reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.6 - Large Group Health Insurance Coverage › Section 27-18.6-4. - Discrimination prohibited.

§ 27-18.6-4. Discrimination prohibited.
(a)(1)
Notwithstanding any of the provisions of this title to the contrary, a group health plan and a health insurance carrier offering group health insurance in connection with a group health plan may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on health status-related factors in relation to the individual or dependent of the individual.
(2)
Rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for enrollment.
(b)
Subsection (a) of this section shall not be construed:
(1)
To require a group health plan or group health insurance coverage to provide particular benefits other than those provided under the terms of the plan or coverage; or
(2)
To prevent a plan or coverage from establishing limitations on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the coverage.
(c)(1)
A group health plan and a health insurance carrier offering health insurance coverage in connection with a group health plan may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as dependent of the individual.
(2)
Nothing contained within this subsection shall be construed to:
(i)
Restrict the amount that an employer may be charged for coverage under a group health plan; or
(ii)
Prevent a group health plan and a health insurance carrier offering group health insurance coverage from establishing premium discounts or rebates or modifying applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.6 - Large Group Health Insurance Coverage › Section 27-18.6-7. - Collective bargaining agreements.

§ 27-18.6-7. Collective bargaining agreements.
(a)
Notwithstanding anything contained in this chapter to the contrary, except as provided in § 27-18.6-3(n), in the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before July 13, 2000, this chapter does not apply to plan years beginning before the later of:
(1)
The date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension of the collective bargaining agreement agreed to after July 13, 2000); or
(2)
July 1, 1997.
(b)
For purposes of subdivision (a)(1) of this section, any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement of this chapter shall not be treated as a termination of the collective bargaining agreement.
History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4; P.L. 2002, ch. 292, § 36.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.6 - Large Group Health Insurance Coverage › Section 27-18.6-8. - Enforcement — Limitation on actions.

§ 27-18.6-8. Enforcement — Limitation on actions.
The director has the power to enforce the provisions of this chapter in accordance with § 42-14-16 and all other applicable state law.
History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.6 - Large Group Health Insurance Coverage › Section 27-18.6-9. - Rules and regulations.

§ 27-18.6-9. Rules and regulations.
The director may promulgate rules and regulations necessary to effectuate the purposes of this chapter.
History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.6 - Large Group Health Insurance Coverage › Section 27-18.6-10. - Severability.

§ 27-18.6-10. Severability.
If any provision of this chapter or the application of any provision to any person or circumstances is for any reason held invalid, the remainder of the chapter and the application of that provision to other persons or circumstances shall not be affected by that invalidity.
History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.6 - Large Group Health Insurance Coverage › Section 27-18.6-11. - Health insurance plan payment and expense reporting.

§ 27-18.6-11. Health insurance plan payment and expense reporting.
A health insurance carrier: (1) providing proposed rate, premium, fee, or other prospective cost information in connection with an offering of health insurance coverage to a large group or large employer setting forth claims cost as an element of cost; or (2) providing information to a large group or large employer (as so defined) regarding claims paid, shall be required to distinguish, set forth and itemize as separate and distinct elements of cost: (i) sums actually payable (or paid) to health care providers; and (ii) sums actually (or proposed to be) retained or paid by the carrier for administration, including, but not limited to, sums relating to claim services, managed care fees, network access fees, and contributions to reserves.
History of Section.
P.L. 2004, ch. 196, § 1; P.L. 2004, ch. 361, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.6 - Large Group Health Insurance Coverage › Section 27-18.6-12. - Health plan loss information.

§ 27-18.6-12. Health plan loss information.
(a)
To ensure maximum competition in the purchase of group health insurance, all employers with at least one hundred (100) employees enrolled in their group health plan shall be entitled to receive their health plan loss information upon request and without charge. No contract between any health insurance carrier, third-party administrator, employer group, or pool of employers shall abridge this right in any manner. For purposes of this section, “health plan loss information” shall mean: (1) aggregate total cost figures for four (4) separate categories of medical claims covered by the employer’s group health plan: physician, hospital, prescription drug, and miscellaneous; and (2) that were incurred for the twelve (12) month period paid through the fourteen (14) months which end within the sixty (60) day period prior to the date of the request. “Health plan loss information” shall not include any information: (1) pertaining to specific medical diagnoses, treatments or drugs; or (2) that identifies or reasonably could lead to the identity of any individuals covered under the group health plan; or (3) that is defined as protected or confidential health information under state or federal laws.
(b)
Upon written request from any employer with one hundred (100) or more employees enrolled in its group health plan, every health insurance carrier shall provide that employer’s health plan loss information within thirty (30) calendar days of receipt of the request. An employer shall not be entitled by this section to more than two (2) health plan loss information requests in any twelve (12) month period, however, nothing shall prohibit a carrier from fulfilling more frequent requests on a mutually agreed upon basis.
(c)
If an employer requests health plan loss information from an insurance agent or other authorized representative, the agent or authorized representative shall transmit the request to the health insurance carrier within four (4) working days.
History of Section.
P.L. 2004, ch. 406, § 1; P.L. 2004, ch. 502, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.7 - Extended Medical Leave › Section 27-18.7-1. - Medical benefits for employees on extended medical leave.

§ 27-18.7-1. Medical benefits for employees on extended medical leave.
Whenever an employee who has been employed on a full-time basis by an employer for at least three (3) months and who is an insured member of a group hospital, surgical, or medical insurance plan is placed on extended medical leave by the employer, the employee may remain on the group hospital, surgical, or medical insurance plan and the benefits of the plan may be continued for no more than eighteen (18) months from the date the employee was placed on extended medical leave.
History of Section.
P.L. 2010, ch. 180, § 1; P.L. 2010, ch. 187, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.7 - Extended Medical Leave › Section 27-18.7-2. - Costs of the plan.

§ 27-18.7-2. Costs of the plan.
An employer may continue to contribute to the cost of the plan benefits for an employee on extended medical leave or may require an employee on extended medical leave to pay up to one hundred percent (100%) of the cost of the plan benefits.
History of Section.
P.L. 2010, ch. 180, § 1; P.L. 2010, ch. 187, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.7 - Extended Medical Leave › Section 27-18.7-3. - Eligibility for medical benefits while on extended medical leave.

§ 27-18.7-3. Eligibility for medical benefits while on extended medical leave.
(a)
An employee shall be considered eligible for continuing coverage under the group hospital, surgical, or medical insurance plan as an employee on extended medical leave if an employer provides to the group hospital, surgical, or medical insurance plan a written statement that explains that, due to medical reasons pertaining to the employee or a member of the employee’s family (parent, child, step-child, spouse, sibling or a person for whom the employee serves as a legal guardian), the employee can no longer work full-time, the employee and the employer anticipate that the employee will someday return to full-time employment, and the employer has placed the employee on extended medical leave.
(b)
Nothing in this statute shall be construed to give an insurance company, a health maintenance organization or a nonprofit hospital and medical service corporation the ability to determine whether an employee is eligible for extended medical leave. The determination of whether an employee is eligible for extended medical leave rests solely with, and in the discretion of, the employer. Nothing in this statute shall be construed to require an employer to offer extended medical leave to its full-time employees.
History of Section.
P.L. 2010, ch. 180, § 1; P.L. 2010, ch. 187, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.7 - Extended Medical Leave › Section 27-18.7-4. - Transition to extended medical benefits.

§ 27-18.7-4. Transition to extended medical benefits.
Once an employee on extended medical leave has remained on a group hospital, surgical, or medical insurance plan for eighteen (18) months and is no longer eligible to participate in that plan, the employee shall be eligible for extended medical benefits under chapter 19.1 of title 27 as if the employee were involuntarily terminated from employment the day he or she is no longer eligible to participate in the plan as an employee on extended medical leave.
History of Section.
P.L. 2010, ch. 180, § 1; P.L. 2010, ch. 187, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.8 - Health Care Accessibility and Quality Assurance Act › Section 27-18.8-1. - Purpose.

§ 27-18.8-1. Purpose.
The legislature declares that:
(1)
It is in the best interest of the public that those individuals and healthcare entities involved with the delivery of health plan coverage in our state meet the standards of this chapter to ensure accessibility and quality for the state’s patients; and
(2)
Nothing in this legislation is intended to prohibit a healthcare entity from forming limited networks of providers; and
(3)
It is a vital state function to establish these standards for the conduct of healthcare entities in Rhode Island and for public health well-being; and
(4)
Nothing in this chapter is intended to prohibit or discourage the health insurance commissioner from consulting or collaborating with the department of health, or any other state or federal agency, to the extent the commissioner in his or her discretion determines such consultation and/or collaboration is necessary and/or appropriate for the administration and enforcement of this chapter.
History of Section.
P.L. 2017, ch. 302, art. 5, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.8 - Health Care Accessibility and Quality Assurance Act › Section 27-18.8-4. - Contracts with providers for dental services.

§ 27-18.8-4. Contracts with providers for dental services.
No contract between a dental plan of a healthcare entity and a dentist for the provision of services to beneficiaries may require that a dentist provide services to its patients at a fee set by the healthcare entity unless said services are covered services under the applicable subscriber agreement. “Covered services,” as used herein, means services reimbursable under the applicable beneficiary agreement, subject to such contractual limitations on beneficiary benefits as may apply, including, for example, deductibles, waiting period, or frequency limitations.
History of Section.
P.L. 2017, ch. 302, art. 5, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.8 - Health Care Accessibility and Quality Assurance Act › Section 27-18.8-5. - Contracts with providers for optometric services.

§ 27-18.8-5. Contracts with providers for optometric services.
(a)
No contract between an eye care provider and a healthcare entity or vision plan may require that an eye care provider provide services or materials to its beneficiaries at a fee set by the insurer or vision plan, unless the insurer or vision plan compensates the eye care provider for the provision of such services or materials to the beneficiary. Reimbursement paid by the insurer or vision plan for covered services and materials shall not provide nominal reimbursement in order to claim that services and materials are covered services.
(b)(1)
“Services” means services and materials for which reimbursement from the vision plan is provided for by a beneficiary’s plan contract, or for which a reimbursement would be available but for the application of the beneficiary’s contractual limitations of deductibles, copayments, or coinsurance.
(2)
“Materials” means and includes, but is not limited to: lenses, devices containing lenses, prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa.
(3)
“Eye care provider” means an optometrist, optician, or ophthalmologist.
History of Section.
P.L. 2017, ch. 302, art. 5, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.8 - Health Care Accessibility and Quality Assurance Act › Section 27-18.8-6. - Reporting requirements.

§ 27-18.8-6. Reporting requirements.
The office shall establish reporting requirements to determine if healthcare entities and/or network plans are in compliance with the provisions of this chapter and applicable regulations as well as in compliance with applicable federal law.
History of Section.
P.L. 2017, ch. 302, art. 5, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.8 - Health Care Accessibility and Quality Assurance Act › Section 27-18.8-7. - Rules and regulations.

§ 27-18.8-7. Rules and regulations.
The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.
History of Section.
P.L. 2017, ch. 302, art. 5, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.8 - Health Care Accessibility and Quality Assurance Act › Section 27-18.8-8. - Denial, suspension, or revocation of certificate — Penalties.

§ 27-18.8-8. Denial, suspension, or revocation of certificate — Penalties.
Adopted pursuant to this chapter;
(a)
The office may deny a certificate or certification upon review of the application if, upon review of the application, it finds that the applicant proposing to establish a network plan does not meet the standards required by this chapter or by any regulations promulgated pursuant to this chapter.
(b)
The office may revoke or suspend a certificate or certification and/or impose monetary penalties not less than one hundred dollars ($100) and not to exceed fifty thousand dollars ($50,000) per violation and/or impose an order requiring a monetary restitution or disgorgement payment in an amount determined by the commissioner to reasonably reflect the amount of damages caused or monies improperly obtained in any case in which:
(1)
The network plan and/or healthcare entity fails to comply with the requirements of this chapter or of regulations;
(2)
The network plan and/or healthcare entity fails to comply with the criteria used by it in its application for a certificate or certification; or
(3)
The network plan and/or healthcare entity refuses to permit or fails to reasonably cooperate with an examination by the commissioner to determine compliance with the requirements of this chapter and regulations promulgated pursuant to the authority granted to the commissioner in this chapter. These determinations may involve consideration of any written grievances filed with the office against the network plan or healthcare entity by patients or providers.
(c)
Any applicant for certification or certificate holder aggrieved by an order or a decision of the commissioner made under this chapter without a hearing may, within thirty (30) days after notice of the order or decision, make a written request to the office for a hearing on the order or decision pursuant to § 42-35-15.
(d)
The procedure governing hearings authorized by this section shall be in accordance with §§ 42-35-9 through 42-35-13 as stipulated in § 42-35-14(a). A full and complete record shall be kept of all proceedings, and all testimony shall be recorded but need not be transcribed unless the decision is appealed pursuant to § 42-35-15. A copy or copies of the transcript may be obtained by any interested party upon payment of the cost of preparing the copy or copies. Witnesses may be subpoenaed by either party.
History of Section.
P.L. 2017, ch. 302, art. 5, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.8 - Health Care Accessibility and Quality Assurance Act › Section 27-18.8-9. - Penalties and enforcement.

§ 27-18.8-9. Penalties and enforcement.
For the purposes of this chapter, in addition to the provisions of § 27-18.8-8, a healthcare entity or any person or entity conducting any activities requiring certification under this chapter shall be subject to the penalty and enforcement provisions of this title and chapters 14 and 14.5 of title 42 and the regulations promulgated thereunder in the same manner as a licensee or any person or entity conducting any activities requiring licensure or certification under this title.
History of Section.
P.L. 2017, ch. 302, art. 5, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.8 - Health Care Accessibility and Quality Assurance Act › Section 27-18.8-10. - Severability.

§ 27-18.8-10. Severability.
If any section, clause, or provision of this chapter shall be held either unconstitutional or ineffective in whole or in part, to the extent that it is not unconstitutional or ineffective, it shall be valid and effective and no other section, clause or provision shall on account thereof be termed invalid or ineffective.
History of Section.
P.L. 2017, ch. 302, art. 5, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.9 - Benefit Determination and Utilization Review Act › Section 27-18.9-1. - Purpose of chapter.

§ 27-18.9-1. Purpose of chapter.
(a)
The purpose of this chapter is to:
(1)
Promote the delivery of quality health care in a cost-effective manner;
(2)
Foster greater coordination between healthcare providers, patients, healthcare entities, health benefit plans and utilization-review entities to ensure public health well-being;
(3)
Protect beneficiaries, businesses, and providers by ensuring that review agents are qualified to perform review activities and to make informed decisions on the medical necessity and appropriateness of medical care;
(4)
Ensure that review agents maintain the confidentiality of medical records in accordance with applicable state and federal laws; and
(5)
Interface and maintain compliance with federal benefit determination and adverse benefit determination requirements.
(b)
Nothing in this chapter is intended to prohibit or discourage the health insurance commissioner from consulting or collaborating with the department of health, or any other state or federal agency, to the extent the commissioner in his or her discretion determines such consultation and/or collaboration is necessary and/or appropriate for the administration and enforcement of this chapter.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.9 - Benefit Determination and Utilization Review Act › Section 27-18.9-5. - Administrative and non-administrative benefit determination procedural requirements.

§ 27-18.9-5. Administrative and non-administrative benefit determination procedural requirements.
(a) Procedural failure by claimant.
(1)
In the event of the failure of claimant or an authorized representative to follow the healthcare entities claims procedures for a pre-service claim the healthcare entity or its review agent must:
(i)
Notify claimant or the authorized representative, as appropriate, of this failure as soon as possible and no later than five (5) calendar days following the failure and this notification must also inform claimant of the proper procedures to file a pre-service claim; and
(ii)
Notwithstanding the above, if the pre-service claim relates to urgent or emergent healthcare services, the healthcare entity or its review agent must notify and inform claimant or the authorized representative, as appropriate, of the failure and proper procedures within twenty-four (24) hours following the failure. Notification may be oral, unless written notification is requested by the claimant or authorized representative.
(2)
Claimant must have stated name, specific medical condition or symptom and specific treatment, service, or product for which approval is requested and submitted to proper claim processing unit.
(b) Utilization review agent procedural requirements:
(1)
All initial, prospective, and concurrent non-administrative, adverse benefit determinations of a healthcare service that had been ordered by a physician, dentist, or other practitioner shall be made, documented, and signed by a licensed practitioner with the same licensure status as the ordering provider;
(2)
Utilization review agents are not prohibited from allowing appropriately qualified review agency staff from engaging in discussions with the attending provider, the attending provider’s designee or appropriate healthcare facility and office personnel regarding alternative service and/or treatment options. Such a discussion shall not constitute an adverse benefit determination; provided, however, that any change to the attending provider’s original order and/or any decision for an alternative level of care must be made and/or appropriately consented to by the attending provider or the provider’s designee responsible for treating the beneficiary and must be documented by the review agent; and
(3)
A utilization review agent shall not retrospectively deny authorization for healthcare services provided to a covered person when an authorization has been obtained for that service from the review agent unless the approval was based upon inaccurate information material to the review or the healthcare services were not provided consistent with the provider’s submitted plan of care and/or any restrictions included in the prior approval granted by the review agent.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.9 - Benefit Determination and Utilization Review Act › Section 27-18.9-9. - Reporting requirements.

§ 27-18.9-9. Reporting requirements.
The office shall establish reporting requirements to determine if adverse benefit determination and/or utilization review programs are in compliance with the provisions of this chapter and applicable regulations as well as in compliance with applicable federal law.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.9 - Benefit Determination and Utilization Review Act › Section 27-18.9-10. - Rules and regulations.

§ 27-18.9-10. Rules and regulations.
The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.9 - Benefit Determination and Utilization Review Act › Section 27-18.9-11. - Waiver of requirements.

§ 27-18.9-11. Waiver of requirements.
(a)
The office shall waive the requirements of this chapter only when a conflict exists with those activities of a review agent that are conducted pursuant to contracts with the state or the federal government or those activities under other state or federal jurisdictions.
(b)
The office shall waive de minimus activity, in accordance with the regulations adopted by the commissioner.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.9 - Benefit Determination and Utilization Review Act › Section 27-18.9-12. - Variance of statutory requirements.

§ 27-18.9-12. Variance of statutory requirements.
Statutory variances shall be issued for a period not to exceed one year and may be subject to such terms and conditions deemed necessary as determined by the commissioner. Prior to issuing a statutory variance, the office may provide notice and public hearing to ensure necessary beneficiary and healthcare provider protections in the process.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.9 - Benefit Determination and Utilization Review Act › Section 27-18.9-13. - Denial, suspension, or revocation of certificate — Penalties.

§ 27-18.9-13. Denial, suspension, or revocation of certificate — Penalties.
Adopted pursuant to this chapter;
(a)
The office may deny a certificate or certification upon review of the application if, upon review of the application, it finds that the applicant proposing to conduct utilization review does not meet the standards required by this chapter or by any regulations promulgated pursuant to this chapter.
(b)
The office may revoke or suspend a certificate or certification and/or impose monetary penalties not less than one hundred dollars ($100) and not to exceed fifty thousand dollars ($50,000) per violation and/or impose an order requiring a monetary restitution or disgorgement payment in an amount determined by the commissioner to reasonably reflect the amount of damages caused or monies improperly obtained in any case in which:
(1)
The healthcare entity and/or review agent fails to comply with the requirements of this chapter or of regulations;
(2)
The review agent/network plan and/or healthcare entity and/or review agent fails to comply with the criteria used by it in its application for a certificate or certification; or
(3)
The healthcare entity and/or review agent refuses to permit or fails to reasonably cooperate with an examination by the commissioner to determine compliance with the requirements of this chapter and regulations promulgated pursuant to the authority granted to the commissioner in this chapter. These determinations may involve consideration of any written grievances filed with the office against the healthcare entity and/or review agent by patients or providers.
(c)
Any applicant or certificate or certification holder aggrieved by an order or a decision of the commissioner made under this chapter without a hearing may, within thirty (30) days after notice of the order or decision, make a written request to the office for a hearing on the order or decision pursuant to § 42-35-15.
(d)
The procedure governing hearings authorized by this section shall be in accordance with §§ 42-35-9 through 42-35-13 as stipulated in § 42-35-14(a). A full and complete record shall be kept of all proceedings, and all testimony shall be recorded but need not be transcribed unless the decision is appealed pursuant to § 42-35-15. A copy or copies of the transcript may be obtained by any interested party upon payment of the cost of preparing the copy or copies. Witnesses may be subpoenaed by either party.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.9 - Benefit Determination and Utilization Review Act › Section 27-18.9-14. - Penalties and enforcement.

§ 27-18.9-14. Penalties and enforcement.
For the purposes of this chapter, in addition to the provisions of § 27-18.9-13, a healthcare entity and/or review agent or any person or entity conducting any activities requiring certification under this chapter shall be subject to the penalty and enforcement provisions of title 27 and chapters 14 and 14.5 of title 42 and the regulations promulgated thereunder in the same manner as a licensee or any person or entity conducting any activities requiring licensure or certification under title 27.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.9 - Benefit Determination and Utilization Review Act › Section 27-18.9-15. - Severability.

§ 27-18.9-15. Severability.
If any provision of this chapter or the application of any provision to any person or circumstance shall be held invalid, that invalidity shall not affect the provisions or application of this 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. 2017, ch. 302, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-2. - Organization as charitable corporation — Insurance laws inapplicable.

§ 27-19-2. Organization as charitable corporation — Insurance laws inapplicable.
Each nonprofit hospital 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 shall not apply to any nonprofit hospital service corporation unless expressly provided in those laws. Each nonprofit hospital 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. 1939, ch. 719, § 2; G.L. 1956, § 27-19-2; P.L. 2007, ch. 73, art. 28, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-2.1. - Investments and holdings in certain corporations authorized.

§ 27-19-2.1. Investments and holdings in certain corporations authorized.
(a)
Each nonprofit hospital service corporation shall have, in addition to all other powers granted under this chapter and the laws of this state, the power to invest in or cause to be organized and established one or more corporations, all or any portion of the issued and outstanding capital stock of which shall be subscribed for or held by the nonprofit hospital service corporation.
(b)
As used in this section, “corporation” means any organization incorporated under the provisions of the law of this or another state for one or more of the following purposes:
(1)
To establish, maintain, and operate hospital service and health insurance plans;
(2)
To develop, establish, purchase, maintain, perform, sell, and lease in connection with carrying out its corporate purpose: (i) Data processing and computer software programs, systems, and techniques; (ii) Data processing, bookkeeping, statistical, or software services; or (iii) Other administrative and related services; or
(3)
To exercise the powers set forth in § 27-19-5 or to carry out and fulfill any of the purposes of a hospital service corporation incorporated under this chapter.
(c)
Any limitation on investments or holdings contained in § 27-19-11 or § 27-19-5.3 or any other law shall not apply with respect to investments or holdings under this section; provided, that the value of any investment shall not exceed twenty percent (20%) of the assets of the hospital service corporation.
History of Section.
P.L. 1982, ch. 165, § 1; P.L. 2006, ch. 182, § 1; P.L. 2006, ch. 600, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-4. - Certificate of public convenience and advantage.

§ 27-19-4. Certificate of public convenience and advantage.
No articles of association of a nonprofit hospital service corporation shall be filed in the office of the secretary of state unless and until the insurance commissioner has 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.
History of Section.
P.L. 1939, ch. 719, § 2; G.L. 1956, § 27-19-4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-5.1. - Cancellation of coverage by employers.

§ 27-19-5.1. 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, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-5.2. - Patient responsibility — Administrative requirements.

§ 27-19-5.2. 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.
(3)
Notification shall be provided to subscribers on an annual basis regarding their responsibility for copayments and deductibles.
History of Section.
P.L. 2001, ch. 283, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-5.3. - Additional powers.

§ 27-19-5.3. Additional powers.
Notwithstanding any other law or section of this chapter that may be inconsistent with this section, each nonprofit hospital service corporation may, through a subsidiary, develop, underwrite, and/or offer for sale life insurance, disability insurance, long-term care insurance, employee assistance programs, and/or other health-related programs; provided, however, prior to underwriting risk under policies of insurance listed above, the nonprofit hospital service corporation must first demonstrate that underwriting such risk is consistent with the statutory mission of the nonprofit hospital service corporation and obtain prior written approval from the health insurance commissioner. Each nonprofit hospital service corporation may also directly, or by contracting with another entity, develop and/or offer for sale the policies or programs described in this section. However, the nonprofit hospital service corporation shall not directly underwrite any risk under a policy of insurance described in this section.
History of Section.
P.L. 2006, ch. 182, § 2; P.L. 2006, ch. 600, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-7. - Rates charged by hospitals.

§ 27-19-7. Rates charged by hospitals.
(a)
The rates charged by contracting hospitals to any nonprofit hospital service corporation for hospital services rendered by the hospitals to the subscribers of the corporation shall be established from time to time by agreement between the contracting hospitals and the corporation.
(b)
Upon completion of its services, each contracting hospital shall, upon request, provide a copy of an itemized bill for each patient; provided, that nothing contained in this subsection shall be construed to apply to any hospital operated by the state of Rhode Island, its departments, or agencies.
History of Section.
P.L. 1939, ch. 719, § 3; G.L. 1956, § 27-19-7; P.L. 1985, ch. 529, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-7.1. - Uniform explanation of benefits and coverage.

§ 27-19-7.1. Uniform explanation of benefits and coverage.
(a)
A nonprofit hospital 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 Patient Protection and 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, § 6; P.L. 2012, ch. 262, § 6.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-7.2. - Filing of policy forms.

§ 27-19-7.2. Filing of policy forms.
(a)
A nonprofit hospital 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, § 6; P.L. 2012, ch. 262, § 6.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-8. - Annual and quarterly statements.

§ 27-19-8. Annual and quarterly statements.
(a)
Every nonprofit hospital 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 the commissioner shall prescribe and shall be available for inspection by the public.
(b)
Every nonprofit hospital 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. 1939, ch. 719, § 4; G.L. 1956, § 27-19-8; P.L. 1994, ch. 404, § 1; P.L. 1996, ch. 188, § 9.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-9. - Examination of affairs of corporations.

§ 27-19-9. Examination of affairs of corporations.
It is the duty of the insurance commissioner to make an examination of the financial condition and methods of doing business of every nonprofit hospital service corporation. The examination shall be performed, and the associated costs borne by the company, in accordance with all of the provisions of chapter 13.1 of this title.
History of Section.
P.L. 1939, ch. 719, § 5; G.L. 1956, § 27-19-9; P.L. 1960, ch. 71, art. 1, § 10; P.L. 1967, ch. 154, § 1; P.L. 1994, ch. 404, § 1; P.L. 2002, ch. 292, § 37.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-10. - Commission plans for solicitors or insurance producers.

§ 27-19-10. Commission plans for solicitors or insurance producers.
No person shall be engaged to solicit subscribers to any nonprofit hospital service plan upon a commission basis or upon any other basis by which the payment of the compensation or expenses of that 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 insurance commissioner.
History of Section.
P.L. 1939, ch. 719, § 6; G.L. 1956, § 27-19-10.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-11. - Investment standards.

§ 27-19-11. Investment standards.
(a)
All nonprofit hospital 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 hospital 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) of this section 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 shall not be considered admitted assets.
History of Section.
P.L. 1939, ch. 719, § 7; G.L. 1956, § 27-19-11; P.L. 1999, ch. 45, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-12. - Corporations deemed public charitable institutions.

§ 27-19-12. Corporations deemed public charitable institutions.
Every nonprofit hospital 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. 1939, ch. 719, § 8; G.L. 1956, 27-19-12.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-13. - Services rendered in certain institutions.

§ 27-19-13. Services rendered in certain institutions.
No nonprofit hospital service corporation may deny payments for services rendered to its subscribers by hospitals operated by the state or any municipality of the state if the nonprofit hospital service corporation permits payment for similar services rendered by contracting hospitals as provided in this chapter.
History of Section.
P.L. 1961, ch. 191, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-14. - Repealed.

§ 27-19-14. Repealed.
History of Section.
P.L. 1971, ch. 208, § 1; P.L. 1984, ch. 4, § 4; P.L. 1988, ch. 213, § 2; P.L. 1990, ch. 132, § 2; P.L. 1991, ch. 290, § 3; P.L. 1994, ch. 392, § 1; P.L. 2009, ch. 68, art. 23, § 8; Repealed by its own terms and pursuant to § 40-8-13.4(g), effective March 30, 2010.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-15. - Repealed.

§ 27-19-15. Repealed.
History of Section.
P.L. 1971, ch. 208, § 1; P.L. 1984, ch. 4, § 4; P.L. 1989, ch. 542, § 80; P.L. 1994, ch. 392, § 1; P.L. 2009, ch. 68, art. 23, § 8; Repealed by its own terms and pursuant to § 40-8-13.4(g), effective March 30, 2010.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-16. - Repealed.

§ 27-19-16. Repealed.
History of Section.
P.L. 1971, ch. 208, § 1; P.L. 2009, ch. 68, art. 23, § 8; Repealed by its own terms and pursuant to § 40-8-13.4(g), effective March 30, 2010.