reglab/housing_qa huggingface dataset:
RI Gen L § 27-18-71 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-71 - Prohibition on preexisting condition exclusions.

§ 27-18-71. Prohibition on preexisting condition exclusions.(a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title and/or chapter:(1) Shall not limit or exclude coverage for an individual under the age of nineteen (19) by imposing a preexisting condition exclusion on that individual.(2) For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude coverage for any individual by imposing a preexisting condition exclusion on that individual.(b) As used in this section:(1) "Preexisting condition exclusion" means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition (whether physical or mental) was present before the effective date of coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, diagnosis, care or treatment was recommended or received before the effective date of coverage.(2) "Preexisting condition exclusion" means any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an 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, § 2; P.L. 2012, ch. 262, § 2.
RI Gen L § 27-18-72 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-72 - Prohibition on rescission of coverage.

§ 27-18-72. Prohibition on rescission of coverage.(a) (1) Coverage under a health benefit plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be rescinded after the individual is covered under the plan, unless:(A) The individual or a person seeking coverage on behalf of the individual, performs an act, practice or omission that constitutes fraud; or(B) The individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage.(2) For purposes of paragraph (a)(1)(A), a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health carrier.(b) At least thirty (30) days advance written notice shall be provided to each health benefit plan enrollee or, for individual health insurance coverage, primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of, in the case of group health insurance coverage, whether the rescission applies to the entire group or only to an individual within the group.(c) For purposes of this section, "to rescind" means to cancel or to discontinue coverage with retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.(d) This section applies to grandfathered health plans.History of Section.P.L. 2012, ch. 256, § 2; P.L. 2012, ch. 262, § 2.
RI Gen L § 27-18-75 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-75 - Medical loss ratio reporting and rebates.

§ 27-18-75. Medical loss ratio reporting and rebates.(a) A health insurance carrier offering group or individual health insurance coverage of a health benefit plan, including a grandfathered health plan, shall comply with the provisions of Section 2718 [42 U.S.C. § 300gg-18] of the Public Health Service Act as amended by the federal Affordable Care Act, in accordance with regulations adopted thereunder.(b) Health insurance carriers required to report medical loss ratio and rebate calculations and other medical loss ratio and rebate information to the U.S. Department of Health and Human Services shall concurrently file such information with the commissioner.History of Section.P.L. 2012, ch. 256, § 2; P.L. 2012, ch. 262, § 2.
RI Gen L § 27-18-77 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-77 - Internal and external appeal of adverse benefit determinations.

§ 27-18-77. Internal and external appeal of adverse benefit determinations.(a) The commissioner shall adopt regulations to implement standards and procedures with respect to internal claims and appeals of adverse benefit determinations, and with respect to external appeals of adverse benefit determinations.(b) The regulations adopted by the commissioner shall apply only to those adverse benefit determinations which are not subject to the jurisdiction of the department of health pursuant to § 23-17.12 et seq. (Utilization Review Act).(c) This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies. This section also shall not apply to grandfathered health plans.History of Section.P.L. 2012, ch. 256, § 2; P.L. 2012, ch. 262, § 2.
RI Gen L § 27-18-78 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-78 - Primary care provider designation requirement.

§ 27-18-78. Primary care provider designation requirement.(a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2013, shall require that the subscriber and each dependent designate a participating primary care provider and the insurer shall collect the designation from the insured. Designation of a primary care provider shall not be a condition of enrollment and failure to designate a primary care provider shall not constitute grounds for cancellation of coverage. For purposes of this section, "primary care provider" means the physician, practice or other medical provider considered by the insured to be his or her usual source of medical care.(b) Requirements for designating a primary care provider enumerated in subsection (a) shall not apply to insurance coverage providing benefits for:(1) Hospital confinement indemnity;(2) Disability income;(3) Accident only;(4) Long-term care;(5) Medicare supplement;(6) Limited benefit health;(7) Specified disease indemnity;(8) Sickness or bodily injury or death by accident or both; or(9) Other limited benefit policies.History of Section.P.L. 2012, ch. 189, § 3; P.L. 2012, ch. 202, § 3.
RI Gen L § 27-18-79 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-79 - Discretionary clauses.

§ 27-18-79. Discretionary clauses.(a) No new or existing policy or certificate issued by an insurer or healthcare entity may contain any provision:(1) Purporting to reserve sole discretion to the insurer or healthcare entity to determine eligibility for benefits or interpret the terms of a policy or certificate; or(2) Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.(b) For purposes of this section, "healthcare entity" means a health insurance company or nonprofit hospital or medical or dental service corporation or plan or health maintenance organization which operates or administers a health plan in this state.(c) Any such clause or language included in a contract, policy or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.(d) Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.History of Section.P.L. 2013, ch. 85, § 2; P.L. 2013, ch. 94, § 2.
RI Gen L § 27-18-80 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-80 - Orally administered anticancer medication - Cost-sharing requirement.

§ 27-18-80. Orally administered anticancer medication — Cost-sharing requirement.(a) Every individual or group hospital or medical expense, insurance policy or individual or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued for delivery, or renewed in this state, on or after January 1, 2014, that offers both medical and prescription drug coverage, and provides coverage for intravenously administered anticancer medication, shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section. Notwithstanding the above, the requirements shall not be construed to impose any form of cap on cost-sharing.(b) This section does not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.History of Section.P.L. 2013, ch. 323, § 1; P.L. 2013, ch. 405, § 1.
RI Gen L § 27-18-81 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-81 - Consumer notification.

§ 27-18-81. Consumer notification.Every health insurer or health plan providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a non-duplication of benefits clause: "NO DUPLICATION OF BENEFITS".History of Section.P.L. 2013, ch. 452, § 1; P.L. 2013, ch. 479, § 1.
RI Gen L § 27-18-82 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-82 - Opioid antagonists.

§ 27-18-82. Opioid antagonists.(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended or renewed in this state on or after January 1, 2017, shall provide coverage for at least one generic opioid antagonist and device. Prior authorization may be required for non-generic forms of opioid antagonists and devices.(b) As used in this section:"Opioid antagonist" means naloxone hydrochloride and any other drug approved by the United States Food and Drug Administration for the treatment of opioid overdose.(c) The coverage mandated by this section shall include generic opioid antagonists prescribed or dispensed via standing order or collaborative-practice agreement intended for use on patients other than the insured. Prior authorization may be required for non-generic forms of opioid antagonists and devices.(d) Notwithstanding § 27-18-19, or any other provision to the contrary, this section shall apply to blanket or group polices of insurance.History of Section.P.L. 2016, ch. 175, § 1; P.L. 2016, ch. 192, § 1.
RI Gen L § 27-18-84 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18 - Accident and Sickness Insurance Policies|Section 27-18-84 - Health insurance contracts - Full year coverage for contraception.

§ 27-18-84. Health insurance contracts — Full year coverage for contraception.Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time.History of Section.P.L. 2018, ch. 230, § 1; P.L. 2018, ch. 234, § 1.
RI Gen L § 27-18.1-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law|Section 27-18.1-1 - Purpose.

§ 27-18.1-1. Purpose.The purpose of this chapter is to assure full federal support of the Rhode Island medical assistance program by providing for full compliance with 42 U.S.C. § 1301 et seq.History of Section.P.L. 1979, ch. 52, § 1.
RI Gen L § 27-18.1-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law|Section 27-18.1-2 - Definitions.

§ 27-18.1-2. Definitions.(a) "Blanket or group policy of insurance" means any accident and sickness insurance policy made exempt from the provisions of chapter 18 of this title by the operation of § 27-18-19(3).(b) "Contract providing a health benefit or benefits" means a policy of accident and health insurance which provides a health benefit or that part of a policy, which provides other benefits in addition to health benefits, which does provide health benefits. It also means a subscriber contract offered by a health maintenance organization or by any nonprofit service corporation, whether or not the contract is described as providing health maintenance organization benefits.(c) "Health benefit" means benefit or health benefit as defined in § 42-62-4.(d) "Health maintenance organization" means a "qualified health maintenance organization" as referred to in § 42-62-9.(e) "Insurance company" means a domestic insurance company incorporated by the general assembly and subject to chapter 1 of this title, or a foreign insurance company licensed to do business in Rhode Island and subject to chapter 2 of this title.(f) "Nonprofit service corporation" means a nonprofit hospital service corporation as defined in chapter 19 of this title, a nonprofit medical service corporation as defined in chapter 20 of this title, a nonprofit dental service corporation as defined in chapter 20.1 of this title, or a nonprofit optometric service corporation as defined in chapter 20.2 of this title.(g) "Policy of accident and sickness insurance" means a policy of accident and sickness insurance as defined in chapter 18 of this title, and, in addition, means any blanket or group policy of insurance, as defined in subsection (a) of this section.History of Section.P.L. 1979, ch. 52, § 1.
RI Gen L § 27-18.1-3 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law|Section 27-18.1-3 - Exclusions and limitations prohibited.

§ 27-18.1-3. Exclusions and limitations prohibited.No insurance company, health maintenance organization, or nonprofit corporation may issue, deliver, or renew any contract providing a health benefit or benefits which contains any provisions excluding or limiting its benefits on account of eligibility for or payment of benefits under 42 U.S.C. § 1396 et seq.; provided, that the application of this section shall not increase the personal liability to health care providers of a medical assistance recipient of health services, as those services are defined in § 42-62-4.History of Section.P.L. 1979, ch. 52, § 1; P.L. 2002, ch. 292, § 34.
RI Gen L § 27-18.1-4 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law|Section 27-18.1-4 - Rules and regulations.

§ 27-18.1-4. Rules and regulations.The director of business regulation shall promulgate any rules and regulations as he or she shall deem necessary for the efficient administration of this chapter.History of Section.P.L. 1979, ch. 52, § 1.
RI Gen L § 27-18.1-5 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law|Section 27-18.1-5 - Applicability.

§ 27-18.1-5. Applicability.In keeping with the provisions of §§ 27-19-2, 27-20-2, 27-20.1-2, and 27-20.2-2, it is expressly provided that all corporations subject to chapters 19, 20, 20.1, and 20.2 of this title are subject to this chapter.History of Section.P.L. 1979, ch. 52, § 1.
RI Gen L § 27-18.1-6 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law|Section 27-18.1-6 - Severability.

§ 27-18.1-6. Severability.If any provision of the chapter or the application of a provision to any person or circumstances shall be held invalid, the remainder of the chapter and the application of the provision to persons or circumstances other than those as to which it is held invalid shall not be affected by that invalidity.History of Section.P.L. 1979, ch. 52 § 1.
RI Gen L § 27-18.2-1 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.2 - Medicare Supplement Insurance Policies|Section 27-18.2-1 - Definitions.

§ 27-18.2-1. Definitions.(a) "Applicant" means:(1) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and(2) In the case of a group Medicare supplement policy, the proposed certificate holder.(b) "Certificate" means, for the purposes of this chapter, any certificate delivered or issued for delivery in this state under a group Medicare supplement policy.(c) "Certificate form" means the form on which the certificate is delivered or issued for delivery by the issuer.(d) "Director" means the director of the department of business regulation.(e) "Issuer" includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates.(f) "Medicare" means the "Health Insurance for the Aged Act," 42 U.S.C. § 1395 et seq.(g) "Medicare supplement policy" means a group or individual policy of accident and sickness insurance, as defined in § 27-18-1, or a subscriber contract of a nonprofit hospital service corporation or of a nonprofit medical service corporation or an evidence of coverage of a health maintenance organization as defined in § 42-62-4(5) or as licensed under chapter 41 of this title, other than a policy issued pursuant to a contract under Section 1876 of the Federal Social Security Act, 42 U.S.C. § 1395mm, or an issued policy under a demonstration project specified in 42 U.S.C. § 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare.(h) "Policy form" means the form on which the policy is delivered or issued for delivery by the issuer.History of Section.P.L. 1984, ch. 49, § 1; P.L. 1988, ch. 631, § 1; P.L. 1989, ch. 428, § 1; P.L. 1992, ch. 445, § 4; P.L. 1993, ch. 180, § 12; P.L. 1996, ch. 190, § 1.
RI Gen L § 27-18.2-2 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.2 - Medicare Supplement Insurance Policies|Section 27-18.2-2 - Applicability and scope.

§ 27-18.2-2. Applicability and scope.(a) Except as otherwise specifically provided, this chapter shall apply to:(1) All Medicare supplement policies and subscriber contracts delivered or issued for delivery in this state on or after July 1, 1992; and(2) All certificates issued under group Medicare supplement policies, which certificates have been delivered or issued for delivery in this state.(b) This chapter shall not apply to a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination of them, for employees or former employees or a combination of them, or for members or former members, or a combination of them, of the labor organizations.(c) Except as otherwise specifically provided in § 27-18.2-6(d), the provisions of this chapter are not intended to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to Medicare eligible persons which policies are not marketed or held to be Medicare supplement policies or benefit plans.History of Section.P.L. 1988, ch. 631, § 2; P.L. 1989, ch. 428, § 1; P.L. 1990, ch. 218, § 1; P.L. 1992, ch. 445, § 4; P.L. 1993, ch. 180, § 12; P.L. 1996, ch. 190, § 1.
RI Gen L § 27-18.2-4 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.2 - Medicare Supplement Insurance Policies|Section 27-18.2-4 - Loss ratio standards.

§ 27-18.2-4. Loss ratio standards.Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director shall issue reasonable regulations to establish minimum standards for loss ratios of Medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices.History of Section.P.L. 1988, ch. 631, § 2; P.L. 1989, ch. 428, § 1; P.L. 1990, ch. 218, § 1; P.L. 1992, ch. 445, § 4; P.L. 1993, ch. 180, § 12.
RI Gen L § 27-18.2-5 (2021)
2021 Rhode Island General Laws|Title 27 - Insurance|Chapter 27-18.2 - Medicare Supplement Insurance Policies|Section 27-18.2-5 - Repealed.

§ 27-18.2-5. Repealed.