reglab/housing_qa huggingface dataset:
RI Gen L § 27-36-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-36 - Consumer Representation at Rate Hearings|Section 27-36-2 - Annual assessments of insurance companies.

§ 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 general's obligations under this chapter. The general expenditures shall be proportionately assessed by the director of the department of business regulation against each company. In addition, actual reasonable costs for experts, such as but not limited to actuaries and economists, and other specific costs incurred by the attorney general related to insurance rate hearings, whether or not a public hearing has been held or the rate review has proceeded through a final decision by the department of business regulation or office of the health insurance commissioner, shall be billed directly by the attorney general to the company that initiated the filing.(b) The company billed for 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 general's office within sixty (60) days of the date invoiced. Assessments made pursuant to this section may be credited to the normal operating costs of each company and shall be deposited as general revenue.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.
RI Gen L § 27-37-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-37 - Cancellation of Group Insurance|Section 27-37-1 - Notice of cancellation.

§ 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.
RI Gen L § 27-38-1 - 27-38-9 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-38 - Insurance Coverage for Treatment of Substance Abuse|Section 27-38-1 - 27-38-9 - Repealed.

§ 27-38-1 — 27-38-9. Repealed.
RI Gen L § 27-38.1-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-38.1 - Insurance Coverage for Pediatric Preventive Care|Section 27-38.1-1 - Definitions.

§ 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.
RI Gen L § 27-38.1-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-38.1 - Insurance Coverage for Pediatric Preventive Care|Section 27-38.1-2 - Coverage required for pediatric preventive care.

§ 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.
RI Gen L § 27-38.1-3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-38.1 - Insurance Coverage for Pediatric Preventive Care|Section 27-38.1-3 - Benefits to be included in basic coverage.

§ 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 insurer's 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.
RI Gen L § 27-38.2-3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-38.2 - Insurance Coverage for Mental Illness and Substance Abuse|Section 27-38.2-3 - Medical necessity and appropriateness of treatment.

§ 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.
RI Gen L § 27-38.2-4 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-38.2 - Insurance Coverage for Mental Illness and Substance Abuse|Section 27-38.2-4 - Network coverage.

§ 27-38.2-4. Network coverage.The healthcare benefits outlined in this chapter apply only to services delivered within the health insurer's provider network; provided, that all health insurers shall be required to provide coverage for those benefits mandated by this chapter outside of the health insurer's provider network where it can be established that the required services are not available from a provider in the health insurer's 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.
RI Gen L § 27-38.2-5 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-38.2 - Insurance Coverage for Mental Illness and Substance Abuse|Section 27-38.2-5 - Repealed.

§ 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.
RI Gen L § 27-39-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-39 - Second Medical Opinion|Section 27-39-1 - Definitions.

§ 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 patient's life or causing serious impairment to the patient's 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 physician's 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.
RI Gen L § 27-39-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-39 - Second Medical Opinion|Section 27-39-2 - Insurance benefits for second opinion.

§ 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 insurer's 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 insurer's 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.
RI Gen L § 27-39-3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-39 - Second Medical Opinion|Section 27-39-3 - Insurance benefits for third opinion.

§ 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.
RI Gen L § 27-39-4 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-39 - Second Medical Opinion|Section 27-39-4 - Exclusions.

§ 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.
RI Gen L § 27-39-5 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-39 - Second Medical Opinion|Section 27-39-5 - Severability.

§ 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.
RI Gen L § 27-40-1 - 27-40-9 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-40 - Insurance Premium Finance Agreements|Section 27-40-1 - 27-40-9 - Repealed.

§ 27-40-1 — 27-40-9. Repealed.
RI Gen L § 27-41-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-1 - Short title.

§ 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.
RI Gen L § 27-41-6 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-6 - Governing body.

§ 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.
RI Gen L § 27-41-7 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-7 - Fiduciary responsibilities.

§ 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.
RI Gen L § 27-41-8 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-8 - Evidence of coverage and charges for health care services.

§ 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.
RI Gen L § 27-41-9 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-9 - Required reports.

§ 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.
RI Gen L § 27-41-10 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-10 - Information to enrollees.

§ 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 organization's method for resolving enrollee complaints.History of Section.P.L. 1983, ch. 225, § 2.
RI Gen L § 27-41-11 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-11 - Complaint system.

§ 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.
RI Gen L § 27-41-13.1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-13.1 - Initial net worth and capital requirements.

§ 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 commissioner's 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.
RI Gen L § 27-41-13.2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-41 - Health Maintenance Organizations|Section 27-41-13.2 - Ongoing net worth and capital requirements.

§ 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 director's discretion.History of Section.P.L. 2005, ch. 176, § 2.