reglab/housing_qa huggingface dataset:
RI Gen L § 27-20-56 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-56 - Enteral nutrition products.

§ 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 Crohn's disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein and shall extend to all recipients regardless of age.(b) Benefit plans offered by a 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.
RI Gen L § 27-20-57 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-57 - Prohibition on preexisting condition exclusions.

§ 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 individual's health status before the individual's effective date of coverage, or if the coverage is denied, the date of denial, under the health benefit plan, such as a condition (whether physical or mental) identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period.(c) This section shall not apply to grandfathered health plans providing individual health insurance coverage.(d) This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.History of Section.P.L. 2012, ch. 256, § 8; P.L. 2012, ch. 262, § 8.
RI Gen L § 27-20-58 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-58 - Prohibition on rescission of coverage.

§ 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.
RI Gen L § 27-20-61 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-61 - Medical loss ratio reporting and rebates.

§ 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.
RI Gen L § 27-20-63 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-63 - Internal and external appeal of adverse benefit determinations.

§ 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.
RI Gen L § 27-20-64 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-64 - Reserved.

§ 27-20-64. Reserved.
RI Gen L § 27-20-65 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-65 - Primary care provider designation requirement.

§ 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.
RI Gen L § 27-20-66 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-66 - Discretionary clauses.

§ 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.
RI Gen L § 27-20-67 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-67 - Orally administered anticancer medication - Cost-sharing requirement.

§ 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.
RI Gen L § 27-20-68 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-68 - Consumer notification.

§ 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.
RI Gen L § 27-20-69 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-69 - Opioid antagonists.

§ 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.
RI Gen L § 27-20-71 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-71 - Unfair discrimination prohibited.

§ 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.
RI Gen L § 27-20-72 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20 - Nonprofit Medical Service Corporations|Section 27-20-72 - Health insurance contracts - Full year coverage for contraception.

§ 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.
RI Gen L § 27-20.1-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.1 - Nonprofit Dental Service Corporations|Section 27-20.1-1 - Definitions.

§ 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.
RI Gen L § 27-20.1-3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.1 - Nonprofit Dental Service Corporations|Section 27-20.1-3 - Contracts.

§ 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 corporation's management decisions, or utilization review provisions for any patient.History of Section.P.L. 1959, ch. 183, § 1; P.L. 1999, ch. 481, § 4.
RI Gen L § 27-20.1-4 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.1 - Nonprofit Dental Service Corporations|Section 27-20.1-4 - Annual and quarterly statements.

§ 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.
RI Gen L § 27-20.1-5 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.1 - Nonprofit Dental Service Corporations|Section 27-20.1-5 - Examination of affairs of corporation.

§ 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.
RI Gen L § 27-20.1-6 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.1 - Nonprofit Dental Service Corporations|Section 27-20.1-6 - Commission plans for solicitors or insurance producers.

§ 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.