reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-86. - Epinephrine injectors.

§ 27-19-86. Epinephrine injectors.
(a)
The Rhode Island general assembly recognizes that epinephrine cartridges and injectors are life-saving devices that must be administered quickly to be effective. Such administration is often done by persons who are not healthcare professionals, and is done in an emergency situation. Accordingly, it is in the best interests of the people of the state to promote the widespread availability of epinephrine cartridges and injectors.
(b)
Every individual or group health insurance contract, plan, or policy that provides prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2025, shall provide coverage for at least one type of epinephrine auto-injectors and cartridges. There shall be no copayment required, and no deductible shall need to be met, to obtain a two (2) pack of the epinephrine auto-injectors or cartridges covered by the contract, plan, or policy, once every twelve-month (12) plan year. A deductible may be applied to health plans that are paired with a federally qualified health savings account pursuant to 26 U.S.C. § 223. Nothing in this section would prohibit a health plan from implementing this benefit prior to January 1, 2025.
History of Section.
P.L. 2023, ch. 263, § 2, effective June 22, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-1. - Legislative findings.

§ 27-19.2-1. Legislative findings.
The general assembly finds and declares that it is in the best interests of the residents of Rhode Island:
(1)
To strengthen and reform the governance structure of nonprofit hospital service and/or medical service corporations;
(2)
To ensure a diverse, independent, and publicly accountable board of directors;
(3)
To prohibit certain activities that may allow self-interest to compromise undivided loyalty to the public interest mission for which these corporations were established; and
(4)
To require adoption of principles and procedures to keep these corporations aligned with their public interest mission.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-2. - Definitions.

§ 27-19.2-2. Definitions.
(a)
“Affiliate” means an entity controlled by, controlling, or in common control with, a nonprofit hospital service corporation.
(b)
“Health insurer” means an insurer defined in § 27-20.6-1(1).
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-3. - Mission statement contents.

§ 27-19.2-3. Mission statement contents.
All nonprofit hospital and/or medical service corporations and any affiliate or subsidiary of such corporation shall, on or before December 31, 2004, have a declared and published mission statement identifying the purposes of said nonprofit as including:
(1)
To provide affordable and accessible health insurance to insureds, including those persons insured by an affiliate or subsidiary of said plan;
(2)
To assist and support public and private healthcare initiatives for individuals without healthcare insurance;
(3)
To promote integration, efficiency, and coherence of a statewide healthcare system that meets the needs of all Rhode Island residents;
(4)
To contribute through its operations, procedures, and investments to the improvement of medical and prevention services delivered in Rhode Island; and
(5)
To provide affordable and accessible health insurance to a comprehensive range of consumers, including business owners, employees, and unemployed individuals.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-4. - Board of directors — Duties and functions of board of directors.

§ 27-19.2-4. Board of directors — Duties and functions of board of directors.
(a)
The board of a nonprofit hospital and/or medical service corporation and its individual members are fiduciaries and shall act at all times:
(1)
In utmost good faith;
(2)
In a manner reasonably believed to be in the best interest of fulfilling the corporation’s mission or the mission of affiliates or subsidiaries;
(3)
In a manner reflecting undivided loyalty to the furtherance of the corporation’s charitable mission;
(4)
At the highest standard of fiduciary care and prudence;
(5)
In accordance with a conflict of interest policy adopted by the board of directors that will be consistent with guidelines recommended and published by the U.S. Internal Revenue Service for nonprofit entities; and
(6)
Physicians who receive compensation from the nonprofit hospital and/or medical service corporation, for services rendered in their professional capacity, directly or indirectly, may serve on board committees that address compensation matters; provided, however, that no such physician member may participate in a vote or deliberate on matters relating to physician compensation.
(b)
The proper and principal functions of the board shall include:
(1)
Ensuring that the corporation effectively carries out the charitable mission for which it was incorporated under § 27-19-2;
(2)
Selecting corporate management and evaluating its performance in light of the corporation’s charitable purpose;
(3)
Recognizing that in the event of a conversion as defined in § 27-66-4, the reserves and assets with which they are entrusted are charitable assets, and treating them with according stewardship;
(4)
Establishing a system of board governance including an annual evaluation of board performance measured against the charitable purpose of the corporation; and
(5)
Holding an annual public meeting with proper notice open to providers and subscribers at which comments shall be heard from the floor.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2; P.L. 2005, ch. 39, § 1; P.L. 2005, ch. 73, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-5. - Composition of board of directors.

§ 27-19.2-5. Composition of board of directors.
(a)(1)
Notwithstanding any public law, rule, or regulation to the contrary, six (6) positions on the board of directors of a nonprofit hospital and/or medical service corporation shall be filled by public appointment for a maximum of three (3) three-year (3) terms. Public appointment of two (2) of the directors shall be made by the governor, two (2) shall be made by the speaker of the house, and two (2) shall be made by the president of the senate. Neither state employees nor elected state officials shall serve as public members of the board of directors. Each appointing authority shall make one such appointment on or after July 1, 2004, and the remaining will be made on or after July 1, 2005. Once appointed, public members may only be removed in accordance with the bylaws of the nonprofit hospital and/or medical service corporation. When sufficient public appointments have been made, vacancies shall thereafter be filled for a maximum of three (3) three-year (3) terms as the board of directors may determine, and consistent with subsection (a)(2) of this section, except that seats filled by public appointment pursuant to this subsection shall always remain subject to such public appointment, upon the resignation, removal, incapacity, or retirement of the incumbent public appointee. Public appointees shall not constitute a majority of the board.
(2)
Future vacancies not filled by public appointment pursuant to subsection (a)(1) of this section shall be filled by an open and public process of recruitment and appointment, to be determined by the board and within its discretion, but to include public solicitation of candidates.
(3)
At the end of their term, directors shall continue to serve until their successors are appointed and qualified. Nothing herein prevents the reappointment of a board member presently serving.
(4)
Public appointees may not:
(i)
Be employed by or have a financial interest in:
(A)
A nonprofit hospital and/or medical service plan or its affiliates or subsidiaries;
(B)
A person regulated under this article; or
(ii)
Within three (3) years before appointment, have been employed by, had a financial interest in, or have received compensation from:
(A)
A nonprofit hospital and/or medical service plan or its affiliates or subsidiaries; or
(B)
A person regulated under this article.
(b)
An officer or employee of a nonprofit hospital and/or medical service plan or any of its affiliates or subsidiaries may not be appointed or elected to the board.
(c)
Each standing committee shall have representation from the public appointee members.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2; P.L. 2006, ch. 616, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-6. - Actions requiring supermajority board approval.

§ 27-19.2-6. Actions requiring supermajority board approval.
Neither a nonprofit hospital service corporation, nor an affiliate (as defined in 27-19.2-2) that is an insurer (as defined in § 27-20.6-1(1)), may take any of the following actions without the prior approval of at least two-thirds percent (66.67%) of the corporation’s entire board of directors:
(1)
Authorize a conversion as defined in 27-66-4;
(2)
Withdraw a health insurance product previously offered in the individual market; or
(3)
Result in the withdrawal from a geographic region.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2; P.L. 2008, ch. 475, § 84.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-7. - Compensation of board members.

§ 27-19.2-7. Compensation of board members.
(a)
Pending appointment and confirmation of the health insurance commissioner, no compensation shall be paid to the board members by a nonprofit hospital or medical services corporation, excluding reimbursement for ordinary and necessary expenses. After such confirmation, the board must file application with the health insurance commissioner for approval of any proposed board compensation. Childcare, parking, transportation, and other reasonable expenses for board members attending meetings shall be compensable.
(b)
On or before March 1, 2005, and annually thereafter, a corporation subject to this paragraph shall report to the health insurance commissioner the ordinary and necessary expenses paid to each board member in the preceding calendar year.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-8. - Compensation of officers and executives.

§ 27-19.2-8. Compensation of officers and executives.
(a)
There shall be a standing compensation committee of the board that shall develop proposed guidelines, for approval by the board, for compensation, including salary, bonuses, perquisites, and severance agreements, of all officers and executives that is reasonable.
(b)
On or before December 31, 2004, the board shall file its proposed guidelines for executive compensation with the health insurance commissioner.
(c)
No corporation organized pursuant to this chapter shall extend or maintain credit, arrange for the extension of credit, or renew an extension of credit in the form of a personal loan to or for any director or officer, nor shall such corporation allow for or arrange any payments or obligations in violation of § 27-66-7.1.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-9. - Code of ethics.

§ 27-19.2-9. Code of ethics.
Each nonprofit hospital and/or medical services corporation shall adopt a code of ethics for its officers and directors that shall include, but is not limited to: a policy protecting the corporation and the public from conflicts of interest and abuse of position; a policy protecting the confidentiality of individuals’ private information the corporation may obtain; procedures for contracts with government agencies; policies on political contributions by board members (with particular attention to offices involved in the appointment process or regulatory oversight); policies for board education, including education in governance and fiduciary duty; and whistleblower protection and document retention policies. Said code of ethics policy shall be filed with the attorney general and the health insurance commissioner. No policy shall be deemed adequate without providing for appropriate distribution, compliance, and enforcement of the policy.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-10. - Nonprofit hospital and/or medical service corporations — Responsibilities.

§ 27-19.2-10. Nonprofit hospital and/or medical service corporations — Responsibilities.
In accordance with their nonprofit hospital and/or medical service corporation mission, nonprofit insurers shall be required to:
(1)
Offer products in the small group;
(2)
Offer products in the individual market, with at least one 30-day open enrollment period every twelve (12) months;
(3)
Employ pricing strategies that enhance the affordability of healthcare coverage; and
(4)
Protect the financial condition of the nonprofit hospital and/or medical service plan.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19.2 - Nonprofit Hospital and Medical Service Corporations › Section 27-19.2-11. - Application to subsidiary entities.

§ 27-19.2-11. Application to subsidiary entities.
The terms of this chapter shall apply to any insurer or health maintenance organization, or other entity involved in delivering health insurance, whether or not organized as a nonprofit corporation, that is owned or controlled by a nonprofit hospital and/or medical service plan, unless specifically exempted by law.
History of Section.
P.L. 2004, ch. 330, § 2; P.L. 2004, ch. 567, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-1.1. - Applicability.

§ 27-20-1.1. Applicability.
This chapter shall apply to any nonprofit hospital service corporation which provides coverage or benefits for medical services under the provisions of chapter 19 of this title or otherwise.
History of Section.
P.L. 1987, ch. 107, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-2. - Organization as charitable corporation — Insurance laws inapplicable.

§ 27-20-2. Organization as charitable corporation — Insurance laws inapplicable.
Each nonprofit medical service corporation shall be incorporated as a charitable corporation under the provisions of chapter 6 of title 7, and shall be subject to that chapter and to this chapter. The laws of this state relative to insurance companies or to the business of insurance, and acts in amendment or in addition to those laws, shall not apply to any nonprofit medical service corporation unless expressly provided in those laws. Each nonprofit medical service corporation shall be deemed to be an insurer, for the purposes of compliance with chapter 17 of title 44.
History of Section.
P.L. 1945, ch. 1598, § 2; G.L. 1956, § 27-20-2; P.L. 2007, ch. 73, art. 28, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-3. - Qualifications of directors.

§ 27-20-3. Qualifications of directors.
A majority of the directors of a nonprofit medical service corporation, other than a corporation organized pursuant to the provisions of chapter 19 of this title, must at all times be doctors of medicine duly licensed to practice under the laws of this state. The directors of any nonprofit medical service corporation formed after January 1, 1964, shall consist of an equal number of representatives of the public, doctors of medicine duly licensed to practice under the laws of this state, and subscribers.
History of Section.
P.L. 1945, ch. 1598, § 2; G.L. 1956, § 27-20-3; P.L. 1964, ch. 79, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-4. - Approval of articles of association.

§ 27-20-4. Approval of articles of association.
No articles of association of a nonprofit medical service corporation shall be filed in the office of the secretary of state unless and until the governor shall have certified in writing upon those articles that he or she has determined that public convenience and advantage will be promoted by the establishment of the corporation and that the filing of the articles has the approval of the Rhode Island Medical Society as evidenced by an affidavit of the president and secretary of the society. No articles of association of a nonprofit medical service corporation formed after January 1, 1964, shall be filed in the office of the secretary of state unless and until the governor shall have certified in writing upon the articles that he or she has determined that public convenience and advantage will be promoted by the establishment of the corporation.
History of Section.
P.L. 1945, ch. 1598, § 2; G.L. 1956, § 27-20-4; P.L. 1964, ch. 79, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-5.1. - Cancellation of coverage by employers.

§ 27-20-5.1. Cancellation of coverage by employers.
No employer shall cancel any contract of insurance provided for the benefit of his or her employee as provided for in this chapter without first allowing the employee the opportunity to continue the contract of insurance, with the employee paying an amount not to exceed the total contribution required of the employer and employee for the continuation of the protection, while the employee is disabled and receiving benefits pursuant to the provision of the Workers’ Compensation Act, chapters 29 — 38 of title 28.
History of Section.
P.L. 1971, ch. 228, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-5.3. - Patient responsibility — Administrative requirements.

§ 27-20-5.3. Patient responsibility — Administrative requirements.
For health benefit contracts issued, renewed, or delivered on or after April 1, 2002, the following shall apply:
(1)
The amount of copayments for physician office visits and hospital emergency room visits shall be printed on the subscriber identification cards issued to insureds;
(2)
A schedule of all applicable copayments, by product or by group, in paper or electronic format, or both, shall be published, updated, and distributed to participating providers; and
(3)
On an annual basis, notification shall be provided to subscribers regarding their responsibility for copayments and deductibles.
History of Section.
P.L. 2001, ch. 283, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-6.1. - Uniform explanation of benefits and coverage.

§ 27-20-6.1. Uniform explanation of benefits and coverage.
(a)
A nonprofit medical service corporation shall provide a summary of benefits and coverage explanation and definitions to policyholders and others required by, and at the times and in the format required by, the federal regulations adopted under section 2715 of the Public Health Service Act, as amended by the federal Affordable Care Act [42 U.S.C. § 300gg-15]. The forms required by this section shall be made available to the commissioner on request. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.
(b)
The provisions of this section shall apply to grandfathered health plans. 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.
(c)
If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioner’s determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.
History of Section.
P.L. 2012, ch. 256, § 8; P.L. 2012, ch. 262, § 8.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-6.2. - Filing of policy forms.

§ 27-20-6.2. Filing of policy forms.
(a)
A nonprofit medical service corporation shall file all policy forms and rates used by it in the state with the commissioner, including the forms of any rider, endorsement, application blank, and other matter generally used or incorporated by reference in its policies or contracts of insurance. No such form shall be used if disapproved by the commissioner under this section, or if the commissioner’s approval has been withdrawn after notice and an opportunity to be heard, or until the expiration of sixty (60) days following the filing of the form. Such a company shall comply with its filed and approved forms. If the commissioner finds from an examination of any form that it is contrary to the public interest, or the requirements of this code or duly promulgated regulations, he or she shall forbid its use, and shall notify the corporation in writing.
(b)
Each rate filing shall include a certification by a qualified actuary that to the best of the actuary’s knowledge and judgment, the entire rate filing is in compliance with applicable laws and that the benefits offered or proposed to be offered are reasonable in relation to the premium to be charged. A health insurance carrier shall comply with its filed and approved rates and forms.
History of Section.
P.L. 2012, ch. 256, § 8; P.L. 2012, ch. 262, § 8.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-7. - Relationship of physician and patient — Actions against corporation.

§ 27-20-7. Relationship of physician and patient — Actions against corporation.
Nothing contained in this chapter or in any nonprofit medical service plan shall affect the ordinary professional relationship between the person rendering medical services under the plan and the subscriber to whom the services are rendered; and no action based upon or arising out of a relationship or relating to medical services rendered pursuant to a nonprofit medical service plan shall be maintained against the nonprofit medical service corporation operating the plan.
History of Section.
P.L. 1945, ch. 1598, § 3; G.L. 1956, § 27-20-7.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-8. - Annual and quarterly statements.

§ 27-20-8. Annual and quarterly statements.
(a)
Every nonprofit medical service corporation shall annually, on or before the first day of March in each year, file in the office of the commissioner of insurance a statement, verified by at least two (2) of the principal officers of the corporation, of its condition on the thirty-first day of December then next preceding, which statement shall be in general form and context as approved by the National Association of Insurance Commissioners and contain any matters as the director of business regulation shall prescribe and shall be available for inspection by the public.
(b)
Every nonprofit medical service corporation shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners’ guidelines and procedures, and shall be available for inspection by the public.
(c)
The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.
History of Section.
P.L. 1945, ch. 1598, § 4; G.L. 1956, § 27-20-8; P.L. 1994, ch. 404, § 2; P.L. 1996, ch. 188, § 10.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-9. - Examination of affairs of corporation.

§ 27-20-9. Examination of affairs of corporation.
It shall be the duty of the director of business regulation to make an examination of the financial condition and methods of doing business of every nonprofit medical service corporation. The examination shall be performed, and the associated costs shall be borne by the company, in accordance with all of the provisions of chapter 13.1 of this title.
History of Section.
P.L. 1945, ch. 1598, § 5; G.L. 1956, § 27-20-9; P.L. 1960, ch. 71, art. 1, § 11; P.L. 1967, ch. 154, § 2; P.L. 1994, ch. 404, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-10. - Commission plans for solicitors or insurance producers.

§ 27-20-10. Commission plans for solicitors or insurance producers.
No person shall be engaged to solicit subscribers to any nonprofit medical service plan upon a commission basis or upon any other basis by which the payment of the compensation or expenses of the person shall be conditioned upon the enrollment of subscribers, unless the method of solicitation and rate of compensation shall have had the prior written approval of the director of business regulation.
History of Section.
P.L. 1945, ch. 1598, § 6; G.L. 1956, § 27-20-10.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-11. - Investment standards.

§ 27-20-11. Investment standards.
(a)
All nonprofit medical service corporations shall protect the interests of subscribers by promoting company solvency and financial strength through the application of investment standards that facilitate a reasonable balance of the following objectives:
(1)
To preserve principal;
(2)
To assure reasonable diversification as to type of investment, issuer, and credit quality; and
(3)
To allow the nonprofit medical service corporation to allocate investments in a manner consistent with principles of prudent investment management to achieve an adequate return so that obligations to subscribers are adequately met and financial strength is sufficient to cover reasonably foreseeable contingencies.
(b)
All investments, including, but not limited to, those referred to in this chapter, shall be made and held in accordance with the objectives in subsection (a) subject to the limitations set forth in this chapter and in regulations promulgated pursuant to this chapter. Investments not conforming to this chapter and any regulations promulgated pursuant to this chapter are not considered admitted assets.
History of Section.
P.L. 1945, ch. 1598, § 7; G.L. 1956, § 27-20-11; P.L. 1999, ch. 45, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-12. - Corporation deemed public charitable institution.

§ 27-20-12. Corporation deemed public charitable institution.
Every nonprofit medical service corporation is declared to be and shall be deemed to be a charitable corporation and an incorporated public charitable institution.
History of Section.
P.L. 1945, ch. 1598, § 8; G.L. 1956, § 27-20-12.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-13. - Adoption of chapter by hospital service corporation.

§ 27-20-13. Adoption of chapter by hospital service corporation.
Any nonprofit hospital service corporation organized pursuant to the provisions of chapter 19 of this title may, with the consent of the Rhode Island Medical Society evidenced by the affidavit of the president and secretary of the society filed in the office of the secretary of state, amend its articles of association to adopt the provisions of this chapter, and, upon that adoption, the corporation shall have and exercise all of the powers and be subject to all of the duties and responsibilities of a nonprofit medical service corporation to the same extent as though it had been incorporated as a nonprofit medical service corporation.
History of Section.
P.L. 1945, ch. 1598, § 9; G.L. 1956, § 27-20-13.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-14. - Coverage for adoptive children.

§ 27-20-14. Coverage for adoptive children.
Subscribers to any nonprofit medical service plan who have satisfied the continuous membership requirements of the plan and who adopt children under the guardianship and custody of the director of the department of children, youth and families shall be afforded coverage under the plan for the adopted child without any waiting period, notwithstanding the fact that the adopted child may have any preexisting medical condition.
History of Section.
P.L. 1982, ch. 183, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-15. - Itemized bills for services rendered.

§ 27-20-15. Itemized bills for services rendered.
Upon completion of medical services under the provisions of this chapter, each provider of those services shall upon request provide a copy of an itemized bill to each patient; provided, that nothing contained in this section shall apply to any hospital operated by the state of Rhode Island, its departments, or agencies.
History of Section.
P.L. 1985, ch. 529, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-16. - Changing coverage.

§ 27-20-16. Changing coverage.
No group health insurer subject to the provisions of this chapter shall change contract provisions as specified in the group plan master contract during the term of that contract without prior written agreement of the employer, except for changes mandated under state or federal legislative enactment and changes resulting from a labor/management collective bargaining agreement, or changes necessary to meet insurance regulations promulgated by the department of business regulation.
History of Section.
P.L. 1988, ch. 384, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-17. - Mammograms and pap smears — Coverage mandated. [Effective until January 1, 2024.]

§ 27-20-17. Mammograms and pap smears — Coverage mandated. [Effective until January 1, 2024.]
(a)
Subscribers to any nonprofit medical service plan shall be afforded coverage under the plan for mammograms and pap smears, in accordance with guidelines established by the American Cancer Society.
(b)
Notwithstanding the provisions of this chapter, subscribers to any nonprofit medical service plan shall be afforded coverage for two (2) paid screening mammograms per year when recommended by a physician for women who have been treated for breast cancer within the last five (5) years or who are at high risk of developing breast cancer due to genetic predisposition (BRCA gene mutation or multiple first-degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or atypical ductal hyperplasia.
History of Section.
P.L. 1988, ch. 532, § 2; P.L. 2005, ch. 405, § 3.
§ 27-20-17. Mammograms and pap smears — Coverage mandated. [Effective January 1, 2024.]
(a)
Subscribers to any nonprofit medical service plan shall be afforded coverage under the plan for mammograms and pap smears, in accordance with guidelines established by the American Cancer Society.
(b)
Notwithstanding the provisions of this chapter, subscribers to any nonprofit medical service plan shall be afforded coverage for:
(1)
Two (2) paid screening mammograms per year when recommended by a physician for women who have been treated for breast cancer within the last five (5) years or who are at high risk of developing breast cancer due to genetic predisposition (BRCA gene mutation or multiple first-degree relatives) or high risk lesion on prior biopsy (lobular carcinoma in situ) or atypical ductal hyperplasia; and
(2)
Any screening deemed medically necessary for proper breast cancer screening in accordance with applicable American College of Radiology guidelines including, but not limited to, magnetic resonance imaging, ultrasound, or molecular breast imaging for any person who has received notice pursuant to § 23-12.9-2 of the existence of dense breast tissue.
History of Section.
P.L. 1988, ch. 532, § 2; P.L. 2005, ch. 405, § 3; P.L. 2023, ch. 331, § 3, effective January 1, 2024; P.L. 2023, ch. 332, § 3, effective January 1, 2024.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-17.1. - Insurance coverage for postpartum hospital stays.

§ 27-20-17.1. Insurance coverage for postpartum hospital stays.
(a)
Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for a forty-eight-hour (48) time period in a hospital after a vaginal birth and ninety-six (96) hours after a cesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending healthcare provider in consultation with the mother. The decision shall be made in accordance with the standards for guidelines for perinatal care published by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics. The standards shall be relative to early discharge, defined as less than forty-eight (48) hours for a vaginal delivery and ninety-six (96) hours for a cesarean delivery. In the case of early discharge, post-delivery care shall include home visits, parent education, assistance and training in breast or bottle feeding, and the performance of any necessary and appropriate clinical tests or any other tests or services consistent with the guidelines provided in this subsection.
(b)
For the purposes of this section, “attending healthcare provider” includes the attending obstetrician, pediatrician, family practitioner, general practitioner, or certified nurse midwife attending the mother and newly born child.
(c)
Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23 [repealed]. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other healthcare provider who orders care consistent with the provisions of this section.
History of Section.
P.L. 1996, ch. 246, § 4; P.L. 1996, ch. 260, § 4; P.L. 2002, ch. 292, § 39.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-18. - Mammograms — Quality assurance standards.

§ 27-20-18. Mammograms — Quality assurance standards.
A mammogram eligible for reimbursement under § 27-20-17 shall be reimbursed only if the facility in which the mammogram has been taken and processed, and the licensed physician interpreting the mammogram, both meet state-approved quality assurance standards for taking, processing, and interpreting mammograms. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section.
History of Section.
P.L. 1989, ch. 217, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-19. - Pap smears — Quality assurance standards.

§ 27-20-19. Pap smears — Quality assurance standards.
A pap smear eligible for reimbursement under § 27-20-17 shall be reimbursed only if the laboratory in which the pap smear is processed is licensed by the department of health specifically to perform cervical cytology, or is accredited by the American Society of Cytology, or is accredited by the College of American Pathologists, or is accredited by the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association, at the time the pap smear is processed.
History of Section.
P.L. 1989, ch. 217, § 10.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-20. - Coverage for infertility.

§ 27-20-20. Coverage for infertility.
(a)
Any nonprofit medical service contract, plan, or insurance policies delivered, issued for delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for the medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a nonprofit medical service corporation provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, those tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent (20%), may be required for those programs and/or procedures the sole purpose of which is the treatment of infertility.
(b)
For purposes of this section, “infertility” means the condition of an otherwise presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.
(c)
For purposes of this section, “standard fertility-preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organizations.
(d)
For purposes of this section, “iatrogenic infertility” means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
(e)
For purposes of this section, “may directly or indirectly cause” means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organizations.
(f)
The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).
History of Section.
P.L. 1989, ch. 478, § 3; P.L. 2002, ch. 292, § 39; P.L. 2006, ch. 246, art. 34, § 3; P.L. 2007, ch. 411, § 3; P.L. 2017, ch. 132, § 3; P.L. 2017, ch. 150, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-21. - Nonprofit medical service corporation assessment.

§ 27-20-21. Nonprofit medical service corporation assessment.
(a)
Notwithstanding any other provisions of law, each domestic nonprofit medical service corporation shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulations.
(b)
The minimum assessment charged shall be one thousand dollars ($1,000).
History of Section.
P.L. 1990, ch. 65, art. 29, § 3; P.L. 1993, ch. 180, § 16; P.L. 2002, ch. 292, § 132.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-22. - Discontinuance of coverage — Chronic disabilities.

§ 27-20-22. Discontinuance of coverage — Chronic disabilities.
No nonprofit medical service corporation subject to the provisions of this chapter shall discontinue reimbursement or providing services for the covered healthcare services of chronic disabilities unless the patient has exhausted benefits to which he or she is entitled under the basic subscriber agreement, or unless it is at the end of the open enrollment period, provided notice of the discontinuation is sent to subscribers who have been reimbursed for or utilized those services in the past three (3) years. The notice shall be mailed at least sixty (60) days prior to the beginning of the open enrollment period. For the purposes of this section, “chronic disability” means an impairment or illness that is likely to continue indefinitely.
History of Section.
P.L. 1991, ch. 127, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-23. - Drug coverage.

§ 27-20-23. Drug coverage.
No group health insurer subject to the provisions of this chapter that provides coverage for prescription drugs under a group plan master contract delivered, issued for delivery, or renewed in this state may require any person covered under the contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for the drugs.
History of Section.
P.L. 1991, ch. 345, § 3; P.L. 2002, ch. 292, § 39.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-23.1. - Medication synchronization.

§ 27-20-23.1. Medication synchronization.
(a)
An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days’ supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days’ supply for the purpose of synchronizing the patient’s medications and the insured’s or enrollee’s maintenance-prescription drug(s) to be synchronized meets all of the following requirements:
(1)
Is covered by the policy, certificate, or contract described in this chapter;
(2)
Is used for the management and treatment of a chronic, long-term care condition and has authorized refills that remain available to the insured or enrollee;
(3)
Except as otherwise provided in this subparagraph, is not a controlled substance included in schedules II to V;
(4)
Meets all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insured’s or enrollee’s multiple maintenance-prescription drugs;
(5)
Is of a formulation that can be effectively split over required short-fill periods to achieve synchronization; and
(6)
Does not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insured’s or enrollee’s multiple maintenance-prescription drugs.
(b)
The plan or policy described in subsection (a) shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insured’s or enrollee’s multiple maintenance-prescription drugs.
(c)
The plan or policy described in subsection (a) shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.
(d)
A synchronization shall only occur once per year per maintenance-prescription drug.
History of Section.
P.L. 2016, ch. 179, § 3; P.L. 2016, ch. 196, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-24. - Rehabilitation, liquidation, or conservation.

§ 27-20-24. Rehabilitation, liquidation, or conservation.
(a)
Any rehabilitation, liquidation, administrative supervision, or conservation of a nonprofit medical service corporation organized under this chapter shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director of business regulation to rehabilitate, liquidate, or conserve a nonprofit medical service corporation upon any one or more of the following grounds:
(1)
That the nonprofit medical service corporation is insolvent; for the purposes of this section, the term “insolvent” means the inability of the nonprofit medical service corporation to meet its debts and financial obligations as they become due;
(2)
That the nonprofit medical service corporation fails or refuses to comply with a lawful order of the director of business regulation reasonably designed to correct unsound business policies or practices which, if uncorrected, could reasonably lead to insolvency as defined in subsection (a)(1) of this section; or
(3)
That the nonprofit medical service corporation’s financial condition is such as to render its further transaction of business hazardous to the public or its subscribers or members.
(b)
A claim by a healthcare provider shall not be asserted against any subscriber or member of the nonprofit medical service corporation in the event of the rehabilitation, liquidation, conservation, or administrative supervision of the nonprofit medical service corporation.
History of Section.
P.L. 1993, ch. 180, § 17.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-25. - Holding company systems.

§ 27-20-25. Holding company systems.
Except to the extent superseded by chapter 64 of this title, all of the provisions of chapter 35 of this title apply to corporations organized or licensed pursuant to this chapter.
History of Section.
P.L. 1993, ch. 180, § 17; P.L. 1998, ch. 90, § 2; P.L. 2000, ch. 178, § 4; P.L. 2000, ch. 200, § 14; P.L. 2000, ch. 229, § 14.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-25.1. - No derogation of attorney general.

§ 27-20-25.1. No derogation of attorney general.
No provision of this chapter shall derogate from the common law or statutory authority of the attorney general nor shall any provision be construed as a limitation on the common law or statutory authority of the attorney general, including the authority to investigate at any time charitable assets for the purpose of determining and ascertaining whether they are being administered in accordance with law and with the terms and purposes of the charity.
History of Section.
P.L. 1998, ch. 90, § 7.