.L. 1993, ch. 227,  1.
  27-9.1-7. Penalty for violation of cease and desist orders.Any insurer which violates a cease and desist order of the director and, while the order is in effect, may, after notice and hearing and upon order of the director, be subject, at the discretion of the director, to:(1) A monetary penalty of not more than twenty-five thousand dollars ($25,000) for each and every act or violation not to exceed an aggregate of two hundred fifty thousand dollars ($250,000) pursuant to any hearing; and/or(2) Suspension or revocation of the insurer's license.History of Section.P.L. 1993, ch. 37,  1; P.L. 1993, ch. 227,  1.
  27-9.1-8. Regulations.The director may, after notice and a hearing, promulgate reasonable rules, regulations, and orders as are necessary or proper to carry out and effectuate the provisions of this chapter. The regulations shall be subject to review in accordance with  42-35-7.History of Section.P.L. 1993, ch. 37,  1; P.L. 1993, ch. 227,  1.
  27-9.1-9. Severability.If any provision of this chapter or the application of the provision to any person or circumstances shall be held invalid, the remainder of the chapter and the application of the provision to any person or circumstances other than those as to which it is held invalid shall not be affected by that invalidity.History of Section.P.L. 1993, ch. 37,  1; P.L. 1993, ch. 227,  1.
  27-9.2-1. Independent medical examinations.When the medical condition of a person is material to a first or third party automobile insurance claim that has been or may be made for past or future medical payment benefits, the person shall submit to a noninvasive medical examination by physicians. Every automobile insurance policy issued in this state shall include reasonable provisions for an examination of persons claiming medical payment benefits.History of Section.P.L. 1993, ch. 184,  1.
  27-9.2-2. Appointment of independent medical examiner.(a) When a person is required to submit to an independent medical examination pursuant to  27-9.2-1, the examination will be conducted by an impartial, competent physician approved by the medical advisory board of the workers' compensation court, as defined in  28-30-22.(b) The expense of the examination shall be paid by the automobile insurance company making the request for the examination.History of Section.P.L. 1993, ch. 184,  1.
  27-9.2-3. Reports of independent medical examinations.If requested by a person examined, a party causing an examination to be made shall deliver to the person a copy of every written report concerning the examination rendered by an examining physician, at least one of which reports shall set out any findings and conclusions in detail. The person shall receive a copy of the findings of the independent medical examination within thirty (30) days of the request.History of Section.P.L. 1993, ch. 184,  1.
  27-9.2-4. "Physician" defined."Physician" as used in this chapter means medical doctor, surgeon, dentist, chiropractor, osteopath, podiatrist and optometrist.History of Section.P.L. 1993, ch. 184,  1.
  27-9.2-5. Rules and regulations.The insurance commissioner may promulgate rules and regulations to carry out the purposes of this chapter.History of Section.P.L. 1993, ch. 184,  1.
  27-9.3-1. Short title.This chapter shall be known and referred to as the "Structured Settlement Protection Act."History of Section.P.L. 2001, ch. 226,  1.
  27-9.3-2. Definitions.For purposes of this chapter:(1) "Annuity issuer" means an insurer that has issued a contract to fund periodic payments under a structured settlement;(2) "Dependents" includes a payee's spouse and minor children and all other persons for whom the payee is legally obligated to provide support, including alimony;(3) "Discounted present value" means the present value of future payments determined by discounting the payments to the present using the most recently published applicable federal rate for determining the present value of an annuity, as issued by the United States Internal Revenue Service;(4) "Gross advance amount" means the sum payable to the payee or for the payee's account as consideration for a transfer of structured settlement payment rights before any reductions for transfer expenses or other deductions to be made from the consideration;(5) "Independent parties" means, with respect to any structured settlement, the payee, any beneficiary irrevocably designated under the annuity contract to receive payments following the payee's death, the annuity issuer, the structured settlement obligor, and any other party that has continuing rights or obligations under the structured settlement;(6) "Independent professional advice" means advice of an attorney, certified public accountant, actuary or other licensed professional adviser;(7) "Net advance amount" means the gross advance amount less the aggregate amount of the actual and estimated transfer expenses required to be disclosed under  27-9.3-3(5);(8) "Payee" means an individual who is receiving tax-free payments under a structured settlement and proposes to make a transfer of payment rights under the settlement;(9) "Periodic payments" includes both recurring payments and scheduled future lump sum payments;(10) "Qualified assignment agreement" means an agreement providing for a qualified assignment within the meaning of Section 130 of the United States Internal Revenue Code, 26 U.S.C.  130;(11) "Responsible administrative authority" means, with respect to a structured settlement, any government authority vested by law with exclusive jurisdiction over the settled claim resolved by the structured settlement;(12) "Settled claim" means the original tort claim or workers' compensation claim resolved by a structured settlement;(13) "Structured settlement" means an arrangement for periodic payment of damages for personal injuries or sickness established by settlement or judgment in resolution of a tort claim or for periodic payments in settlement of a workers' compensation claim;(14) "Structured settlement agreement" means the agreement, judgment, stipulation, or release embodying the terms of a structured settlement;(15) "Structured settlement obligor" means, with respect to any structured settlement, the party has the continuing obligation to make periodic payments to the payee under a structured settlement agreement or a qualified assignment agreement;(16) "Structured settlement payment rights" means rights to receive periodic payments under a structured settlement, whether from the structured settlement obligor or the annuity issuer, where:(i) The payee is domiciled in, or the domicile or principal place of business of the structured settlement obligor or the annuity issuer is located in, this state; or(ii) The structured settlement agreement was approved by a court or responsible administrative authority in this state; or(iii) The structured settlement agreement is expressly governed by the laws of this state;(17) "Terms of the structured settlement" includes, with respect to any structured settlement, the terms of the structured settlement agreement, the annuity contract, any qualified assignment agreement and any order or other approval of any court or responsible administrative authority or other government authority that authorized or approved the structured settlement;(18) "Transfer" means any sale, assignment, pledge, hypothecation or another alienation or encumbrance of structured settlement payment rights made by a payee for consideration; provided that the term "transfer" does not include the creation or perfection of a security interest in structured settlement payment rights under a blanket security agreement entered into with an insured depository institution, in the absence of any action to redirect the structured settlement payments to an insured depository institution, or an agent or successor in interest of an insured depository institution, or to enforce the blanket security interest against the structured settlement payment rights;(19) "Transfer agreement" means the agreement providing for a transfer of structured settlement payment rights;(20) "Transfer expenses" means all expenses of a transfer that are required under the transfer agreement to be paid by the payee or deducted from the gross advance amount, including, without limitation, court filing fees, attorneys' fees, escrow fees, lien recordation fees, judgment and lien search fees, finders' fees, commissions, and other payments to a broker or other intermediary; "transfer expenses" do not include preexisting obligations of the payee payable for the payee' s account from the proceeds of a transfer;(21) "Transferee" means a party acquiring or proposing to acquire structured settlement payment rights through a transfer.History of Section.P.L. 2001, ch. 226,  1.
  27-9.3-3. Required disclosures to payee.Not less than three (3) days prior to the date on which a payee signs a transfer agreement, the transferee shall provide to the payee a separate disclosure statement, in bold type no smaller than fourteen (14) points, setting forth:(1) The amounts and due dates of the structured settlement payments to be transferred;(2) The aggregate amount of these payments;(3) The discounted present value of the payments to be transferred, which shall be identified as the "calculation of current value of the transferred structured settlement payments under federal standards for valuing annuities," and the amount of the applicable federal rate used in calculating the discounted present value;(4) The gross advance amount;(5) An itemized listing of all applicable transfer expenses, other than attorneys' fees and related disbursements payable in connection with the transferee's application for approval of the transfer, and the transferee's best estimate of the amount of the fees and disbursements;(6) The net advance amount;(7) The amount of any penalties or liquidated damages payable by the payee in the event of any breach of the transfer agreement by the payee; and(8) A statement that the payee has the right to cancel the transfer agreement, without penalty or further obligation, not later than the third (3rd) business day after the date the agreement is signed by the payee.History of Section.P.L. 2001, ch. 226,  1.
  27-9.3-4. Approval of transfers of structured settlement payment rights.(a) No direct or indirect transfer of structured settlement payment rights shall be effective and no structured settlement obligor or annuity issuer shall be required to make any payment directly or indirectly to any transferee of structured settlement payment rights unless the transfer has been approved in advance by a final court order of the superior court for the county in which the payee resides finding that:(1) The transfer is in the best interest of the payee, taking into account the welfare and support of the payee's dependents; and(2) The payee has been advised in writing by the transferee to seek independent professional advice regarding the transfer and has either received independent professional advice or knowingly waived the advice in writing; and(3) The transfer does not contravene any applicable statute or the order of any court or other government authority.(b) The payee shall have the right to cancel the transfer agreement, without penalty or further obligation, not later than the third (3rd) business day after the date the transfer agreement is signed by the payee.History of Section.P.L. 2001, ch. 226,  1.
  27-9.3-5. Effects of transfer of structured settlement payment rights.Following a transfer of structured settlement payment rights under this chapter:(1) The structured settlement obligor and the annuity issuer shall, as to all parties except the transferee, be discharged and released from any and all liability for the transferred payments;(2) The transferee shall be liable to the structured settlement obligor and the annuity issuer:(i) If the transfer contravenes the terms of the structured settlement, for any taxes incurred by the parties as a consequence of the transfer; and(ii) For any other liabilities or costs, including reasonable costs and attorneys' fees, arising from compliance by the parties with the order of the superior court or arising as a consequence of the transferee's failure to comply with this chapter;(3) Neither the annuity issuer nor the structured settlement obligor may be required to divide any periodic payment between the payee and any transferee or assignee or between two (2) (or more) transferees or assignees; and(4) Any further transfer of structured settlement payment rights by the payee may be made only after compliance with all of the requirements of this chapter.History of Section.P.L. 2001, ch. 226,  1.
  27-9.3-6. Procedure for approval of transfers.(a) An application under this chapter for approval of a transfer of structured settlement payment rights shall be made by the transferee and shall be brought in the superior court for the county in which the payee resides.(b) Not less than twenty (20) days prior to the scheduled hearing on any application for approval of a transfer of structured settlement payment rights under  27-9.3-4, the transferee shall file with the court and serve on all interested parties a notice of the proposed transfer and the application for its authorization, including with the notice:(1) A copy of the transferee's application;(2) A copy of the transfer agreement;(3) A copy of the disclosure statement required under  27-9.3-3;(4) A listing of each of the payee's dependents, together with each dependent's age;(5) Notification that any interested party is entitled to support, oppose or respond to the transferee's application, either in person or by counsel, by submitting written comments to the court or responsible administrative authority or by participating in the hearing; and(6) Notification of the time and place of the hearing and notification of the manner in which and the time by which written responses to the application must be filed (which shall be not less than fifteen (15) days after service of the transferee's notice) in order to be considered by the court or responsible administrative authority.History of Section.P.L. 2001, ch. 226,  1.
  27-9.3-7. General provisions  Construction.(a) The provisions of this chapter may not be waived by any payee.(b) Any transfer agreement entered into on or after July 13, 2001 by a payee who resides in this state shall provide that disputes under the transfer agreement, including any claim that the payee has breached the agreement, shall be determined in and under the laws of this state. No transfer agreement shall authorize the transferee or any other party to confess judgment or consent to entry of judgment against the payee.(c) No transfer of structured settlement payment rights shall extend to any payments that are life-contingent unless, prior to the date on which the payee signs the transfer agreement, the transferee has established and has agreed to maintain procedures reasonably satisfactory to the annuity issuer and the structured settlement obligor for: (1) periodically confirming the payee's survival, and (2) giving the annuity issuer and the structured settlement obligor prompt written notice in the event of the payee's death.(d) No payee who proposes to make a transfer of structured settlement payment rights shall incur any penalty, forfeit any application fee or other payment, or incur any liability to the proposed transferee or any assignee based on any failure of the transfer to satisfy the conditions of this chapter.(e) Nothing contained in this chapter shall be construed to authorize any transfer of structured settlement payment rights in contravention of any law or to imply that any transfer under a transfer agreement entered into prior to July 13, 2001 is valid or invalid.(f) Compliance with the requirements set forth in  27-9.3-3 and fulfillment of the conditions set forth in  27-9.3-4 shall be solely the responsibility of the transferee in any transfer of structured settlement payment rights, and neither the structured settlement obligor nor the annuity issuer shall bear any responsibility for, or any liability arising from, noncompliance with the requirements or failure to fulfill the conditions.History of Section.P.L. 2001, ch. 226,  1.
  27-9.4-1. Short title.This chapter shall be known and may be cited as the "Model Act Regarding Use of Property and Casualty Insurance Binders as Evidence of Coverage."History of Section.P.L. 2013, ch. 19,  1; P.L. 2013, ch. 22,  1.
  27-9.4-2. Purpose.This chapter requires that property and casualty insurance binders obligate coverage until a policy is issued or cancelled.History of Section.P.L. 2013, ch. 19,  1; P.L. 2013, ch. 22,  1.
  27-9.4-3. Definitions.As used in this chapter:(1) "Insurance binder" means a written temporary contract of insurance authorized by an insurer issued prior to the insurance policy that includes:(i) The name and address of the insured and any additional named insureds, mortgagees, or lienholders;(ii) A description of the property insured;(iii) A description of the nature and amount of coverage;(iv) The identity of the insurer and of the authorized representative executing the binder;(v) The effective and expiration date of coverage; and(vi) The binder number or the policy number where applicable to a policy extension.(2) "Insurance policy" means a contract of insurance describing the term, coverage, premiums, and deductibles.(3) "Insured" means the person, group, or property for which an insurance policy is issued.(4) "Insurer" means any organization that issues property or casualty insurance.(5) "Lender" means an individual, partnership, corporation, association, or other entity, or loan servicer acting on behalf of such party, who lends money and receives or otherwise acquires a mortgage, a lien, a deed of trust, or any other security interest in or on any real or personal property as security for the loan.History of Section.P.L. 2013, ch. 19,  1; P.L. 2013, ch. 22,  1.
  27-9.4-4. Insurer obligations.An insurer that provides an insurance binder is obligated to provide the coverage according to the terms of such binder until the insurer issues the insurance policy or cancels the binder.History of Section.P.L. 2013, ch. 19,  1; P.L. 2013, ch. 22,  1.
  27-9.4-5. Penalties.Any person or entity who violates this chapter may be subject to action pursuant to  42-14-16.History of Section.P.L. 2013, ch. 19,  1; P.L. 2013, ch. 22,  1.
  27-9-1. Purpose of chapter.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 rate making and in other matters within the scope of this chapter. Nothing in this chapter is intended to: (1) prohibit or discourage reasonable competition, or (2) prohibit or encourage, except to the extent necessary to accomplish the stated purpose of this chapter, 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.History of Section.P.L. 1948, ch. 2089,  1; G.L. 1956,  27-9-1.
  27-9-10.1. Costs.For the purpose of determining whether the filing meets the requirements of this chapter, the director may employ staff personnel and outside consultants, including, but not limited to, those authorized pursuant to  27-9-52. The reasonable costs related to the review of rate filings, including the conduct of the hearing, shall be borne by the rating organizations or insurers making the filing.History of Section.P.L. 2005, ch. 174,  3.
  27-9-10. Waiting period  Effective date of filings.Subject to the exception specified in  27-9-9, each filing shall be on file for a waiting period of thirty (30) days before it becomes effective, which period may be extended by the commissioner for an additional period not to exceed thirty (30) days if the commissioner gives written notice within that waiting period to the insurer or rating organization which made the filing that he or she needs that additional time for the consideration of the filing. Upon written application by the insurer or rating organization, the commissioner may authorize a filing that the commissioner has reviewed to become effective before the expiration of the waiting period or any extension of it. A filing shall be deemed to meet the requirements of this chapter and to become effective unless disapproved as provided in this chapter by the commissioner within the waiting period or any extension of it; provided, that if the commissioner gives written notice to the insurer or rating organization within the waiting period or any extension that he or she will hold a hearing on the filing, the filing shall not become effective before or until the commissioner issues his or her decision. Upon giving that notice the commissioner shall also give public notice of the hearing by causing a notice to be published in a newspaper of general circulation in the state at least ten (10) days prior to the hearing stating the name of the insurer or rating organization which has made the filing and including a general description of the subject matter and sending a copy of that notice to the consumer protection unit of the department of attorney general. The commissioner shall hold a hearing on major filings. The hearing shall be held and a decision issued by the commissioner as soon as reasonably possible.History of Section.P.L. 1948, ch. 2089,  4; G.L. 1956,  27-9-10; P.L. 1968, ch. 286,  2; P.L. 1971, ch. 252; P.L. 1998, ch. 441,  19.
  27-9-11. Special filings as to surety or guaranty bonds.Any special filing with respect to a surety or guaranty bond required by law, by court or executive order, or by order, rule, or regulation of a public body, not covered by a previous filing, shall become effective when filed and shall be deemed to meet the requirements of this chapter until the commissioner reviews the filing and so long after this as the filing remains in effect.History of Section.P.L. 1948, ch. 2089,  4; G.L. 1956,  27-9-11.
  27-9-12. Suspension or modification of filing requirements.Under rules and regulations the commissioner adopts, the commissioner may, by written order, suspend or modify the requirements of filing as to any kind of insurance, or subdivision or combination of insurance, or as to classes of risks, the rates for which cannot practically 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  27-9-4(a)(4).History of Section.P.L. 1948, ch. 2089,  4; G.L. 1956,  27-9-12.
  27-9-13. Approval of rates in excess of those filed.Upon the written consent of the insured, stating his or her reasons, filed with and approved by the commissioner, a rate in excess of that provided by an applicable filing may be used on any specific risk.History of Section.P.L. 1948, ch. 2089,  4; G.L. 1956,  27-9-13.
  27-9-14. Compliance with filings required.No insurer shall make or issue a contract or policy at a rate or premium in excess of filings which are in effect for that insurer as provided in this chapter, except in accordance with  27-9-12 or  27-9-13.History of Section.P.L. 1948, ch. 2089,  4; G.L. 1956,  27-9-14.
  27-9-15. Review of rates not covered by filings.Within ten (10) days after any insurer has made or issued a contract or policy at a rate or premium other than is provided for by any filing made with the commissioner by or in its behalf, that insurer shall notify the commissioner, in writing, of that action in the form the commissioner may require. The commissioner shall review the notice as soon as reasonably possible after it has been received by him or her, in order to determine whether the contract or policy has been written at a rate or premium which meets the requirements of this chapter. When the notice is not accompanied by the information upon which the insurer supports the rate or premium, and the commissioner does not have sufficient information to determine whether the rate or premium meets the requirements of the chapter, the commissioner shall require the insurer to furnish, within ten (10) days after the receipt of the notice of the requirement, the information upon which it supports the rate or premium. Unless, within thirty (30) days after the receipt of the notice or the supporting information, the commissioner shall issue an order following a hearing, as provided in  27-9-18, the rate or premium charged for the contract or policy shall be deemed to meet the requirements of this chapter; provided, that all contracts and policies issued under the provisions of this section shall state that the rate or premium charged for the contract or policy has not been reviewed by the commissioner and that it is subject to disapproval or modification as of the effective date of the contracts or policies.History of Section.P.L. 1948, ch. 2089,  4; G.L. 1956,  27-9-15.
  27-9-16. Disapproval of filing within waiting period.If, within the waiting period or any extension of it as provided in  27-9-10, the commissioner finds that a filing does not meet the requirements of this chapter, the commissioner shall send to the insurer or rating organization which made the filing written notice of disapproval of the filing specifying in the notice in what respects he or she finds the filing fails to meet the requirements of this chapter and stating that the filing shall not become effective.History of Section.P.L. 1948, ch. 2089,  5; G.L. 1956,  27-9-16.
  27-9-17. Disapproval of special surety or guaranty filing.If, within thirty (30) days after a special surety or guaranty filing subject to  27-9-11 has become effective, the commissioner finds that the filing does not meet the requirements of this chapter, the commissioner shall send to the insurer or rating organization which made the filing written notice of disapproval of the filing specifying in the notice in what respects he or she finds that the filing fails to meet the requirements of this chapter and stating when, within a reasonable period after this, the filing shall be deemed no longer effective. That disapproval shall not affect any contract made or issued prior to the expiration of the period set forth in the notice.History of Section.P.L. 1948, ch. 2089,  5; G.L. 1956,  27-9-17.
  27-9-18. Disapproval of filing after review period  Removal of discrimination  Hearings to determine effect of legislation.(a) If at any time, subsequent to the applicable review period provided for in  27-9-16 or  27-9-17, the commissioner finds that a rate or filing does not meet the requirements of this chapter, he or she shall, after a hearing held upon not less than ten (10) days written notice specifying the matters to be considered at that hearing to every insurer and rating organization which used that rate or made that filing, issue an order specifying on what respects he or she finds that the rate or filing fails to meet the requirements of this chapter, and stating when, within a reasonable period after this, the rate shall no longer be used or the filing shall be deemed no longer effective. That order shall not affect any contract or policy made or issued prior to the expiration of the period set forth in the order. If the commissioner finds that an unfair discrimination exists in the application of a rate or filing to an individual risk the commissioner may, after a hearing held on similar notice to the insurer affected and to any rating organization which made the filing, issue an order that the discrimination be removed.(b) (1) Whenever legislation is enacted that restricts or removes common law rights of action in tort and/or statutory rights as to causes of action or damages, within one year after the passage of that restrictive legislation, those insurance companies underwriting affected lines shall request hearings to be held to determine the effect of that legislation on insurance policies, their cost and benefits;(2) The findings of the hearings with reference to the decrease of frequency in claims shall constitute the basis for an immediate reduction of rates and if excess profits have been obtained, the commissioner shall order a refund of all excess profits, and he or she shall annually review the continued effect of the legislation until it is reasonably ascertained that a proper rate level has been established. Copies of any order issued pursuant to this section shall be sent to every affected insurer and rating organization.History of Section.P.L. 1948, ch. 2089,  5; G.L. 1956,  27-9-18; P.L. 1978, ch. 137,  1.
  27-9-19. Hearings on application by persons aggrieved by filing  Order terminating filing  Removal of discrimination.(a) Any person or organization aggrieved with respect to any rate or filing which is in effect may make a 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. The 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 his or her grounds are established, and that his or her 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 which 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 he or she finds that the rate or filing fails to meet the requirements of this chapter, and stating when, within a reasonable period after this, the rate shall no longer be used or the filing shall be deemed no longer effective. That order shall not affect any contract or policy made or issued prior to the expiration of the period set forth in the order. If the commissioner finds that an unfair discrimination exists in the application of a rate or filing to an individual risk the commissioner may, after a hearing held on similar notice to the insurer affected and to any rating organization which made the filing, issue an order that the discrimination be removed. Copies of any order issued pursuant to this section shall be sent to every affected insurer and rating organization.History of Section.P.L. 1948, ch. 2089,  5; G.L. 1956,  27-9-19; P.L. 1968, ch. 286,  4.
  27-9-2. Applicability.This chapter applies to casualty insurance, including fidelity, surety, and guaranty bonds, and to all other forms of motor vehicle insurance, on risks or operations in this state, except:(1) Reinsurance, other than joint reinsurance to the extent stated in  27-9-34 and 27-9-35;(2) Accident and health insurance; and(3) Insurance against loss of or damage to aircraft, or against liability, other than workers' compensation and employers' liability, arising out of the ownership, maintenance, or use of aircraft.History of Section.P.L. 1948, ch. 2089,  2; G.L. 1956,  27-9-2.
  27-9-20. Competitive rates as evidence of fairness  Profit as evidence of adequacy.If the insurer making or issuing a contract or policy at a rate or premium less than that provided by any filing shall, at any hearing held pursuant to  27-9-16  27-9-21, or pursuant to  27-9-15, show 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 a kind or class of insurance at a profit, that showing shall be prima facie evidence that the rate or premium used is not inadequate.History of Section.P.L. 1948, ch. 2089,  5; G.L. 1956,  27-9-20.
  27-9-21. Filed schedules and plans not to be disapproved if rates meet requirements.No manual of classifications, rules, rating plan, or any modification of any of these which establishes standards for measuring variations in hazards or expense provisions, or both, and which has been filed pursuant to the requirements of  27-9-7  27-9-15, shall be disapproved if the rates produced by it meet the requirements of this chapter.History of Section.P.L. 1948, ch. 2089,  5; G.L. 1956,  27-9-21.
  27-9-22. Licensing of rating organization.(a) A corporation, an unincorporated association, a partnership, or an individual whether located within or outside this state may make an application to the commissioner for a license as a rating organization for those kinds of insurance or subdivisions of insurance specified in its application and shall file with the application:(1) A copy of its constitution, articles of agreement or association, or certificate of incorporation, and bylaws, rules, and regulations governing the conduct of its business;(2) A list of its members and subscribers;(3) The name and address of a resident of this state upon whom notices or orders of the commissioner or process affecting the rating organization may be served; and(4) A statement of its qualifications as a rating organization.(b) If the commissioner finds that the applicant is competent, trustworthy, and qualified to act as a rating organization and that its constitution, articles of agreement or association, or certificate of incorporation, and bylaws, rules, and regulations governing the conduct of its business conform to the requirements of law, the commissioner shall issue a license specifying the kinds of insurance or subdivisions of insurance for which the applicant is authorized to act as a rating organization. Every application shall be granted or denied in whole or in part by the commissioner within sixty (60) days of the date of its filing with him or her. Licenses issued pursuant to this section shall remain in effect for three (3) years unless sooner suspended or revoked by the commissioner. The fee for the license shall be three hundred dollars ($300). All in force licenses shall be transitioned into a three (3) year licensing cycle beginning June 1, 2006, to expire every three (3) years thereafter. License fees may be prorated for the initial renewal period as deemed appropriate by the director.(c) Licenses issued pursuant to this section may be suspended or revoked by the commissioner, after a hearing upon notice, in the event the rating organization ceases to meet the requirements of this section. Every rating organization shall notify the commissioner promptly of every change in:(1) Its constitution, articles of agreement or association or certificate of incorporation, and bylaws, rules, and regulations governing the conduct of its business;(2) Its list of members and subscribers; and(3) The name or address of the resident of this state designated by it upon whom notices or orders of the commissioner or process affecting the rating organization may be served.History of Section.P.L. 1948, ch. 2089,  6; G.L. 1956,  27-9-22; P.L. 1960, ch. 71, art. 1,  4; P.L. 1993, ch. 138, art. 62,  12; P.L. 2005, ch. 174,  4.
  27-9-23. Admission of and services to subscribers.Subject to rules and regulations which have been approved by the commissioner as reasonable, each rating organization shall permit any insurer not a member to be a subscriber to its rating services for any kind of insurance or subdivision of insurance for which it is authorized to act as a rating organization. Notice of proposed changes in those rules and regulations shall be given to subscribers. Each rating organization shall furnish its rating services without discrimination to its members and subscribers. The reasonableness of any rule or regulation in its application to subscribers, or the refusal of any rating organization to admit an insurer as a subscriber, shall, at the request of any subscriber or any affected insurer, be reviewed by the commissioner at a hearing held upon at least ten (10) days written notice to the rating organization and to the subscriber or insurer. If the commissioner finds that the rule or regulation is unreasonable in its application to subscribers, the commissioner shall order that the rule or regulation shall not be applicable to subscribers. If the rating organization fails to grant or reject an insurer's application for subscribership within thirty (30) days after it was made, the insurer may request a review by the commissioner as if the application had been rejected. If the commissioner finds that the insurer has been refused admittance to the rating organization as a subscriber without justification, the commissioner shall order the rating organization to admit the insurer as a subscriber. If the commissioner finds that the action of the rating organization was justified, the commissioner shall make an order affirming its action.History of Section.P.L. 1948, ch. 2089,  6; G.L. 1956,  27-9-23.
  27-9-24. Regulation by rating organization of payments by insurers to policyholders or members.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.History of Section.P.L. 1948, ch. 2089,  6; G.L. 1956,  27-9-24.
  27-9-25. Cooperation among organizations and insurers  Review of cooperative practices.Cooperation among rating organizations or among rating organizations and insurers and concert of action among insurers under the same general management or control in rate making or in other matters within the scope of this chapter are authorized, provided the filings resulting from that cooperation are subject to all of the provisions of this chapter which are applicable to filing generally. The commissioner may review cooperative activities and practices and if, after a hearing, he or she finds that any cooperative activity or practice is unfair or unreasonable or inconsistent with the provisions of this chapter, the commissioner may issue a written order specifying in what respects that activity or practice is unfair or unreasonable or inconsistent with the provisions of this chapter, and requiring the discontinuance of that activity or practice.History of Section.P.L. 1948, ch. 2089,  6; G.L. 1956,  27-9-25.
  27-9-26. Adherence to rating organization filings  Deviation filings.Every member of or subscriber to a rating organization shall adhere to the filings made on its behalf by the organization, except that any affected insurer may file with the commissioner a uniform percentage decrease or increase to be applied to the premiums produced by the rating system filed for a kind of insurance or for a class of insurance which is found by the commissioner to be a proper rating unit for the application of the uniform percentage decrease or increase or for a subdivision of a kind of insurance: (1) comprised of a group of manual classifications which is treated as a separate unit for rate making purposes, or (2) for which separate expense provisions are included in the filings of the rating organization. The deviation filing shall specify the basis for the modification and shall be accompanied by the data upon which the applicant relies. A copy of the filing and data shall be sent simultaneously to the rating organization. Any deviation developing a lower rate than filed by the rating organization may be utilized immediately by the member or subscriber developing the decrease. Any eventual return to the rate level as authorized for the rating organization, from which a lower deviation has been made, shall also be accomplished by submitting simultaneously to the insurance commissioner and the rating organization a copy of the filing and data.History of Section.P.L. 1948, ch. 2089,  6; G.L. 1956,  27-9-26; P.L. 1978, ch. 134,  1.
  27-9-27. Appeals from action of rating organization on changes in filings.(a) Any member of or subscriber to a rating organization may appeal to the commissioner from the action or decision of the rating organization in the promulgation of rates or with regard to any proposed change in or addition to the filings of the rating organization, and the commissioner shall after a hearing held upon not less than ten (10) days written notice to the appellant and to the rating organization issue an order approving or disapproving the action or decision of the rating organization. Provided, that if the appeal is from the action of the rating organization with regard to a rate on a proposed change in or addition to its filings, the commissioner shall approve the rate applied by the rating organization or the rate suggested by the appellant if either rate is in accordance with this chapter.(b) If the appeal is based upon the failure of the rating organization to make a filing on behalf of any member or subscriber which is based on a system of expense provisions which differs in accordance with the right granted in  27-9-4(a)(2) from the system of expense provisions included in a filing made by the rating organization, the commissioner shall, if he or she grants the appeal, order the rating organization to make the requested filing for use by the appellant. In deciding the appeal, the commissioner shall apply the standards set forth in  27-9-4  27-9-6.History of Section.P.L. 1948, ch. 2089,  7; G.L. 1956,  27-9-27.
  27-9-28. Rate information furnished to insured.Any rate filings subject to this chapter and filed by an insurer or rating organization on behalf of its members or subscribers with the insurance commissioner shall be deemed public information at the time of the filing; provided, the insurance commissioner shall furnish the rate filings and all pertinent information as to the rate filings, upon written request, to any insured, to any authorized representative of an insured, to any insurance company trade association, or to any trade association of insurance producers.History of Section.P.L. 1948, ch. 2089,  8; G.L. 1956,  27-9-28; P.L. 1992, ch. 267,  2.
  27-9-29. Review of application of rating system to insured.Every rating organization and every insurer which makes its own rates shall provide within this state reasonable means by which any person aggrieved by the application of its rating system may be heard, in person or by his or her authorized representative, on his or her written request to review the manner in which the rating system has been applied in connection with the insurance afforded to that person. If the rating organization or insurer fails to grant or reject that request within thirty (30) days after it is made, the applicant may proceed in the same manner as if the applicant's application had been rejected. Any party affected by the action of the rating organization or insurer on that party's request may, within thirty (30) days after written notice of the action, appeal to the commissioner, who, after a hearing held upon not less than ten (10) days written notice to the appellant and to the rating organization or insurer, may affirm or reverse the action.History of Section.P.L. 1948, ch. 2089,  8; G.L. 1956,  27-9-29.
  27-9-3. Insurers covered  Election between regulatory laws.This chapter applies to all insurers, which, under any provision of the laws of this state, write any of the kinds of insurance to which this chapter applies. If any kind of insurance, or subdivision or combination of insurance, or type of coverage, subject to this chapter is also subject to regulation by another rate regulatory act of this state, an insurer to which both acts are applicable shall file with the insurance commissioner, referred to in this chapter as "the commissioner," a designation as to which rate regulatory act shall be applicable to it with respect to that kind of insurance, or subdivision or combination of insurance, or type of coverage.History of Section.P.L. 1948, ch. 2089,  2; G.L. 1956,  27-9-3.
  27-9-30. "Advisory organization" defined.Every group, association, or other organization of insurers, whether located within or outside this state, which assists insurers which make their own filings or rating organizations in rate making, 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.History of Section.P.L. 1948, ch. 2089,  9; G.L. 1956,  27-9-30.
  27-9-31. Documents filed by advisory organizations.Every advisory organization shall file with the commissioner:(1) A copy of its constitution, articles of agreement or association, or certificate of incorporation, and bylaws, rules, and regulations governing its activities;(2) A list of its members;(3) The name and address of a resident of this state upon whom notices or orders of the commissioner or process issued at the commissioner's direction may be served; and(4) An agreement that the commissioner may examine that advisory organization in accordance with the provisions of  27-9-36 and 27-9-37.History of Section.P.L. 1948, ch. 2089,  9; G.L. 1956,  27-9-31.
  27-9-32. Unlawful practices of advisory organizations.If, after a hearing, the commissioner finds that the furnishing of information or assistance by an advisory organization involves any act or practice which is unfair or unreasonable or inconsistent with the provisions of this chapter, the commissioner may issue a written order specifying in what respects the act or practice is unfair or unreasonable or inconsistent with the provisions of this chapter, and requiring the discontinuance of the act or practice.History of Section.P.L. 1948, ch. 2089,  9; G.L. 1956,  27-9-32.
  27-9-33. Use of information from noncomplying advisory organization.No insurer which makes its own filings or any rating organization shall support its filings by statistics, or adopt rate making recommendations, furnished to it by an advisory organization which has not complied with  27-9-30  27-9-32, or with an order of the commissioner involving statistics or recommendations issued under  27-9-32. If the commissioner finds any insurer or rating organization to be in violation of this section the commissioner may issue an order requiring the discontinuance of that violation.History of Section.P.L. 1948, ch. 2089,  9; G.L. 1956,  27-9-33.
  27-9-34. Provisions applicable to joint underwriting and reinsurance.Every group, association, or other organization of insurers which engages in joint underwriting or joint reinsurance shall be subject to regulation with respect to them as provided in  27-9-35, subject, with respect to joint underwriting, to all other provisions of this chapter and, with respect to joint reinsurance, to  27-9-36, 27-9-37, and 27-9-44  27-9-50.History of Section.P.L. 1948, ch. 2089,  10; G.L. 1956,  27-9-34.
  27-9-35. Unlawful joint underwriting or reinsurance practices.If, after a hearing, the commissioner finds that any activity or practice of any joint underwriting or reinsurance group, association, or other organization is unfair or unreasonable or inconsistent with the provisions of this chapter, the commissioner may issue a written order specifying in what respects the activity or practice is unfair or unreasonable or inconsistent with the provisions of this chapter, and requiring the discontinuance of the activity or practice.History of Section.P.L. 1948, ch. 2089,  10; G.L. 1956,  27-9-35.
  27-9-36. Examination of rating and advisory organizations and underwriting and reinsurance groups.The commissioner may, as often as he or she may deem it necessary, make or cause to be made an examination of each rating organization licensed in this state as provided in  27-9-22 and the commissioner may, as often as he or she may deem it expedient, make or cause to be made an examination of each advisory organization referred to in  27-9-30 and of each group, association, or other organization referred to in  27-9-34, including any workers' compensation assigned risk servicing carrier or carriers. All such examinations shall be performed in accordance with the requirements of  27-13.1-1 et seq. The officers, managers, agents, and employees of any rating organization, advisory organization, or group, association, or other organization of insurers, including workers' compensation assigned risk servicing carrier or carriers, may be examined at any time under oath and shall exhibit all books, records, accounts, documents, or agreements governing its method of operation. In lieu of any examination the commissioner may accept the report of an examination made by the insurance supervisory official of another state, pursuant to the laws of that state.History of Section.P.L. 1948, ch. 2089,  11; G.L. 1956,  27-9-36; P.L. 1960, ch. 71, art. 1,  4; P.L. 1992, ch. 31,  26; P.L. 2008, ch. 371,  3.
  27-9-37. Reports on examinations  Hearing and filing.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 his or her 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.History of Section.P.L. 1948, ch. 2089,  11; G.L. 1956,  27-9-37.
  27-9-38. Collection and compilation of experience data.The commissioner shall promulgate reasonable rules and statistical plans reasonably adapted to each of the rating systems on file with the commissioner, which may be modified and which shall be used after this by each insurer in the recording and reporting of its loss and country wide expense experience, in order that the experience of all insurers may be made available at least annually in a form and detail as may be necessary to aid him or her in determining whether rating systems comply with the standards set forth in  27-9-4  27-9-6. Those rules and plans may also provide for the recording and reporting of expense experience items which are specially applicable to the state and are not susceptible of determination by a prorating of country wide expense experience. In promulgating those rules and plans, the commissioner shall give due consideration to the rating systems on file with him or her and, in order that those rules and plans may be as uniform as is practicable among the several states, to the rules and to the form of the plans used for the rating systems in other states. No insurer shall be required to record or report its loss experience on a classification basis that is inconsistent with the rating system filed by it. The commissioner may designate one or more rating organizations or other agencies to assist the commissioner in gathering that experience and making compilations of it, and those compilations shall be made available, subject to reasonable rules promulgated by the commissioner, to insurers and rating organizations.History of Section.P.L. 1948, ch. 2089,  12; G.L. 1956,  27-9-38.
  27-9-39. Interchange of rating plan data.Reasonable rules and plans may be promulgated by the commissioner for the interchange of data necessary for the application of rating plans.History of Section.P.L. 1948, ch. 2089,  12; G.L. 1956,  27-9-39.
  27-9-4.1. Repealed.History of Section.P.L. 1982, ch. 369,  1; Repealed by P.L. 2013, ch. 31,  4, effective May 24, 2013; P.L. 2013, ch. 36,  4, effective May 24, 2013.
  27-9-4. Considerations in making of rates  Cancellation of policy.(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 his or her 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 his or her 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 his or her 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 his or her 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; and(5) 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 of 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 his or her discretion he or she 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, he or she shall reduce his or her 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, he or she 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.History of Section.P.L. 1948, ch. 2089,  3; G.L. 1956,  27-9-4; P.L. 1980, ch. 130,  1; P.L. 1984, ch. 72,  1; P.L. 1989, ch. 199,  1; P.L. 1989, ch. 416,  1; P.L. 1989, ch. 517,  1; P.L. 1990, ch. 481,  1; P.L. 1993, ch. 125,  1; P.L. 1993, ch. 333,  1; P.L. 1994, ch. 110,  1; P.L. 1995, ch. 237,  1; P.L. 1996, ch. 344,  1; P.L. 1996, ch. 406,  1; P.L. 2002, ch. 208,  1; P.L. 2002, ch. 409,  1; P.L. 2005, ch. 434,  1; P.L. 2009, ch. 58,  1; P.L. 2009, ch. 78,  1; P.L. 2017, ch. 196,  2; P.L. 2017, ch. 322,  2; P.L. 2018, ch. 346,  19; P.L. 2019, ch. 183,  1; P.L. 2019, ch. 208,  1.
  27-9-40. Cooperation with other states.In order to further the uniform administration of rate regulatory laws, the commissioner and every insurer and rating organization may exchange information and experience data with insurance supervisory officials, insurers, and rating organizations in other states and may consult and cooperate with them with respect to rate making and the application of rating systems.History of Section.P.L. 1948, ch. 2089,  12; G.L. 1956,  27-9-40.
  27-9-41. Rules and regulations.The commissioner may make reasonable rules and regulations necessary to effect the purposes of this chapter.History of Section.P.L. 1948, ch. 2089,  12; G.L. 1956,  27-9-41.
  27-9-42. False or misleading information.No person or organization shall willfully withhold information from or knowingly give false or misleading information to the commissioner, to any statistical agency designated by the commissioner, to any rating organization, or to any insurer, which will affect the rates or premiums chargeable under this chapter. A violation of this section shall subject the one guilty of that violation to the penalties provided in  27-9-45 and 27-9-46.History of Section.P.L. 1948, ch. 2089,  13; G.L. 1956,  27-9-42.
  27-9-43. Assigned risk agreements  Modification of rates.(a) Agreements may be made among insurers with respect to the equitable apportionment among them of insurance which may be afforded applicants who are in good faith entitled to but who are unable to procure insurance through ordinary methods, and insurers may agree among themselves on the use of reasonable rate modifications for that insurance, those agreements and rate modifications to be subject to the approval of the commissioner.(b) All of the manuals of classifications, rules and rates, rating plans, and rating systems, and every modification of these, to be used by insurers pursuant to assigned risk agreements shall be filed with the commissioner pursuant to  27-9-8 and shall be used by all insurers writing workers' compensation and employers' liability insurance in this state, notwithstanding any provision of  27-9-8 to the contrary.History of Section.P.L. 1948, ch. 2089,  14; G.L. 1956,  27-9-43; P.L. 1982, ch. 32, art. 5,  1.
  27-9-44. Terms to be stated in policy  Rebates prohibited.No insurer, or any officer, insurance producer, or their representative, shall make any contract for insurance, on property or risks located within this state, or against any liability, casualty, accident, or hazard that may arise or occur in this state, or any agreements as to any contract, other than as plainly expressed in the policy issued or to be issued on the agreement or contract; nor shall any insurer, or officer, insurance producer, or their representative, directly or indirectly, in any manner, pay or allow or offer to pay or allow to the insured named in the policy or to any employee of the insured as an inducement to the insurance, or after the insurance shall have been effected, any rebate from the premium which is specified in the policy or any special favor or advantage in the dividends or other benefit to accrue on the policy, or any valuable consideration or inducement, not specified in the policy or contract of insurance, or give, sell, or purchase, as an inducement to the insurance, or in connection with the insurance, any stock, bonds, or other securities of any insurance or other corporation or association, or any dividends or profits accrued on the stock, bonds, or securities, or anything of value, not specified in the policy, nor shall any insurance producer or representative, or any other person, directly or indirectly, either by sharing commissions or in any manner, pay or allow or offer to pay or allow to the insured named in the policy, or to any employee of the insured, as an inducement to the insurance, or after the insurance shall have been effected, any rebate from the premium which is specified in the policy, nor shall any insured, or party, or applicant for insurance, his, her or its employee, agent, or representative, knowingly receive or accept, or agree to accept, or agree to receive or accept, directly or indirectly, any rebate of a premium or any part of the premium or all or any part of any commission on the premium, or any favor or advantage, or share in any benefit to accrue under any contract of insurance, or any valuable consideration or inducement, other than what is specified in the policy; provided, that nothing in this section shall prevent any insurer from the distribution of surplus, dividends, savings, or the unused or unabsorbed portion of premiums and premium deposits to participating policyholders, nor shall this section prevent any insurer, or its agent, from paying commissions to a licensed insurance producer who shall have negotiated for the insurance, nor shall it prevent any licensed insurance producer from sharing or dividing a commission earned or received by the insurance producer with any other licensed insurance producer who shall have aided the insurance producer in respect to the insurance for the negotiation of which the commission shall have been earned or paid; but no insurer, or insurance producer shall pay or allow commissions or brokerage to any person acting as an insurance producer in this state who is required by law to be licensed but is not licensed. As used in this section, the word "insurance" includes suretyship and the word "policy" includes bond. Sections 27-8-7  27-8-10 shall not apply to the kinds of insurance subject to the provisions of this chapter.History of Section.P.L. 1948, ch. 2089,  15; G.L. 1956,  27-9-44.
  27-9-45. Penalty for violations.Any person or organization willfully violating any provision of this chapter shall, upon their conviction, be fined not less than one hundred dollars ($100) and not more than five hundred dollars ($500) for each violation. That penalty may be in addition to any other penalty provided by law.History of Section.P.L. 1948, ch. 2089,  16; G.L. 1956,  27-9-45.
  27-9-46. Suspension or revocation of licenses.(a) The commissioner may suspend the license of any rating organization or insurer, which fails to comply with an order of the commissioner within the time limited by that order, or any extension of time which the commissioner may grant. The commissioner shall not suspend the license of any rating organization or insurer for failure to comply with an order until the time prescribed for an appeal has expired or, if an appeal has been taken, until the order has been affirmed.(b) The commissioner may determine when a suspension of a license shall become effective and it shall remain in effect for the period fixed by the commissioner, unless he or she modifies or rescinds the suspension, or until the order upon which the suspension is based is modified, rescinded, or reversed.(c) No license shall be suspended or revoked except upon a written order of the commissioner, stating his or her findings, made after a hearing held upon not less than ten (10) days written notice to the person or organization affected specifying the alleged violation.History of Section.P.L. 1948, ch. 2089,  16; G.L. 1956,  27-9-46.
  27-9-47. Hearings on rules and decisions of commissioner.Any insurer or rating organization 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 to the insurer or organization make a written request to the commissioner for a hearing, except that a hearing provided for by  27-9-16  27-9-21 shall be held as provided in those sections. Within twenty (20) days after the receipt of that 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 his or her previous action, specifying his or her reasons. Pending the hearing and decision the commissioner may suspend or postpone the effective date of his or her previous action.History of Section.P.L. 1948, ch. 2089,  17; G.L. 1956,  27-9-47.
  27-9-48, 27-9-49. Repealed.
  27-9-5.1. Uniform safe driver point system.The director of the department of business regulation is authorized and empowered to promulgate rules and regulations regarding a uniform safe driver point system on either a flat dollar rate or on a percentage rate for motor vehicle accidents and/or motor vehicle convictions without regard to age, sex, or the location of the garaging of the motor vehicle. Those rules shall be promulgated in accordance with the Administrative Procedures Act, chapter 35 of title 42.History of Section.P.L. 1978, ch. 136,  1; P.L. 2006, ch. 106,  1; P.L. 2006, ch. 132,  1.
  27-9-5. Uniformity among insurers.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.History of Section.P.L. 1948, ch. 2089,  3; G.L. 1956,  27-9-5.
  27-9-50. Severability.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.History of Section.P.L. 1948, ch. 2089,  19; G.L. 1956,  27-9-50.
  27-9-51. Repealed.History of Section.P.L. 1982, ch. 32, art. 4,  1; P.L. 2002, ch. 292,  25; Repealed by P.L. 2017, ch. 195,  1, effective July 18, 2017; P.L. 2017, ch. 372,  1, effective October 4, 2017.
  27-9-52. Assessment for costs of rate filings, review, and pricing.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 his or her 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 chapter 37 of title 28.History of Section.P.L. 1982, ch. 32, art. 5,  2; P.L. 1989, ch. 126, art. 34,  1; P.L. 1999, ch. 31, art. 8,  5; P.L. 1999, ch. 216,  4; P.L. 1999, ch. 384,  4; P.L. 2005, ch. 174,  4.
  27-9-53. Motor vehicle insurance rate increases relating to violations and accidents.Any insurance group, carrier, or company, in establishing any rate of insurance or rating system relative to a motor vehicle policy which provides for premium or rate increases based on accidents or moving or other chargeable violations, shall consider and include in those rates or rating system only those accidents or moving or other chargeable violations, which have occurred within three (3) years of the most recent accident or moving or other chargeable violation.History of Section.P.L. 1989, ch. 512,  1.
  27-9-54. Rules and regulations  Auto insurance buyer's guide.(a) The director of the department of business regulation is authorized and empowered to promulgate rules and regulations to compile data regarding automobile insurance premiums. Those rules shall be promulgated in accordance with the Administrative Procedures Act, chapter 35 of title 42.(b) The director of the department of business regulation shall formulate a plan for the publication of the automobile insurance premiums, including but not limited to, an automobile insurance buyer's guide and rate comparison booklet.History of Section.P.L. 1993, ch. 152,  1.
  27-9-55. Repealed.History of Section.P.L. 1993, ch. 152,  1; Repealed by P.L. 2011, ch. 158,  2, effective June 30, 2011; P.L. 2011, ch. 274,  2, effective July 12, 2011.
  27-9-56. Use of credit rating.(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 his, her or its 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, non-renew 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 which 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 his or her 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.History of Section.P.L. 2002, ch. 303,  3; P.L. 2003, ch. 316,  2; P.L. 2003, ch. 370,  2.
  27-9-6.1. Approval of policies.(a) Every insurance company and every rating/advisory organization issuing policies covering casualty insurance provided for in this chapter shall file with the director a copy of the form of the policies proposing to use. A policy may not be issued until the director has approved the form.(b) Any policy form, subject to this chapter and filed by an insurer or rating/advisory organization on behalf of its members or subscribers with the director, shall be deemed public information at the time of filing.History of Section.P.L. 2002, ch. 175,  2.
  27-9-6. Contracts as to commissions or compensation.Nothing in  27-9-4 and 27-9-5 or in this chapter shall abridge or restrict the freedom of contract between insurers and insurance producers with respect to commissions or between insurers and their employees or other persons with respect to compensation for goods or services.History of Section.P.L. 1948, ch. 2089,  3; G.L. 1956,  27-9-6.
  27-9-7.1. Premium reduction for completing a motor vehicle accident prevention course.(a) Every schedule of rates, rating plan, or rating system for automobile liability and physical damage insurance filed with the commissioner shall provide for a reduction in premium charges for those persons fifty-five (55) years of age and older who successfully complete a motor vehicle accident prevention course approved by the division of motor vehicles. All insurers shall allow a reduction in the premium deemed appropriate by the commissioner to persons successfully completing that course.(b) Motor vehicle accident prevention courses shall be taught by instructors who may be members of the American Association of Retired Persons, and are certified or approved by the division of motor vehicles. Courses, may be approved which provide for a form of instruction, including, but not limited to, online courses, classroom, or driving instruction for a minimum number of hours determined by the division of motor vehicles. Instructors may or may not receive compensation.(c) Each person who completes an approved course shall be issued a certificate by the course sponsor, provided that person has no chargeable accidents or convictions within a three (3) year period. Any certificate issued shall be valid for a period of two (2) years from its issuance, provided the holder has had no chargeable accidents or convictions within a three (3) year period. Any person who desires to renew or extend a certificate shall be required to successfully complete another course.(d) Nothing provided in this section shall preclude an insurer from increasing the premium or charging an insured a surcharge for motor vehicle accidents and/or motor vehicle convictions during the two (2) year period for which a certificate was issued.(e) This section shall not apply to any group automobile insurance policy under which premiums are broadly averaged for the group rather than determined individually.History of Section.P.L. 1984, ch. 414,  1; P.L. 2012, ch. 300,  1; P.L. 2012, ch. 322,  1.
  27-9-7.2. Premium reduction for antitheft devices.Every schedule of rates, rating plan, or rating system for automobile liability and physical damage insurance filed with the commissioner shall provide for an appropriate reduction in premium charges for vehicles equipped with an antitheft mechanism or device approved by the commissioner. The commissioner is authorized to promulgate rules and regulations to carry out the purpose of this section.History of Section.P.L. 1988, ch. 261,  1.
  27-9-7.3. Rating for nonbusiness policies.(a) Notwithstanding the requirements of  27-9-7, a filing made by an insurer under this section that provides for an overall statewide rate increase or decrease of no more than five percent (5%) in the aggregate for all coverages that are subject to the filing may take effect the date it is filed. The five percent (5%) limitation does not apply on an individual insured basis. No more than one rate filing may be made by an insurer pursuant to the expedited process provided in this subsection during any twelve (12) month period, unless a rate filing, when combined with any other rate filing or filings made by an insurer within the preceding twelve (12) months, does not result in an overall statewide increase or decrease of more than five percent (5%) in the aggregate for all coverages that are subject to the filing.(b) Rate filings falling outside of the limitation provided for in subsection (a) of this section shall be subject to  27-9-9, unless those filings are other exempt from those provisions pursuant to another section of the insurance code.(c) A filing submitted pursuant to subsection (a) of this section is considered to comply with state law. However, if the commissioner of insurance determines that the filing is inadequate or unfairly discriminatory, he/she shall issue a written order specifying in detail the provisions of the insurance code the insurer has violated and the reasons the filing is inadequate or unfairly discriminatory and stating a reasonable future date on which the filing is to be considered no longer effective. An order by the commissioner pursuant to this subsection that is issued more than thirty (30) days from the date on which the commissioner received the rate filing is prospective only and does not affect any contract issued or made before the effective date of the order. For purposes of this act, "unfairly discriminatory" means a rate for a risk that is classified in whole or in part on the basis of race, color, creed or national origin.(d) No rate increase within the limitation specified in subsection (a) of this section may be implemented with regard to an individual existing policy, unless the increase is applied at the time of a renewal or conditional renewal of an existing policy and the insurer, at least thirty (30) days in advance of the end of the insured's policy period, mails or delivers to the named insured, at the address shown in the policy, a written notice that clearly and conspicuously discloses its intention to change the rate. A notice of renewal or conditional renewal that clearly and conspicuously discloses the renewal premium applicable to the policy shall be deemed to be in compliance with this subsection.History of Section.P.L. 2004, ch. 481,  1.
  27-9-7.4. Automobile insurance  Persons on active duty in United States armed forces.An insurer shall not refuse to insure, or continue to insure, limit coverage available to, charge a reinstatement fee for, or increase the premiums for automobile insurance solely because a person failed to maintain insurance for a vehicle owned by the person during the six-month (6) period immediately preceding application if the person certifies, on a form provided by the insurer, that the lapse in coverage was because the person was on active duty in the armed forces of the United States for at least thirty (30) consecutive days and that the vehicle was not driven or moved during the six-month (6) period immediately preceding the application for insurance, or during the period of time the insurance was not maintained, whichever period is shorter.History of Section.P.L. 2016, ch. 376,  4; P.L. 2016, ch. 392,  4.
  27-9-7. Filing of rate plans and systems.Every insurer shall file with the commissioner every manual of classification, rule, rate, rating plan, rating system, and modification of any of these which it proposes to use; provided, that classification rates may be modified without additional filings to produce rates for individual risks which are lower than those filed and which evaluate variations in physical or moral hazards, individual risk experience, or expense provisions, and which are not inadequate or unfairly discriminatory. Every filing shall state the proposed effective date of the plan or system and shall indicate the character and extent of the coverage contemplated. When a filing is not accompanied by the information upon which the insurer supports that filing, and the commissioner does not have sufficient information to determine whether the filing meets the requirements of the chapter, the commissioner may require the insurer to furnish the information upon which it supports the filing. The information furnished in support of a filing may include: (1) the experience or judgment of the insurer or rating organization making the filing, (2) its interpretation of any statistical data it relies upon, (3) the experience of other insurers or rating organizations, or (4) any other relevant factors. A filing and any supporting information shall be open to public inspection.History of Section.P.L. 1948, ch. 2089,  4; G.L. 1956,  27-9-7; P.L. 1968, ch. 286,  1.
  27-9-8.1. Advisory organization  Permitted activity.Any advisory organization, in addition to other activities not prohibited, is authorized, on behalf of its members and subscribers, to:(1) Develop statistical plans including territorial and class definitions;(2) Collect statistical data from members, subscribers, or any other source;(3) Prepare and distribute prospective loss costs which may include provisions for special assessments;(4) Prepare and distribute factors, calculations, or formulas pertaining to classification, territory, increased limits, and other variables;(5) Prepare and distribute manuals of rating rules and rating schedules that do not include final rates, expense provisions, profit provisions, or minimum premiums;(6) Distribute information that is required or directed to be filed with the director;(7) Conduct research and collect statistics in order to discover, identify, and classify information relating to causes or prevention of losses;(8) Conduct research and collect information to determine the impact of statutory changes upon prospective loss costs and special assessments;(9) Prepare policy forms and endorsements and consult with members, subscribers, and others relative to their use and application;(10) Conduct research and on-site inspections for the purpose of providing risk information relating to individual structures;(11) Conduct on-site inspections to determine rating classifications for individual insured;(12) Establish a committee that may include insurance company representatives to review the determination of the rating classification for individual insured and suggest modifications to the classification system;(13) Collect, compile, and distribute past and current prices of individual insurers and publish that information;(14) Collect and compile exposure and loss experience for the purpose of individual risk experience ratings; and(15) Furnish any other services, as approved by the director, related to those services enumerated in this section.History of Section.P.L. 1998, ch. 148,  5.
  27-9-8.2. Applicability.Except as expressly provided in this chapter and chapter 7.1 of this title, the provisions of this chapter shall not apply to workers' compensation insurance.History of Section.P.L. 1998, ch. 148,  5.
  27-9-8. Filings by advisory organizations.(a) An insurer may satisfy its obligation to make filings by becoming a member of, or a subscriber to, a licensed advisory organization which 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.History of Section.P.L. 1948, ch. 2089,  4; G.L. 1956,  27-9-8; P.L. 1982, ch. 32, art. 5,  1; P.L. 1985, ch. 365,  19; P.L. 1987, ch. 579,  1; P.L. 1998, ch. 148,  4.
  27-9-9. Review of filings.The commissioner shall review filings as soon as reasonably possible after they have been made in order to determine whether they meet the requirements of this chapter.History of Section.P.L. 1948, ch. 2089,  4; G.L. 1956,  27-9-9.