reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-87. - Perinatal doulas.

§ 27-18-87. Perinatal doulas.
(a)
As used in this section, “doula” or “perinatal doula” means a trained professional providing continuous physical, emotional, and informational support to a pregnant individual, from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.
(b)
Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurer’s respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas’ area of professional competence as defined by the doula certification standard developed and maintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other healthcare provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement, except when those requirements are also applicable to other categories of healthcare providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other healthcare provider.
(c)
Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover perinatal doula services, as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023, and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
(d)
This section shall not apply to insurance coverage providing benefits for:
(1)
Hospital confinement indemnity;
(2)
Disability income;
(3)
Accident only;
(4)
Long-term care;
(5)
Medicare supplement;
(6)
Limited-benefit health;
(7)
Specified disease indemnity;
(8)
Sickness or bodily injury or death by accident or both; and
(9)
Other limited-benefit policies.
History of Section.
P.L. 2021, ch. 209, § 2, effective July 1, 2022; P.L. 2021, ch. 321, § 2, effective July 1, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-88. - Gender rating.

§ 27-18-88. Gender rating.
(a)
No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state, that provides medical coverage that includes coverage for physician services in a physician’s office, and no policy that provides major medical or similar comprehensive-type coverage, excluding disability income, long-term care, and insurance supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall vary the premium rate for a health coverage plan based on the gender of the individual policy holders, enrollees, subscribers, or members.
(b)
This section shall not apply to insurance coverage providing benefits for any of the following:
(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 of bodily injury or death by accident or both; and
(9)
Other limited benefit policies.
History of Section.
P.L. 2021, ch. 88, § 1, effective January 1, 2023; P.L. 2021, ch. 89, § 1, effective January 1, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-91. - Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective January 1, 2024.]

§ 27-18-91. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective January 1, 2024.]
(a)
Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis (“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall constitute a separate method of administration. A health insurer is not required to cover any pre-exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network pharmacy benefit.
(b)
The healthcare benefits outlined in this chapter apply only to services delivered within the health insurer’s provider network; provided that, all health insurers shall be required to provide coverage for those benefits mandated by this chapter outside of the health insurer’s provider network where it can be established that the required services are not available from a provider in the health insurer’s network.
History of Section.
P.L. 2023, ch. 254, § 1, effective January 1, 2024.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-92. - Expedited prior authorization. [Effective January 1, 2024.]

§ 27-18-92. Expedited prior authorization. [Effective January 1, 2024.]
To the extent a prior authorization is permitted and applied, then it shall be conducted in an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-18.9-6(a)(1).
History of Section.
P.L. 2023, ch. 254, § 1, effective January 1, 2024.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-94. - Epinephrine injectors.

§ 27-18-94. 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, § 1, effective June 22, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law › Section 27-18.1-1. - Purpose.

§ 27-18.1-1. Purpose.
The purpose of this chapter is to assure full federal support of the Rhode Island medical assistance program by providing for full compliance with 42 U.S.C. § 1301 et seq.
History of Section.
P.L. 1979, ch. 52, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law › Section 27-18.1-2. - Definitions.

§ 27-18.1-2. Definitions.
(a)
“Blanket or group policy of insurance” means any accident and sickness insurance policy made exempt from the provisions of chapter 18 of this title by the operation of § 27-18-19(3).
(b)
“Contract providing a health benefit or benefits” means a policy of accident and health insurance which provides a health benefit or that part of a policy, which provides other benefits in addition to health benefits, which does provide health benefits. It also means a subscriber contract offered by a health maintenance organization or by any nonprofit service corporation, whether or not the contract is described as providing health maintenance organization benefits.
(c)
“Health benefit” means benefit or health benefit as defined in § 42-62-4.
(d)
“Health maintenance organization” means a “qualified health maintenance organization” as referred to in § 42-62-9.
(e)
“Insurance company” means a domestic insurance company incorporated by the general assembly and subject to chapter 1 of this title, or a foreign insurance company licensed to do business in Rhode Island and subject to chapter 2 of this title.
(f)
“Nonprofit service corporation” means a nonprofit hospital service corporation as defined in chapter 19 of this title, a nonprofit medical service corporation as defined in chapter 20 of this title, a nonprofit dental service corporation as defined in chapter 20.1 of this title, or a nonprofit optometric service corporation as defined in chapter 20.2 of this title.
(g)
“Policy of accident and sickness insurance” means a policy of accident and sickness insurance as defined in chapter 18 of this title, and, in addition, means any blanket or group policy of insurance, as defined in subsection (a) of this section.
History of Section.
P.L. 1979, ch. 52, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law › Section 27-18.1-3. - Exclusions and limitations prohibited.

§ 27-18.1-3. Exclusions and limitations prohibited.
No insurance company, health maintenance organization, or nonprofit corporation may issue, deliver, or renew any contract providing a health benefit or benefits which contains any provisions excluding or limiting its benefits on account of eligibility for or payment of benefits under 42 U.S.C. § 1396 et seq.; provided, that the application of this section shall not increase the personal liability to health care providers of a medical assistance recipient of health services, as those services are defined in § 42-62-4.
History of Section.
P.L. 1979, ch. 52, § 1; P.L. 2002, ch. 292, § 34.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law › Section 27-18.1-4. - Rules and regulations.

§ 27-18.1-4. Rules and regulations.
The director of business regulation shall promulgate any rules and regulations as he or she shall deem necessary for the efficient administration of this chapter.
History of Section.
P.L. 1979, ch. 52, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law › Section 27-18.1-5. - Applicability.

§ 27-18.1-5. Applicability.
In keeping with the provisions of §§ 27-19-2, 27-20-2, 27-20.1-2, and 27-20.2-2, it is expressly provided that all corporations subject to chapters 19, 20, 20.1, and 20.2 of this title are subject to this chapter.
History of Section.
P.L. 1979, ch. 52, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.1 - Compliance of Health Benefit Contracts and Medical Assistance Program with Federal Law › Section 27-18.1-6. - Severability.

§ 27-18.1-6. Severability.
If any provision of the chapter or the application of a provision to any person or circumstances shall be held invalid, the remainder of the chapter and the application of the provision to persons or circumstances other than those as to which it is held invalid shall not be affected by that invalidity.
History of Section.
P.L. 1979, ch. 52 § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-1. - Definitions.

§ 27-18.2-1. Definitions.
(1)
“Applicant” means:
(i)
In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and
(ii)
In the case of a group Medicare supplement policy, the proposed certificate holder.
(2)
“Certificate” means, for the purposes of this chapter, any certificate delivered or issued for delivery in this state under a group Medicare supplement policy.
(3)
“Certificate form” means the form on which the certificate is delivered or issued for delivery by the issuer.
(4)
“Director” or “Commissioner” means the commissioner for the office of the health insurance commissioner.
(5)
“Issuer” includes insurance companies, fraternal benefit societies, healthcare service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates.
(6)
“Medicare” means the “Health Insurance for the Aged Act,” 42 U.S.C. § 1395 et seq.
(7)
“Medicare supplement policy” means a group or individual policy of accident and sickness insurance, as defined in § 27-18-1, or a subscriber contract of a nonprofit hospital service corporation or of a nonprofit medical service corporation or an evidence of coverage of a health maintenance organization as defined in § 42-62-4 or as licensed under chapter 41 of this title, other than a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act, 42 U.S.C. § 1395mm, or an issued policy under a demonstration project specified in 42 U.S.C. § 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare.
(8)
“Policy form” means the form on which the policy is delivered or issued for delivery by the issuer.
History of Section.
P.L. 1984, ch. 49, § 1; P.L. 1988, ch. 631, § 1; P.L. 1989, ch. 428, § 1; P.L. 1992, ch. 445, § 4; P.L. 1993, ch. 180, § 12; P.L. 1996, ch. 190, § 1; P.L. 2022, ch. 393, § 1, effective July 1, 2023; P.L. 2022, ch. 394, § 1, effective July 1, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-2. - Applicability and scope.

§ 27-18.2-2. Applicability and scope.
(a)
Except as otherwise specifically provided, this chapter shall apply to:
(1)
All Medicare supplement policies and subscriber contracts delivered or issued for delivery in this state on or after July 1, 1992; and
(2)
All certificates issued under group Medicare supplement policies, which certificates have been delivered or issued for delivery in this state.
(b)
This chapter shall not apply to a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination of them, for employees or former employees or a combination of them, or for members or former members, or a combination of them, of the labor organizations.
(c)
Except as otherwise specifically provided in § 27-18.2-6(d), the provisions of this chapter are not intended to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to Medicare eligible persons which policies are not marketed or held to be Medicare supplement policies or benefit plans.
History of Section.
P.L. 1988, ch. 631, § 2; P.L. 1989, ch. 428, § 1; P.L. 1990, ch. 218, § 1; P.L. 1992, ch. 445, § 4; P.L. 1993, ch. 180, § 12; P.L. 1996, ch. 190, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-3.1. - Premium rate review.

§ 27-18.2-3.1. Premium rate review.
(a)
An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has been filed with and approved by the commissioner in accordance with filing requirements and procedures prescribed by the commissioner.
(b)
The commissioner shall review the rate, rating formula, or rate manual filing and approve the filing, propose to the health insurance issuer how the filing can be amended and approved, or take other actions separately or in combination as the commissioner deems appropriate and as authorized by law.
(c)
The commissioner may approve, disapprove, or modify the rates, rating formula, or rating manual filed by the issuer.
(d)
A health insurance rate, rating formula, or rate manual shall not be approved unless the commissioner determines that the health insurance issuer has demonstrated to the satisfaction of the commissioner that it is consistent with the proper conduct of the business of the issuer, and consistent with the interests of the public. In considering the interests of the public, the commissioner shall seek to ensure affordability and to minimize unreasonable disparities in access to coverage.
History of Section.
P.L. 2022, ch. 393, § 2, effective July 1, 2023; P.L. 2022, ch. 394, § 2, effective July 1, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-4. - Loss ratio standards.

§ 27-18.2-4. Loss ratio standards.
Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director shall issue reasonable regulations to establish minimum standards for loss ratios of Medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices.
History of Section.
P.L. 1988, ch. 631, § 2; P.L. 1989, ch. 428, § 1; P.L. 1990, ch. 218, § 1; P.L. 1992, ch. 445, § 4; P.L. 1993, ch. 180, § 12.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-6. - Disclosure standards.

§ 27-18.2-6. Disclosure standards.
(a)
In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time application is made.
(b)
The director shall prescribe the format and content of the outline of coverage required by subsection (a) of this section. For the purposes of this section, “format” means style, arrangements, and overall appearance, including such items as the size, color, and prominence of type and arrangement of text and captions. The outline of coverage shall include:
(1)
A description of the principal benefits and coverage provided in the policy;
(2)
A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums, and a disclosure of the existence of any automatic renewal premium increase based on the policyholder’s age; and
(3)
A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
(c)
The director may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for Medicare, which is intended to improve the buyer’s ability to select the most appropriate coverage and improve the buyer’s understanding of Medicare. Except in the case of direct response insurance policies, the director may require by regulation that the information brochure be provided to any prospective insureds eligible for Medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the director may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for Medicare, but in no event later than the time of policy delivery.
(d)
The director may adopt regulations for captions or notice requirements, determined to be in the public interest and designed to inform prospective insured that particular insurance coverage is not Medicare supplement coverage, for all accident and sickness insurance policies sold to persons eligible for Medicare other than:
(1)
Medicare supplement policies; or
(2)
Disability income policies.
(e)
The director may adopt reasonable regulations to govern the full and fair disclosure of the information in connection with the replacement of accident and sickness policies, subscriber contracts or certificates by persons eligible for Medicare.
History of Section.
P.L. 1988, ch. 631, § 2; P.L. 1989, ch. 428, § 1; P.L. 1992, ch. 445, § 4; P.L. 1993, ch. 180, § 12. P.L. 1996, ch. 190, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-7. - Notice of free examination.

§ 27-18.2-7. Notice of free examination.
Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate or attached to it stating in substance that the applicant shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Any refund made pursuant to this section shall be paid in a timely manner directly to the applicant by the insurer.
History of Section.
P.L. 1989, ch. 428, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-8. - Filing requirements for advertising.

§ 27-18.2-8. Filing requirements for advertising.
Every issuer of Medicare supplement insurance policies or certificates in this state shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio, or television medium to the director for review or approval by the director to the extent it may be required under state law.
History of Section.
P.L. 1989, ch. 428, § 1; P.L. 1992, ch. 445, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-9. - Administrative procedures.

§ 27-18.2-9. Administrative procedures.
Regulations adopted pursuant to this chapter shall be subject to the provisions of chapter 35 of title 42.
History of Section.
P.L. 1989, ch. 428, § 1; P.L. 1992, ch. 445, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-10. - Enforcement and penalties.

§ 27-18.2-10. Enforcement and penalties.
Whenever the director has cause to believe that a violation of this chapter or the regulations promulgated pursuant to this chapter has occurred, the director may, in accordance with the requirements of the Administrative Procedures Act, chapter 35 of title 42, revoke or suspend a license, levy an administrative penalty in an amount not less than five hundred dollars ($500) nor more than fifty thousand dollars ($50,000), order the violator to cease marketing any Medicare supplement policy or certificate in the state, require the violator to take any actions necessary to comply with the provisions of law, or any combination of these.
History of Section.
P.L. 1989, ch. 428, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.2 - Medicare Supplement Insurance Policies › Section 27-18.2-11. - Severability.

§ 27-18.2-11. Severability.
If any provision of this chapter or the application of any provision to any person or circumstances is for any reason held to be 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. 1989, ch. 428, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.4 - Health Insurance — Coordination with Federal Medicaid Program › Section 27-18.4-1. - Definitions.

§ 27-18.4-1. Definitions.
(a)
“Insurer” means any health insurer (including a group health plan, as defined in § 607(1) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1167(1)), a health maintenance organization as defined in § 27-41-2, a qualified health maintenance organization as referred to in § 42-62-9, a non-profit hospital service corporation as defined in § 27-19-1, a non-profit medical service corporation as defined in § 27-20-1, a non-profit dental service corporation as defined in § 27-20.1-1, a non-profit optometric service corporation as defined in § 27-20.2-1, self insured plans, pharmacy benefit managers (PBM), and other parties that are by statute, contract, or agreement, legally responsible for payment of a claim for a health care item of service doing business in the state, a domestic insurance company subject to chapter 1 of this title, and a foreign insurance company subject to chapter 2 of this title.
(b)
“Medical assistance” and “Medicaid” mean medical assistance provided in whole or in part by the department of human services pursuant to chapter 5.1, 8, 8.4 of title 40 or 12.3 of title 42 and/or title XIX or XXI of the federal Social Security Act, as amended, 42 U.S.C. § 1396 et seq. and 42 U.S.C. § 1397aa et seq., respectively.
History of Section.
P.L. 1994, ch. 237, § 2; P.L. 2002, ch. 65, art. 35, § 2; P.L. 2007, ch. 73, art. 18, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.4 - Health Insurance — Coordination with Federal Medicaid Program › Section 27-18.4-2. - Coordination of benefits with Medical Assistance — Acquired rights to payments.

§ 27-18.4-2. Coordination of benefits with Medical Assistance — Acquired rights to payments.
(a)
An insurer is prohibited from considering the availability or eligibility for medical assistance in this or any other state when considering eligibility for coverage or making payments under its plan for eligible enrollees, subscribers, policyholders or certificate holders.
(b)
To the extent that payment for covered expenses has been made under the state Medicaid program for health care items or services furnished to an individual in any case where a third party, including an insurer, has a legal liability to make payments, the department of human services is considered to have acquired the rights of the individual to payment by any other party, including an insurer, for those health care items or services. These rights are further defined and are enforceable in accordance with §§ 40-6-9 and 40-6-9.1.
History of Section.
P.L. 1994, ch. 237, § 2; P.L. 2002, ch. 65, art. 35, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.4 - Health Insurance — Coordination with Federal Medicaid Program › Section 27-18.4-3. - Nondiscrimination in enrollment — Claims submission.

§ 27-18.4-3. Nondiscrimination in enrollment — Claims submission.
(a)
An insurer shall not deny enrollment of a child under any health plan of the child’s parent on the grounds that:
(1)
The child was born out of wedlock;
(2)
The child is not claimed as a dependent on the parent’s federal tax return; or
(3)
The child does not reside with the parent or in the insurer’s service area.
(b)
Where a child has health coverage through an insurer of a noncustodial parent the insurer shall:
(1)
Provide any information to the custodial parent as may be necessary for the child to obtain benefits through that coverage;
(2)
Permit the custodial parent (or the provider, with the custodial parent’s approval) to submit claims for covered services without the approval of the noncustodial parent; and
(3)
Make payments on claims submitted in accordance with subsection (b)(2) of this section directly to the custodial parent, the provider or the department of human services.
(c)
Where a parent is required by a court or administrative order to provide health coverage for a child, and the parent is eligible for family health coverage, the insurer is required:
(1)
To permit the parent to enroll, under the family coverage, a child who is eligible for the coverage without regard to any enrollment season restrictions;
(2)
If the parent is enrolled but fails to make application to obtain coverage for the child, to enroll the child under family coverage upon application of the child’s other parent, or the department of human services which administers the Medicaid program and the child support enforcement program under 42 U.S.C. § 651 et seq.; and
(3)
Not to disenroll (or eliminate coverage of) the child unless the insurer is provided satisfactory written evidence that:
(i)
The court or administrative order is no longer in effect; or
(ii)
The child is or will be enrolled in comparable health coverage through another insurer that will take effect not later than the effective date of disenrollment.
(d)
An insurer may not impose requirements on the department of human services, which has been assigned the rights of an individual eligible for medical assistance pursuant to § 40-6-9 and covered for health benefits from the insurer, that are different from requirements applicable to an agent or assignee of any other covered individual.
History of Section.
P.L. 1994, ch. 237, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.4 - Health Insurance — Coordination with Federal Medicaid Program › Section 27-18.4-4. - Employer obligations.

§ 27-18.4-4. Employer obligations.
Where a parent is required by a court or administrative order to provide health coverage, which is available through an employer doing business in this state, the employer is required:
(1)
To permit the parent to enroll under family coverage any child who is eligible for coverage without regard to any enrollment season restrictions;
(2)
If the parent is enrolled but fails to make application to obtain coverage of the child, to enroll the child under family coverage upon application by the child’s other parent, or by the department of human services acting as the state Medicaid and/or child support enforcement program;
(3)
Not to disenroll (or eliminate coverage of) this child unless the employer is provided satisfactory written evidence that:
(i)
The court order is no longer in effect;
(ii)
The child is or will be enrolled in comparable coverage which will take effect no later than the effective date of disenrollment; or
(iii)
The employer has eliminated family health coverage for all of its employees.
(4)
To withhold from the employee’s compensation the employee’s share (if any) of premiums for health coverage and to pay this amount to the insurer.
History of Section.
P.L. 1994, ch. 237, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.4 - Health Insurance — Coordination with Federal Medicaid Program › Section 27-18.4-5. - Rules and regulations.

§ 27-18.4-5. Rules and regulations.
The director of business regulation may promulgate any rules and regulations as he or she shall deem necessary for the efficient administration of this chapter.
History of Section.
P.L. 1994, ch. 237, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.4 - Health Insurance — Coordination with Federal Medicaid Program › Section 27-18.4-6. - Severability.

§ 27-18.4-6. Severability.
If any provision of the chapter, or the application of a provision to any person or circumstances, is held invalid, the remainder of the chapter, and the application of the provision to persons or circumstances other than those as to which it is held invalid, shall not be affected by that invalidity.
History of Section.
P.L. 1994, ch. 237, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.5 - Individual Health Insurance Coverage › Section 27-18.5-1. - Purpose.

§ 27-18.5-1. Purpose.
The purpose of this chapter is, among other things, to insure compliance of all policies, contracts, certificates, and agreements of individual health insurance coverage offered or delivered in this state with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).
History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4; P.L. 2006, ch. 273, § 2; P.L. 2006, ch. 297, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.5 - Individual Health Insurance Coverage › Section 27-18.5-5. - Enforcement — Limitation on actions.

§ 27-18.5-5. Enforcement — Limitation on actions.
The commissioner has the power to enforce the provisions of this chapter in accordance with § 42-14-16 and all other applicable laws.
History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4; P.L. 2023, ch. 214, § 1, effective June 21, 2023; P.L. 2023, ch. 215, § 1, effective June 21, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.5 - Individual Health Insurance Coverage › Section 27-18.5-6. - Rules and regulations.

§ 27-18.5-6. Rules and regulations.
The commissioner 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; P.L. 2023, ch. 214, § 1, effective June 21, 2023; P.L. 2023, ch. 215, § 1, effective June 21, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.5 - Individual Health Insurance Coverage › Section 27-18.5-7. - Severability.

§ 27-18.5-7. 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 the 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 27-18.5 - Individual Health Insurance Coverage › Section 27-18.5-8. - Wellness health benefit plan.

§ 27-18.5-8. Wellness health benefit plan.
All carriers that offer health insurance in the individual market shall actively market and offer the wellness health direct benefit plan to eligible individuals. The wellness health direct benefit plan shall be determined by regulation promulgated by the office of the health insurance commissioner (OHIC). The OHIC shall develop the criteria for the direct wellness health benefit plan, including, but not limited to, benefit levels, cost sharing levels, exclusions and limitations in accordance with the following:
(1)
Form and utilize an advisory committee in accordance with subsection 27-50-10(5).
(2)
Set a target for the average annualized individual premium rate for the direct wellness health benefit plan to be less than ten percent (10%) of the average annual statewide wage, dependent upon the availability of reinsurance funds, as reported by the Rhode Island department of labor and training, in their report entitled “Quarterly Census of Rhode Island Employment and Wages.” In the event that this report is no longer available, or the OHIC determines that it is no longer appropriate for the determination of maximum annualized premium, an alternative method shall be adopted in regulation by the OHIC. The maximum annualized individual premium rate shall be determined no later than August 1st of each year, to be applied to the subsequent calendar year premiums rates.
(3)
Ensure that the direct wellness health benefit plan creates appropriate incentives for employers, providers, health plans and consumers to, among other things:
(i)
Focus on primary care, prevention and wellness;
(ii)
Actively manage the chronically ill population;
(iii)
Use the least cost, most appropriate setting; and
(iv)
Use evidence based, quality care.
(4)
The plan shall be made available in accordance with title 27, chapter 18.5 as required by regulation on or before May 1, 2007.
History of Section.
P.L. 2006, ch. 258, § 5; P.L. 2006, ch. 296, § 5; P.L. 2008, ch. 475, § 82.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.5 - Individual Health Insurance Coverage › Section 27-18.5-9. - Affordable health plan reinsurance program for individuals.

§ 27-18.5-9. Affordable health plan reinsurance program for individuals.
(a)
The commissioner shall allocate funds from the affordable health plan reinsurance fund for the affordable health reinsurance program.
(b)
The affordable health reinsurance program for individuals shall only be available to high-risk individuals as defined in § 27-18.5-2, and who purchase the direct wellness health benefit plan pursuant to the provisions of this section. Eligibility shall be determined based on state and federal income tax filings.
(c)
The affordable health plan reinsurance shall be in the form of a carrier cost-sharing arrangement, which encourages carriers to offer a discounted premium rate to participating individuals, and whereby the reinsurance fund subsidizes the carriers’ losses within a prescribed corridor of risk as determined by regulation.
(d)
The specific structure of the reinsurance arrangement shall be defined by regulations promulgated by the commissioner.
(e)
The commissioner shall determine total eligible enrollment under qualifying individual health insurance contracts by dividing the funds available for distribution from the reinsurance fund by the estimated per member annual cost of claims reimbursement from the reinsurance fund.
(f)
The commissioner shall suspend the enrollment of new individuals under qualifying individual health insurance contracts if the director determines that the total enrollment reported under such contracts is projected to exceed the total eligible enrollment, thereby resulting in anticipated annual expenditures from the reinsurance fund in excess of ninety-five percent (95%) of the total funds available for distribution from the fund.
(g)
The commissioner shall provide the health maintenance organization, health insurers and health plans with notification of any enrollment suspensions as soon as practicable after receipt of all enrollment data.
(h)
The premiums of qualifying individual health insurance contracts must be no more than ninety percent (90%) of the actuarially-determined and commissioner approved premium for this health plan without the reinsurance program assistance.
(i)
The commissioner shall prepare periodic public reports in order to facilitate evaluation and ensure orderly operation of the funds, including, but not limited to, an annual report of the affairs and operations of the fund, containing an accounting of the administrative expenses charged to the fund. Such reports shall be delivered to the co-chairs of the joint legislative committee on health care oversight by March 1st of each year.
History of Section.
P.L. 2006, ch. 273, § 4; P.L. 2006, ch. 297, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.5 - Individual Health Insurance Coverage › Section 27-18.5-10. - Prohibition on preexisting condition exclusions.

§ 27-18.5-10. Prohibition on preexisting condition exclusions.
(a)
A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title and/or chapter shall not limit or exclude coverage for any individual by imposing a preexisting condition exclusion on that individual.
(b)
As used in this section, “preexisting condition exclusion” means any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individual’s health status before the individual’s effective date of coverage, or if the coverage is denied, the date of denial, under the health benefit plan, such as a condition (whether physical or mental) identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period.
(c)
This section shall not apply to grandfathered health plans providing individual health insurance coverage.
(d)
This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
History of Section.
P.L. 2012, ch. 256, § 4; P.L. 2012, ch. 262, § 4; P.L. 2023, ch. 214, § 1, effective June 21, 2023; P.L. 2023, ch. 215, § 1, effective June 21, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.5 - Individual Health Insurance Coverage › Section 27-18.5-10.1. - Special enrollment — Pregnancy.

§ 27-18.5-10.1. Special enrollment — Pregnancy.
(a) In general.
A carrier shall establish a special enrollment period that allows for the enrollment of a pregnant individual at any time after the commencement of the pregnancy. Coverage shall be effective as of the first of the month in which the pregnant individual applies for coverage. This special enrollment period shall be applicable to all health insurance coverage offered by a carrier.
(b) Non-interference with federal and state law.
Nothing in subsection (a) shall be construed to conflict with or preempt any other applicable requirements for enrollment in health insurance coverage under federal and state law. The special enrollment period described in subsection (a) is in addition to any other special enrollment periods that are required under federal and state law.
History of Section.
P.L. 2022, ch. 145, § 1, effective January 1, 2023; P.L. 2022, ch. 146, § 1, effective January 1, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.6 - Large Group Health Insurance Coverage › Section 27-18.6-1. - Purpose.

§ 27-18.6-1. Purpose.
The purpose of this chapter is to insure compliance of all policies, contracts, certificates, and agreements of group health insurance coverage offered or delivered in this state with the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).
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 27-18.6-3.1. - Special enrollment — Pregnancy.

§ 27-18.6-3.1. Special enrollment — Pregnancy.
(a) In general.
A group health plan and a carrier shall establish a special enrollment period that allows for the enrollment of a pregnant individual at any time after the commencement of the pregnancy. Coverage shall be effective as of the first of the month in which the pregnant individual applies for coverage. This special enrollment period shall be applicable to all group health insurance coverage and health insurance coverage offered by a group health plan or a carrier.
(b) Non-interference with federal and state law.
Nothing in subsection (a) shall be construed to conflict with or preempt any other applicable requirements for enrollment in health insurance coverage under federal and state law. The special enrollment period described in subsection (a) is in addition to any other special enrollment periods that are required under federal and state law.
History of Section.
P.L. 2022, ch. 145, § 2, effective January 1, 2023; P.L. 2022, ch. 146, § 2, effective January 1, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18.6 - Large Group Health Insurance Coverage › Section 27-18.6-3.2. - Preventive services.

§ 27-18.6-3.2. Preventive services.
(a)
As used in this section, “preventive services” means those services described in 42 U.S.C. § 300gg-13 and implementing regulations and guidance.
(b)
If any provision of the federal Patient Protection and Affordable Care Act and implementing regulations relating to preventive services without cost sharing are determined by the commissioner to have been repealed or to have been declared invalid or nullified by the final judgment of a federal court applicable to the state or by executive or administrative action, which shall be deemed to include an action of the executive or judicial branch that nullifies the effectiveness of the obligation to provide coverage without cost sharing for a meaningful range of preventive services substantially similar to those in effect as of January 1, 2023, then the following shall apply:
(1)
A health insurance policy, subscriber contract, or health plan offered, issued, renewed, issued for delivery, or issued to cover a resident of this state, by a health insurance company licensed pursuant to this title and/or chapter, shall provide coverage of preventive services from in-network providers without applying any copayments, deductibles, coinsurance, or other cost sharing, as described in 42 U.S.C. § 300gg-13 and related regulations and guidance, including existing exemptions, in effect as of the date immediately prior to their repeal, revocation, or nullification, as set forth above.
(2)
To the extent that the U.S. Preventive Services Taskforce revises its recommendations with respect to grade “A” or “B” preventive services or other expert advisory panel described in 42 U.S.C. § 300gg-13, similarly provides new or revised recommendations the office of the health insurance commissioner shall have the authority to issue guidance clarifying the services that shall qualify as preventive services under this section, consistent with said recommendations, and in accordance with the process as had been described by the version of 42 U.S.C. § 300gg-13(b) and related regulations and guidance in effect as of the date immediately prior to their repeal, revocation, or nullification, as set forth above.
(c)
If a health insurance policy, subscriber contract, or health plan offered, issued, renewed, issued for delivery, or issued to cover a resident of this state, by a health insurance company licensed pursuant to this title and/or chapter, was not subject to the requirements described in subsection (b) of this section prior to their repeal, revocation, or nullification, then such policy, contract, or plan shall remain so exempt and the provisions of this section shall not apply.
History of Section.
P.L. 2023, ch. 214, § 3, effective June 21, 2023; P.L. 2023, ch. 215, § 3, effective June 21, 2023.