reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.2 - Long-Term Care Insurance › Section 27-34.2-22. - Discretionary clauses.

§ 27-34.2-22. Discretionary clauses.
(a)
No new or existing policy or certificate may contain any provision:
(1)
Purporting to reserve sole discretion to the insurance company to determine eligibility for benefits or interpret the terms of a policy or certificate; or
(2)
Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.
(b)
Any such clause or language included in a contract, policy, or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.
(c)
Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.
History of Section.
P.L. 2013, ch. 85, § 6; P.L. 2013, ch. 94, § 6.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-1. - Short title.

§ 27-34.3-1. Short title.
This chapter shall be known and may be cited as the “Rhode Island Life and Health Insurance Guaranty Association Act.”
History of Section.
P.L. 1995, ch. 114, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-2. - Purpose.

§ 27-34.3-2. Purpose.
(a)
The purpose of this chapter is to protect, subject to certain limitations, the persons specified in § 27-34.3-3(a) against failure in the performance of contractual obligations, under life and health insurance policies and annuity contracts specified in § 27-34.3-3(b), because of the impairment or insolvency of the member insurer that issued the policies or contracts.
(b)
To provide this protection, an association of insurers is created to pay benefits and to continue coverages as limited in this chapter, and members of the association are subject to assessment to provide funds to carry out the purpose of this chapter.
(c)
In accordance with this purpose, in determining the coverage limits to be applied in § 27-34.3-3 in cases in which there were different statutory limits at the time the insurer was declared impaired and the time the insurer was declared insolvent, the statute with the higher limits shall be applied to the claim.
History of Section.
P.L. 1995, ch. 114, § 1; P.L. 2012, ch. 296, § 3; P.L. 2012, ch. 326, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-4. - Construction.

§ 27-34.3-4. Construction.
This chapter shall be construed to effect the purpose under § 27-34.3-2.
History of Section.
P.L. 1995, ch. 141, § 1; P.L. 2004, ch. 39, § 1; P.L. 2004, ch. 44, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-6. - Creation of the association.

§ 27-34.3-6. Creation of the association.
(a)
There is created a nonprofit legal entity to be known as the Rhode Island life and health insurance guaranty association. All member insurers shall be and remain members of the association as a condition of their authority to transact insurance in this state. The association shall perform its functions under the plan of operation established and approved under § 27-34.3-10, or as previously established and approved under § 27-34.1-11 [repealed] and shall exercise its powers through a board of directors established under § 27-34.3-7 or as previously established under § 27-34.1-8 [repealed]. For purposes of administration and assessment, the association shall maintain two (2) accounts:
(1)
The life insurance and annuity account which includes the following subaccounts:
(i)
Life insurance account;
(ii)
Annuity account; which shall include annuity contracts owned by a governmental retirement plan (or its trustee) established under § 401, § 403(b), or § 457 of the Internal Revenue Code, 26 U.S.C. § 401, § 403(b), or § 457, but shall otherwise exclude unallocated annuities; and
(iii)
Unallocated annuity account which shall exclude contracts owned by a governmental retirement benefit plan (or its trustee) established under § 401, § 403(b), or § 457 of the Internal Revenue Code, 26 U.S.C. § 401, § 403(b), or § 457.
(2)
The health insurance account.
(b)
The association shall come under the immediate supervision of the commissioner and shall be subject to the applicable provisions of the insurance laws of this state. Meetings or records of the association may be open to the public upon majority vote of the board of directors. The commissioner or his or her designee shall have full and complete access to all documents received by, created by, or otherwise obtained by the association and shall be invited to be present at all association meetings. The disclosure of confidential or privileged association information, documents, or records to the commissioner shall not change the confidential or privileged status of the information, documents, or records.
History of Section.
P.L. 1995, ch. 114, § 1; P.L. 2004, ch. 39, § 1; P.L. 2004, ch. 44, § 1; P.L. 2008, ch. 475, § 92; P.L. 2012, ch. 296, § 3; P.L. 2012, ch. 326, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-7. - Board of directors.

§ 27-34.3-7. Board of directors.
(a)
The board of directors of the association shall consist of:
(1)
Not less than five (5) nor more than nine (9) member insurers serving terms as established in the plan of operation; and
(2)
The commissioner or the commissioner’s designee. Only member insurers shall be eligible to vote. The members of the board shall be selected by member insurers subject to the approval of the commissioner. The board of directors, previously established under § 27-34.1-8 [repealed], shall continue to operate in accordance with the provision of this section. Vacancies on the board shall be filled for the remaining period of the term by a majority vote of the remaining board members, subject to the approval of the commissioner.
(b)
In approving selections to the board, the commissioner shall consider, among other things, whether all member insurers are fairly represented.
(c)
Members of the board may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors but members of the board shall not be compensated by the association for their services.
History of Section.
P.L. 1995, ch. 114, § 1; P.L. 2004, ch. 39, § 1; P.L. 2004, ch. 44, § 1; P.L. 2008, ch. 475, § 92; P.L. 2012, ch. 296, § 3; P.L. 2012, ch. 326, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-10. - Plan of operation.

§ 27-34.3-10. Plan of operation.
(a)(1)
The plan of operation as previously established and approved under this section shall continue to be effective. The association may amend the plan of operation when necessary or suitable to assure the fair, reasonable, and equitable administration of the association. Amendments shall become effective upon the commissioner’s written approval.
(2)
If at any time the association fails to submit suitable amendments to the plan, the commissioner shall, after notice and hearing, adopt and promulgate any reasonable rules necessary or advisable to effectuate the provisions of this chapter. The rules shall continue in force until modified by the commissioner or superseded by amendments to the plan submitted by the association and approved by the commissioner.
(b)
All member insurers shall comply with the plan of operation.
(c)
The plan of operation shall, in addition to requirements enumerated in this chapter:
(1)
Establish procedures for handling the assets of the association;
(2)
Establish the amount and method of reimbursing members of the board of directors under § 27-34.3-7;
(3)
Establish regular places and times for meetings including telephone conference calls of the board of directors;
(4)
Establish procedures for records to be kept of all financial transactions of the association, its agents, and the board of directors;
(5)
Establish the procedures by which selections for the board of directors will be made and submitted to the commissioner;
(6)
Establish any additional procedures for assessments under § 27-34.3-9;
(7)
Contain additional provisions necessary or proper for the execution of the powers and duties of the association;
(8)
Establish procedures whereby a director may be removed for cause, including in the case where a member insurer director becomes an impaired or insolvent insurer; and
(9)
Require the board of directors to establish a policy and procedures for addressing conflicts of interests.
(d)
The plan of operation may provide that any or all powers and duties of the association, except those under §§ 27-34.3-8(
l
)(3) and 27-34.3-9, are delegated to a corporation, association, or other organization which performs or will perform functions similar to those of this association, or its equivalent, in two (2) or more states. This corporation, association, or organization shall be reimbursed for any payments made on behalf of the association and shall be paid for its performance of any function of the association. A delegation under this subsection shall take effect only with the approval of both the board of directors and the commissioner, and may be made only to a corporation, association, or organization which extends protection not substantially less favorable and effective than that provided by this chapter.
History of Section.
P.L. 1995, ch. 114, § 1; P.L. 2004, ch. 39, § 1; P.L. 2004, ch. 44, § 1; P.L. 2009, ch. 158, § 1; P.L. 2009, ch. 169, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-11. - Duties and powers of the commissioner.

§ 27-34.3-11. Duties and powers of the commissioner.
In addition to the duties and powers enumerated in this chapter,
(a)
The commissioner shall:
(1)
Upon request of the board of directors, provide the association with a statement of the premiums in this and any other appropriate states for each member insurer;
(2)
When an impairment is declared and the amount of the impairment is determined, serve a demand upon the impaired insurer to make good the impairment within a reasonable time; notice to the impaired insurer shall constitute notice to its shareholders, if any; the failure of the insurer to promptly comply with a demand shall not excuse the association from the performance of its powers and duties under this chapter; and
(3)
[Deleted by P.L. 2009, ch. 158, § 1 and by P.L. 2009, ch. 169, § 1].
(4)
Maintain the confidentiality and privileged status of confidential association information provided to the commissioner or department of business regulation.
(b)
The commissioner may suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this state of any member insurer which fails to pay an assessment when due or fails to comply with the plan of operation. As an alternative the commissioner may levy a forfeiture on any member insurer that fails to pay an assessment when due. The forfeiture shall not exceed five percent (5%) of the unpaid assessment per month, but no forfeiture shall be less than one hundred dollars ($100) per month.
(c)
A final action of the board of directors or the association may be appealed to the commissioner by any member insurer if the appeal is taken within sixty (60) days of its receipt of notice of the final action being appealed. A final action or order of the commissioner shall be subject to judicial review.
(d)
The liquidator, rehabilitator, or conservator of any impaired or insolvent insurer may notify all interested persons of the effect of this chapter.
(e)
The commissioner shall not participate in the association’s adjudication of a protest by an insurer pursuant to § 27-34.3-9(i).
History of Section.
P.L. 1995, ch. 114, § 1; P.L. 2004, ch. 39, § 1; P.L. 2004, ch. 44, § 1; P.L. 2009, ch. 158, § 1; P.L. 2009, ch. 169, § 1; P.L. 2012, ch. 296, § 3; P.L. 2012, ch. 326, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-13. - Credits for assessments paid (tax offsets).

§ 27-34.3-13. Credits for assessments paid (tax offsets).
(a)
A member insurer may offset against its premium, franchise or income tax liability (or liabilities) to this state an assessment described in § 27-34.3-9(h) to the extent of ten percent (10%) of the amount of the assessment for each of the five (5) calendar years following the year in which the assessment was paid. In the event a member insurer should cease doing business, all uncredited assessments may be credited against its premium, franchise, or income tax liability (or liabilities) for the year it ceases doing business.
(b)
Any sums that are acquired by refund, pursuant to § 27-34.3-9(f), from the association by member insurers, and that have been offset against premium, franchise or income taxes as provided in subsection (a) of this section, shall be paid by the insurers to this state in any manner that the tax authorities may require. The association shall notify the commissioner that refunds have been made.
History of Section.
P.L. 1995, ch. 114, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-15. - Examination of the association — Annual report.

§ 27-34.3-15. Examination of the association — Annual report.
The association shall be subject to examination and regulation by the commissioner. The board of directors shall submit to the commissioner each year, not later than one hundred twenty (120) days after the association’s fiscal year, a financial report in a form approved by the commissioner and a report of its activities during the preceding fiscal year. Upon the request of a member insurer, the association shall provide the member insurer with a copy of the report.
History of Section.
P.L. 1995, ch. 114, § 1; P.L. 2004, ch. 39, § 1; P.L. 2004, ch. 44, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-16. - Tax exemptions.

§ 27-34.3-16. Tax exemptions.
The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real property.
History of Section.
P.L. 1995, ch. 114, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-17. - Immunity.

§ 27-34.3-17. Immunity.
There shall be no liability on the part of and no cause of action of any nature shall arise against any member insurer or its agents or employees, the association or its agents or employees, members of the board of directors, or the commissioner or the commissioner’s representatives, for any action or omission by them in the performance of their powers and duties under this chapter. The immunity shall extend to the participation in any organization of one or more other state associations of similar purposes and to any such organization and its agents or employees.
History of Section.
P.L. 1995, ch. 114, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-18. - Stay of proceedings — Reopening default judgments.

§ 27-34.3-18. Stay of proceedings — Reopening default judgments.
All proceedings in which the insolvent insurer is a party in any court in this state shall be stayed one hundred eighty (180) days from the date an order of liquidation, rehabilitation, or conservation is final to permit proper legal action by the association on any matters germane to its powers or duties. As to judgment under any decision, order, verdict, or finding based on default, the association may apply to have the judgment set aside by the same court that made the judgment and shall be permitted to defend against the suit on the merits.
History of Section.
P.L. 1995, ch. 114, § 1; P.L. 2009, ch. 158, § 1; P.L. 2009, ch. 169, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-34.3 - Rhode Island Life and Health Insurance Guaranty Association Act › Section 27-34.3-20. - Prospective application.

§ 27-34.3-20. Prospective application.
This chapter shall not apply to any insurer that is insolvent or unable to fulfill its contractual obligations prior to January 1, 1996, and any such insurer shall be subject to the provisions under chapter 34.1 [repealed] of this title. Nothing in this chapter shall be construed to require an insurer to recompute its assessment bases for any year prior to January 1, 2005, and any assessment bases computed between January 1, 1966, and December 31, 2004, are hereby acknowledged and recognized as factual on the basis of premium date collected from or reported by member insurers with respect to those years.
History of Section.
P.L. 1995, ch. 114, § 1; P.L. 2004, ch. 39, § 1; P.L. 2004, ch. 44, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-35 - Insurance Holding Company Systems › Section 27-35-7. - Rules and regulations.

§ 27-35-7. Rules and regulations.
The commissioner may, upon notice and opportunity for all interested persons to be heard, issue rules, regulations, and orders that are necessary to carry out the provisions of this chapter.
History of Section.
P.L. 1971, ch. 273, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-35 - Insurance Holding Company Systems › Section 27-35-9. - Sanctions.

§ 27-35-9. Sanctions.
(a)
Any insurer failing, without just cause, to file any registration statement as required in this chapter shall be required, after notice and hearing, to pay a penalty of five hundred dollars ($500) for each day’s delay, to be recovered by the commissioner, and the penalty so recovered shall be paid into the general revenue fund of this state. The maximum penalty under this section is that determined pursuant to § 42-14-16. The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.
(b)
Every director or officer of an insurance holding company system who knowingly violates, participates in, or assents to, or who knowingly shall permit any of the officers or agents of the insurer to engage in transactions or make investments which have not been properly reported or submitted as required by this chapter or which violate this chapter shall pay, in their individual capacity, a civil forfeiture determined pursuant to § 42-14-16, after notice and hearing. In determining the amount of the civil forfeiture, the commissioner shall take into account the appropriateness of the forfeiture with respect to the gravity of the violation, the history of previous violations, and such other matters as justice may require.
(c)
Whenever it appears to the commissioner that any insurer subject to this act or any director, officer, employee, or agent of the insurer has engaged in any transaction or entered into a contract which is subject to § 27-35-4 of this chapter and which would not have been approved had approval been requested, the commissioner may order the insurer to immediately cease and desist any further activity under the transaction or contract. After notice and hearing the commissioner may also order the insurer to void any contracts and restore the status quo if that action is in the best interest of the policyholders, creditors, or the public.
(d)
Whenever it appears to the commissioner that any insurer or any director, officer, employee, or agent thereof has committed a willful violation of this chapter, that insurer or any director, officer, employee, or agent thereof shall be in violation of chapter 54 of this title.
(e)
Whenever it appears to the commissioner that any person has committed a violation of § 27-35-2 of this chapter and which prevents the full understanding of the enterprise risk to the insurer by affiliates or by the insurance holding company system, the violation may serve as an independent basis for disapproving dividends or distributions and for placing the insurer under an order of supervision in accordance with chapter 14.1 of this title.
History of Section.
P.L. 1971, ch. 273, § 1; P.L. 1991, ch. 257, § 5; P.L. 1991, ch. 348, § 10; P.L. 2010, ch. 55, § 1; P.L. 2010, ch. 70, § 1; P.L. 2011, ch. 15, § 2; P.L. 2011, ch. 26, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-35 - Insurance Holding Company Systems › Section 27-35-10. - Receivership.

§ 27-35-10. Receivership.
Whenever it appears to the commissioner that any person has committed a violation of this chapter which impairs the financial condition of a domestic insurer as to threaten insolvency or make the further transaction of business by it hazardous to its policyholders, creditors, shareholders, or the public, then the commissioner may proceed as provided in chapter 14.3 of this title to take possession of the property of the domestic insurer and to conduct its business.
History of Section.
P.L. 1971, ch. 273, § 1; P.L. 2011, ch. 15, § 2; P.L. 2011, ch. 26, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-35 - Insurance Holding Company Systems › Section 27-35-10.5. - Recovery.

§ 27-35-10.5. Recovery.
(a)
If an order for liquidation or rehabilitation of a domestic insurer has been entered, the receiver appointed under the order shall have a right to recover on behalf of the insurer, (i) From any parent corporation or holding company or person or affiliate who otherwise controlled the insurer, the amount of distributions (other than distributions of shares of the same class of stock) paid by the insurer on its capital stock; or (ii) Any payment in the form of a bonus, termination settlement, or extraordinary lump sum salary adjustment made by the insurer or its subsidiary to a director, officer, or employee, where the distribution or payment pursuant to (i) or (ii) is made at any time during the one year preceding the petition for liquidation, conservation, or rehabilitation, as the case may be, subject to the limitations of subsections (b), (c), and (d).
(b)
No distribution shall be recoverable if the parent or affiliate shows that when paid the distribution was lawful and reasonable, and that the insurer did not know and could not reasonably have known that the distribution might adversely affect the ability of the insurer to fulfill its contractual obligations.
(c)
Any person who was a parent corporation or holding company or a person who otherwise controlled the insurer or affiliate at the time the distributions were paid shall be liable up to the amount of distributions or payments under subsection (a) which the person received. Any person who otherwise controlled the insurer at the time the distributions were declared shall be liable up to the amount of distributions that would have been received if they had been paid immediately. If two (2) or more persons are liable with respect to the same distributions, they shall be jointly and severally liable.
(d)
The maximum amount recoverable under this section shall be the amount needed in excess of all other available assets of the impaired or insolvent insurer to pay the contractual obligations of the impaired or insolvent insurer and to reimburse any guaranty funds.
(e)
To the extent that any person liable under subsection (c) is insolvent or otherwise fails to pay claims due from it, its parent corporation or holding company or person who otherwise controlled it at the time the distribution was paid, shall be jointly and severally liable for any resulting deficiency in the amount recovered from the parent corporation or holding company or person who otherwise controlled it.
History of Section.
P.L. 2010, ch. 55, § 2; P.L. 2010, ch. 70, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-35 - Insurance Holding Company Systems › Section 27-35-11. - Revocation, suspension, or nonrenewal of insurer’s license.

§ 27-35-11. Revocation, suspension, or nonrenewal of insurer’s license.
Whenever it appears to the commissioner that any person has committed a violation of this chapter which makes the continued operation of an insurer contrary to the interests of policyholders or the public, the commissioner may, after giving notice and an opportunity to be heard, determine to suspend, revoke, or refuse to renew the insurer’s license or authority to do business in this state for any period that he or she finds is required for the protection of policyholders or the public. That determination shall be accompanied by specific findings of fact and conclusions of law.
History of Section.
P.L. 1971, ch. 273, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-35 - Insurance Holding Company Systems › Section 27-35-12. - Judicial review — Mandamus.

§ 27-35-12. Judicial review — Mandamus.
(a)
Any person aggrieved by any act, determination, rule, regulation, or order or any other action of the commissioner pursuant to this chapter may appeal the action to the superior court. The court shall conduct its review without a jury and by trial de novo, except that if all parties, including the commissioner, so stipulate, the review shall be confined to the record. Portions of the record may be introduced by stipulation into evidence in a trial de novo as to those parties so stipulating.
(b)
The filing of an appeal pursuant to this section shall stay the application of any rule, regulation, order, or other action of the commissioner to the appealing party unless the court, after giving the party notice and an opportunity to be heard, determines that a stay would be detrimental to the interest of policyholders, shareholders, creditors, or the public.
(c)
Any person aggrieved by any failure of the commissioner to act or make a determination required by this chapter may petition the superior court of Providence County for a writ in the nature of a mandamus or a peremptory mandamus directing the commissioner to act or make the determination.
History of Section.
P.L. 1971, ch. 273, § 1; P.L. 2010, ch. 55, § 1; P.L. 2010, ch. 70, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-35 - Insurance Holding Company Systems › Section 27-35-13. - Conflict with other laws.

§ 27-35-13. Conflict with other laws.
All laws and parts of laws of this state inconsistent with this chapter are superseded with respect to matters covered by this chapter.
History of Section.
P.L. 1971, ch. 273, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-35 - Insurance Holding Company Systems › Section 27-35-14. - Severability.

§ 27-35-14. Severability.
If any provision of this chapter or its application to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application, and for this purpose the provisions of this chapter are severable.
History of Section.
P.L. 1971, ch. 273, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-36 - Consumer Representation at Rate Hearings › Section 27-36-1. - Representation.

§ 27-36-1. Representation.
All hearings conducted in accordance with the provisions of this title and chapter 62 of title 42 shall be attended by the attorney general or his or her designee and he or she shall represent, protect, and advocate the rights of the consumers at the hearings; provided, that if the hearings are related to a rate increase request by a health insurer, then the hearings shall be open to the public and shall be held by the department of business regulation. The department shall promulgate rules and regulations to ensure that the general public is given adequate notice. The term “health insurer” as used in this chapter includes all persons, firms, corporations, or other organizations offering and assuring health services on a prepaid or primarily expense incurred basis, including, but not limited to, policies of accident or sickness insurance, as defined by chapter 18 of this title, nonprofit hospital or medical service plans, whether organized under chapter 19 or 20 of this title or under any public law or by special act of the general assembly, health maintenance organizations, and any other entity that insures or reimburses for diagnostic, therapeutic, or preventive services to a defined population on the basis of a periodic premium. It shall also include all organizations providing health benefits coverage for employees on a self-insurance basis without the intervention of other entities.
History of Section.
P.L. 1977, ch. 219, § 1; P.L. 1987, ch. 569, § 1; P.L. 1990, ch. 335, § 1; P.L. 1996, ch. 355, § 1; P.L. 2023, ch. 395, art. 1, § 13, effective December 31, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-36 - Consumer Representation at Rate Hearings › Section 27-36-2. - Annual assessments of insurance companies.

§ 27-36-2. Annual assessments of insurance companies.
(a)
The director of the department of business regulation shall make an annual assessment against each insurance company, those corporations and other entities subject to this title and chapter 62 of title 42, hereafter referred to as a “company,” for payment of all reasonable expenditures incurred by the attorney general in representation at insurance rate hearings for matters involving insurance regulation. The assessments shall be in amounts annually determined and certified by the attorney general to the director of the department of business regulation as sufficient reimbursement for the general expenditures of the attorney general to fulfill the attorney general’s obligations under this chapter. The general expenditures shall be proportionately assessed by the director of the department of business regulation against each company. In addition, actual reasonable costs for experts, such as but not limited to actuaries and economists, and other specific costs incurred by the attorney general related to insurance rate hearings, whether or not a public hearing has been held or the rate review has proceeded through a final decision by the department of business regulation or office of the health insurance commissioner, shall be billed directly by the attorney general to the company that initiated the filing.
(b)
The company billed for these specific costs shall make payment to the attorney general by forwarding a check, payable to the service provider, to the chief of the insurance advocacy unit of the attorney general’s office within sixty (60) days of the date invoiced. Assessments made pursuant to this section may be credited to the normal operating costs of each company and shall be deposited as general revenue.
History of Section.
P.L. 1977, ch. 219, § 1; P.L. 1987, ch. 569, § 1; P.L 1995, ch. 370, art. 40, § 87; P.L. 2000, ch. 55, art. 11, § 1; P.L. 2001, ch. 127, § 1; P.L. 2008, ch. 9, art. 15, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-37 - Cancellation of Group Insurance › Section 27-37-1. - Notice of cancellation.

§ 27-37-1. Notice of cancellation.
No policy of group insurance issued in this state shall be canceled by the insurer unless written notice of cancellation is mailed to the group contract holder by certified or registered mail at least thirty (30) days prior to the cancellation date in order for the cancellation to be effective.
History of Section.
P.L. 1979, ch. 215, § 1; P.L. 2002, ch. 292, § 81.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-38.1 - Insurance Coverage for Pediatric Preventive Care › Section 27-38.1-1. - Definitions.

§ 27-38.1-1. Definitions.
For the purposes of this chapter, the following words and terms have the following meanings:
(1)
“Health insurers” as used in this chapter includes all persons, firms, corporations, or other organizations offering and assuring health services on a prepaid or primarily expense incurred basis, including, but not limited to, policies of accident or sickness insurance, as defined by chapter 18 of this title, except for supplemental policies that only provide coverage for specified diseases, or other supplemental policies, nonprofit hospital or medical service plans, whether organized under chapter 19 or 20 of this title or under any public law or by special act of the general assembly, health maintenance organizations, and any other entity that insures or reimburses for diagnostic, therapeutic, or preventive services to a determined population on the basis of a periodic premium.
(2)
“Pediatric preventive care” means those services recommended by the committee on practice and ambulatory medicine of the American Academy of Pediatrics when delivered, supervised, prescribed, or recommended by a physician and rendered to a child from birth through age nineteen (19).
(3)
“School policy” means a policy of accident and sickness insurance, as defined in § 27-18-1, providing coverage for a minor child only and issued by or through the school attended by the child.
History of Section.
P.L. 1988, ch. 488, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-38.1 - Insurance Coverage for Pediatric Preventive Care › Section 27-38.1-2. - Coverage required for pediatric preventive care.

§ 27-38.1-2. Coverage required for pediatric preventive care.
(a)
Every health insurance plan providing coverage for a dependent or minor child, other than school policies, shall include benefits for pediatric preventive care. All benefits shall be reimbursed in accordance with the reimbursement policies and procedure of each health insurer.
(b)
Every health insurer shall provide benefits for pediatric preventive care or make that care available to its enrolled participants. Benefits do not need to be provided pursuant to this section for pediatric preventive care services that are paid for or offered free of charge by the state of Rhode Island. Benefits do not need to be provided for the cost of biologicals used for vaccinations.
History of Section.
P.L. 1988, ch. 488, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-38.1 - Insurance Coverage for Pediatric Preventive Care › Section 27-38.1-3. - Benefits to be included in basic coverage.

§ 27-38.1-3. Benefits to be included in basic coverage.
The benefits mandated by this chapter shall be included in all benefit plans offered by every health insurer and health maintenance organization. Benefit plans offered by health insurers and health maintenance organizations may impose copayment charges for the benefits mandated by this chapter; in no instance shall the copayment amounts be greater than copayment charges imposed for other physician office visits, nor shall the copayment charges pose a barrier to obtaining pediatric preventive care. Benefits for pediatric services shall be reimbursed in accordance with each health insurer’s respective principles and mechanisms of reimbursement. The provisions of this benefit will supersede any deductible requirements.
History of Section.
P.L. 1988, ch. 488, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-38.2 - Insurance Coverage for Mental Illness and Substance Use Disorders › Section 27-38.2-3. - Medical necessity and appropriateness of treatment.

§ 27-38.2-3. Medical necessity and appropriateness of treatment.
(a)
Upon request of the reimbursing health insurers, all providers of treatment of mental illness shall furnish medical records or other necessary data that substantiates that initial or continued treatment is at all times medically necessary and appropriate. When the provider cannot establish the medical necessity and/or appropriateness of the treatment modality being provided, neither the health insurer nor the patient shall be obligated to reimburse for that period or type of care that was not established. The exception to the preceding can only be made if the patient has been informed of the provisions of this subsection and has agreed in writing to continue to receive treatment at his or her own expense.
(b)
The health insurers, when making the determination of medically necessary and appropriate treatment, must do so in a manner consistent with that used to make the determination for the treatment of other diseases or injuries covered under the health insurance policy or agreement.
(c)
Any subscriber who is aggrieved by a denial of benefits provided under this chapter may appeal a denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 [repealed] of title 23.
History of Section.
P.L. 1994, ch. 225, § 1; P.L. 1994, ch. 336, § 1; P.L. 1999, ch. 148, § 1; P.L. 2001, ch. 174, § 2; P.L. 2001, ch. 409, § 2; P.L. 2008, ch. 475, § 93.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-38.2 - Insurance Coverage for Mental Illness and Substance Use Disorders › Section 27-38.2-4. - Network coverage.

§ 27-38.2-4. Network coverage.
The healthcare benefits outlined in this chapter apply only to services delivered within the health insurer’s provider network; provided, that all health insurers shall be required to provide coverage for those benefits mandated by this chapter outside of the health insurer’s provider network where it can be established that the required services are not available from a provider in the health insurer’s network.
History of Section.
P.L. 1994, ch. 225, § 1; P.L. 1994, ch. 336, § 1; P.L. 2001, ch. 174, § 2; P.L. 2001, ch. 409, § 2; P.L. 2014, ch. 108, § 1; P.L. 2014, ch. 130, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-38.2 - Insurance Coverage for Mental Illness and Substance Use Disorders › Section 27-38.2-5. - Repealed.

§ 27-38.2-5. Repealed.
History of Section.
P.L. 2001, ch. 174, § 3; P.L. 2001, ch. 409, § 3; Repealed by P.L. 2014, ch. 108, § 2, effective June 16, 2014; P.L. 2014, ch. 130, § 2, effective June 16, 2014.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-39 - Second Medical Opinion › Section 27-39-1. - Definitions.

§ 27-39-1. Definitions.
As used in this chapter:
(1)
“Elective surgical procedure” means any non-emergency surgical procedure that may be scheduled at the convenience of the patient or the surgeon without jeopardizing the patient’s life or causing serious impairment to the patient’s bodily functions.
(2)
“Eligible physician” means a physician licensed to practice medicine and surgery who holds the rank of diplomate of an American board (M.D.) or certified specialist (D.O.) in the surgical or medical specialty for which surgery is proposed.
(3)
“Second surgical opinion” means an opinion of an eligible physician based on that physician’s examination of a person for the purpose of evaluating the medical advisability of that person undergoing an elective surgical procedure. The examinations must be performed after another physician licensed to practice medicine and surgery has proposed to perform the surgical procedure on the person but prior to the performance of the surgical procedure.
History of Section.
P.L. 1983, ch. 143, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-39 - Second Medical Opinion › Section 27-39-2. - Insurance benefits for second opinion.

§ 27-39-2. Insurance benefits for second opinion.
(a)
Any insurer issuing an individual insurance policy that provides coverage of surgical operations performed on a person while confined in a hospital as an inpatient shall make available under the policy benefits for a second surgical opinion for elective surgical procedures performed in a hospital either on an inpatient or outpatient basis or in a licensed surgical facility.
(b)
Benefits for a second surgical opinion shall include payment for the second surgical opinion services of an eligible physician and for essential laboratory and X-ray services incidental to those services, either as a benefit under the individual policy or, at the insurer’s option, as an additional benefit offered to the prospective policyholder at issue of a policy. Benefit payments may be limited to second surgical opinion services of eligible physicians who have agreed to participate in an insurer’s second surgical opinion program. The benefits shall be equal to amounts payable under the policy for covered in-hospital consultations. As a condition of eligibility for a second surgical opinion benefit, the subscriber shall notify the insurer in advance to verify eligibility and compliance with the provisions in this section.
History of Section.
P.L. 1983, ch. 143, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-39 - Second Medical Opinion › Section 27-39-3. - Insurance benefits for third opinion.

§ 27-39-3. Insurance benefits for third opinion.
If a second surgical opinion does not confirm that a proposed elective surgical procedure is medically advisable, benefits must be provided under the policy for a third surgical opinion in the same manner as for the second opinion. As a condition of eligibility for a second surgical opinion benefit, the subscriber shall notify the insured in advance to verify eligibility and compliance with the provisions in this section.
History of Section.
P.L. 1983, ch. 143, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-39 - Second Medical Opinion › Section 27-39-4. - Exclusions.

§ 27-39-4. Exclusions.
(a)
The second surgical opinion benefit provisions of a policy may exclude: (1) Benefits while the patient is confined in a hospital as an inpatient; (2) Any surgical procedures not covered by the policy; and (3) Surgical procedures in the following categories: cosmetic surgery, pregnancy-related surgery, dental surgery, podiatric surgery, and sterilization.
(b)
If an eligible physician who furnishes a second or third surgical opinion also performs the surgical procedure, the policy need not provide payment for the second and third opinion services of that physician.
History of Section.
P.L. 1983, ch. 143, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-39 - Second Medical Opinion › Section 27-39-5. - Severability.

§ 27-39-5. Severability.
If any provision of this chapter or its application to any person or circumstances is held invalid, that invalidity shall not affect other provisions or applications of the chapter which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are declared to be severable.
History of Section.
P.L. 1983, ch. 143, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-1. - Short title.

§ 27-41-1. Short title.
This chapter may be cited as the “Health Maintenance Organization Act.”
History of Section.
P.L. 1983, ch. 225, § 2; P.L. 2002, ch. 292, § 85.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-6. - Governing body.

§ 27-41-6. Governing body.
(a)
The governing body of any health maintenance organization may include providers, other individuals, or both.
(b)
The governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms.
History of Section.
P.L. 1983, ch. 225, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-7. - Fiduciary responsibilities.

§ 27-41-7. Fiduciary responsibilities.
(a)
Any director, officer, or employee of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the organization shall be responsible for those funds in a fiduciary relationship to the enrollees.
(b)
A health maintenance organization shall maintain in force a fidelity bond on employees or officers in an amount not less than one hundred thousand dollars ($100,000) or any greater sum that may be prescribed by the director. All fidelity bonds shall be written with at least a one-year discovery period and if written with less than a three-year (3) discovery period shall contain a provision that no cancellation or termination of the bond, whether by or at the request of the insured or by the underwriter, shall take effect prior to the expiration of ninety (90) days after written notice of cancellation or termination has been filed with the director unless an earlier date of cancellation or termination is approved by the director.
History of Section.
P.L. 1983, ch. 225, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-8. - Evidence of coverage and charges for healthcare services.

§ 27-41-8. Evidence of coverage and charges for healthcare services.
(a)
Every enrollee residing in this state is entitled to evidence of coverage for the payment and for the provision of healthcare services under a health maintenance organization. The health maintenance organization shall issue that evidence of coverage.
(b)
Any evidence of coverage issued by a health maintenance organization licensed under this chapter shall comply with the minimum standards protection of § 42-62-12 and regulations pursuant to that section.
(c)
No schedule of charges, rates, or rating formulae for enrollee coverage for healthcare services, or amendment to any schedule, may be used by any health maintenance organization until a copy of that schedule, rate, or rating formula, or amendment to it, has been filed with and approved by the director under the provisions of § 42-62-13.
History of Section.
P.L. 1983, ch. 225, § 2.