reglab/housing_qa huggingface dataset:
RI Gen L § 27-20.7-6 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.7 - Third Party Health Insurance Administrators|Section 27-20.7-6 - Approval of advertising.

§ 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.
RI Gen L § 27-20.7-7 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.7 - Third Party Health Insurance Administrators|Section 27-20.7-7 - Responsibilities of the insurer.

§ 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.
RI Gen L § 27-20.7-8 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.7 - Third Party Health Insurance Administrators|Section 27-20.7-8 - Premium collection and payment of claims.

§ 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.
RI Gen L § 27-20.7-9 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.7 - Third Party Health Insurance Administrators|Section 27-20.7-9 - Compensation to the administrator.

§ 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 administrator's commissions, fees, or charges contingent upon savings effected in the adjustment, settlement and payment of losses covered by the insurer's 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.
RI Gen L § 27-20.7-10 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.7 - Third Party Health Insurance Administrators|Section 27-20.7-10 - Notice and disclosure of charges and fees.

§ 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.
RI Gen L § 27-20.7-11 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.7 - Third Party Health Insurance Administrators|Section 27-20.7-11 - Delivery of materials.

§ 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.
RI Gen L § 27-20.7-13 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.7 - Third Party Health Insurance Administrators|Section 27-20.7-13 - Waiver of application for certification.

§ 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.
RI Gen L § 27-20.7-14 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.7 - Third Party Health Insurance Administrators|Section 27-20.7-14 - Annual report and filing fee.

§ 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.
RI Gen L § 27-20.7-16 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.7 - Third Party Health Insurance Administrators|Section 27-20.7-16 - Unauthorized third party administrator business.

§ 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.
RI Gen L § 27-20.8-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.8 - Prescription Drug Benefits|Section 27-20.8-1 - Definitions.

§ 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.
RI Gen L § 27-20.8-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.8 - Prescription Drug Benefits|Section 27-20.8-2 - Pharmacy benefit, limits and co-payments.

§ 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 plan's pharmacy benefit has a dollar limit, the insured's use of such benefit shall be determined based on the health plan's contracted rate to purchase the drug minus the enrollee's applicable co-payment for covered drugs. The balance will apply towards the enrollee's 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 plan's 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.
RI Gen L § 27-20.9-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.9 - Contract With Health Care Providers|Section 27-20.9-1 - Health care contracts - Required provisions - Definitions.

§ 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.
RI Gen L § 27-20.9-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.9 - Contract With Health Care Providers|Section 27-20.9-2 - Credentialing - Insurers shall notify providers of initial credentialing within ten business days of approval by the insurer credentialing committee.

§ 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 insurer's subscribers or members following the first business day after the credentialing committee's 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.
RI Gen L § 27-20.9-3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.9 - Contract With Health Care Providers|Section 27-20.9-3 - Pay-for-performance guidelines.

§ 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.
RI Gen L § 27-20.10-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.10 - Rental Network Contract Arrangements|Section 27-20.10-2 - Scope.

§ 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 children's 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 provider's healthcare services and contractual discounts to any other entity.History of Section.P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1.
RI Gen L § 27-20.10-3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.10 - Rental Network Contract Arrangements|Section 27-20.10-3 - Registration.

§ 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 entity's main headquarters; and(iii) The name and telephone number of the contracting entity's 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.
RI Gen L § 27-20.10-5 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.10 - Rental Network Contract Arrangements|Section 27-20.10-5 - Third-party rights and responsibilities.

§ 27-20.10-5. Third-party rights and responsibilities.(a) A third-party, having itself been granted access to a provider's 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 provider's 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 provider's healthcare services and contractual discounts pursuant to the provider network contract.(2) The website will allow the providers under the contracting entity's 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.
RI Gen L § 27-20.10-6 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.10 - Rental Network Contract Arrangements|Section 27-20.10-6 - Unauthorized access to provider network contracts.

§ 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 provider's 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 provider's services and discount to any other third-party.History of Section.P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1.
RI Gen L § 27-20.10-7 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.10 - Rental Network Contract Arrangements|Section 27-20.10-7 - Enforcement.

§ 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.
RI Gen L § 27-20.11-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.11 - Autism Spectrum Disorders|Section 27-20.11-1 - Mandatory coverage for Autism spectrum disorders.

§ 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.
RI Gen L § 27-20.11-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-20.11 - Autism Spectrum Disorders|Section 27-20.11-2 - Definitions.

§ 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.