reglab/housing_qa huggingface dataset:
RI Gen L § 27-41-71 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-71 - Mandatory coverage for scalp hair prosthesis.

§ 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.
RI Gen L § 27-41-73 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-73 - Licensed ambulance service.

§ 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.
RI Gen L § 27-41-74 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-74 - Enteral nutrition products.

§ 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 Crohn's disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein and shall extend to all recipients regardless of age.(b) Benefit plans offered by a health maintenance organization may impose a copayment 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.
RI Gen L § 27-41-75 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-75 - Prohibition on rescission of coverage.

§ 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.
RI Gen L § 27-41-78 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-78 - Medical loss ratio reporting and rebates.

§ 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.
RI Gen L § 27-41-80 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-80 - Internal and external appeal of adverse benefit determinations.

§ 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.
RI Gen L § 27-41-81 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-81 - Prohibition on preexisting condition exclusions.

§ 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 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, § 10; P.L. 2012, ch. 262, § 10.
RI Gen L § 27-41-82 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-82 - Primary care provider designation requirement.

§ 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.
RI Gen L § 27-41-83 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-83 - Discretionary clauses.

§ 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.
RI Gen L § 27-41-84 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-84 - Orally administered anticancer medication - Cost-sharing requirement.

§ 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.
RI Gen L § 27-41-85 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-85 - Consumer notification.

§ 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.
RI Gen L § 27-41-86 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-86 - Opioid antagonists.

§ 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.
RI Gen L § 27-41-88 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-88 - Unfair discrimination prohibited.

§ 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.
RI Gen L § 27-41-89 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-89 - Health insurance contracts - Full year coverage for contraception.

§ 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.
RI Gen L § 27-42-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Health Care Benefits|Section 27-42-1 - Purpose.

§ 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.
RI Gen L § 27-42-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Health Care Benefits|Section 27-42-2 - Authority and jurisdiction of director of business regulation.

§ 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.
RI Gen L § 27-42-3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Health Care Benefits|Section 27-42-3 - How to show jurisdiction.

§ 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.
RI Gen L § 27-42-4 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Health Care Benefits|Section 27-42-4 - Examination.

§ 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.
RI Gen L § 27-42-5 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Health Care Benefits|Section 27-42-5 - Subject to state laws.

§ 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.
RI Gen L § 27-42-6 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Health Care Benefits|Section 27-42-6 - Disclosure.

§ 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.