reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-13. - Effect of policies inconsistent with chapter.

§ 27-18-13. Effect of policies inconsistent with chapter.
A policy delivered or issued for delivery to any person in this state in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties, and obligations of the insurer, the insured, and the beneficiary shall be governed by the provisions of this chapter.
History of Section.
P.L. 1956, ch. 3808, § 4; G.L. 1956, § 27-18-13.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-14. - Copies of applications.

§ 27-18-14. Copies of applications.
The insured shall not be bound by any statement made in an application for a policy unless a copy of the application is attached to or endorsed on the policy when issued as a part of the policy. If the policy delivered or issued for delivery to any person in this state shall be reinstated or renewed, and the insured or the beneficiary or assignee of the policy shall make written request to the insurer for a copy of the application, if any, for the reinstatement or renewal, the insurer shall within fifteen (15) days after the receipt of the request at its home office or any branch office of the insurer, deliver or mail to the person making the request a copy of the application. If the copy shall not be delivered or mailed in this manner, the insurer shall be precluded from introducing the application as evidence in any action or proceeding based upon or involving the policy or its reinstatement or renewal.
History of Section.
P.L. 1956, ch. 3808, § 5; G.L. 1956, § 27-18-14.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-15. - Alteration of application.

§ 27-18-15. Alteration of application.
No alteration of any written application for the policy shall be made by any person other than the applicant without his or her written consent, except that insertions may be made by the insurer, for administrative purposes only, in a manner to indicate clearly that the insertions are not to be ascribed to the applicant.
History of Section.
P.L. 1956, ch. 3808, § 5; G.L. 1956, § 27-18-15.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-16. - False statements in application.

§ 27-18-16. False statements in application.
The falsity of any statement in the application for any policy covered by this chapter may not bar the right to recovery under the policy unless the false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer.
History of Section.
P.L. 1956, ch. 3808, § 5; G.L. 1956, § 27-18-16.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-17. - Acts not constituting waiver of insurer’s defenses.

§ 27-18-17. Acts not constituting waiver of insurer’s defenses.
The acknowledgment by an insurer of the receipt of notice given under any policy covered by this chapter, the furnishing of forms for filing proofs of loss, or the acceptance of those proofs, or the investigation of any claim under the policy, shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under the policy.
History of Section.
P.L. 1956, ch. 3808, § 6; G.L. 1956, § 27-18-17.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-18. - Acceptance of premiums after effective period of policy.

§ 27-18-18. Acceptance of premiums after effective period of policy.
If a policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if the date falls within a period for which a premium is accepted by the insurer or if the insurer accepts a premium after the date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which the premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of the premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
History of Section.
P.L. 1956, ch. 3808, § 7; G.L. 1956, § 27-18-18.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-19. - Insurance exempt from chapter.

§ 27-18-19. Insurance exempt from chapter.
Nothing in the chapter shall apply to or affect:
(1)
Any policy of workers’ compensation insurance or any policy of liability insurance with or without supplementary expense coverage in the policy;
(2)
Any policy or contract of reinsurance; or
(3)
[Deleted by P.L. 2017, ch. 196, § 4 and P.L. 2017, ch. 322, § 4].
(4)
Life insurance, endowment, or annuity contracts, or contracts supplemental to those contracts, which contain only those provisions relating to accident and sickness insurance as: (i) Provide additional benefits in case of death or dismemberment or loss of sight by accident, or (ii) Operate to safeguard those contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract.
History of Section.
P.L. 1956, ch. 3808, § 8; G.L. 1956, § 27-18-19; P.L. 2017, ch. 196, § 4; P.L. 2017, ch. 322, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-20. - Penalties for violations.

§ 27-18-20. Penalties for violations.
Any person, partnership, or corporation willfully violating any provision of this chapter or order of the commissioner made in accordance with this chapter shall forfeit to the people of the state a sum not to exceed one hundred dollars ($100) for each violation, which may be recovered by a civil action. The commissioner may also suspend or revoke the license of an insurer or insurance producer for any of these willful violations.
History of Section.
P.L. 1956, ch. 3808, § 9; G.L. 1956, § 27-18-20.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-21. - Appeals from commissioner.

§ 27-18-21. Appeals from commissioner.
Any order or decision of the commissioner under this chapter shall be subject to appeal to the superior court at the instance of any party in interest. The filing of the appeal shall operate as a stay of the order or decision until the court directs otherwise. The court may review all of the facts and, in disposing of the issue before it, may modify, affirm, or reverse the order or decision of the commissioner in whole or in part. Any person aggrieved by the decision or decree of the superior court may appeal to the supreme court on questions of law. The appeal shall follow the course of equity. Pending the determination of the appeal, all orders or decisions or decrees of either the commissioner or the superior court shall be stayed until the supreme court directs otherwise.
History of Section.
P.L. 1956, ch. 3808, § 10; G.L. 1956, § 27-18-21.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-22. - Effect on other law.

§ 27-18-22. Effect on other law.
Nothing in this chapter shall be construed to repeal the provisions of chapter 13.1 of this title.
History of Section.
P.L. 1956, ch. 3808, § 12; G.L. 1956, § 27-18-22; P.L. 2002, ch. 292, § 35.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-23. - Severability.

§ 27-18-23. Severability.
If any provision of this 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. 1956, ch. 3808, § 11; G.L. 1956, § 27-18-23.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-24. - Immunity of benefits from process.

§ 27-18-24. Immunity of benefits from process.
The proceeds, avails, and benefits to be paid by virtue of any policy of accident and sickness insurance shall not be liable to attachment, garnishment, or other process, or be seized, taken, appropriated, or applied by any legal or equitable process or operation of law to pay any debt or liability of the owner, insured, beneficiary, or any person who may have any right under the policy; provided, that, subject to any statute of limitations, the amount of any premiums for the insurance paid with the intent to defraud creditors, with interest on that amount, shall inure to their benefit from the proceeds of the policy, but the company issuing the policy shall be discharged of all liability on it by payment of its proceeds in accordance with its terms unless, before the payment, the company shall have written notice by or on behalf of a creditor of a claim to recover for premiums paid with intent to defraud creditors with specifications of the amounts claimed.
History of Section.
P.L. 1962, ch. 179, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-25. - Unfair discrimination prohibited.

§ 27-18-25. Unfair discrimination prohibited.
Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services that may be legally performed by any person licensed under the provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37 of title 5.
History of Section.
P.L. 1968, ch. 98, § 1; P.L. 1989, ch. 542, § 79; P.L. 1991, ch. 62, § 1; P.L. 1992, ch. 452, § 1; P.L. 2002, ch. 292, § 33; P.L. 2017, ch. 165, § 1; P.L. 2017, ch. 314, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-26. - Physical examinations by insurance company.

§ 27-18-26. Physical examinations by insurance company.
Any applicant for accident and/or sickness insurance with any company organized or doing business within this state shall be provided, upon request, any and all medical reports by a physician or other medical personnel which were performed at the request or direction of the company. The reports shall only be provided to a physician of the applicant’s choice whether the applicant receives a rating or rejection from a company, and the provisions of this section shall also apply to medical examinations performed pursuant to applications for an increase in insurance coverage.
History of Section.
P.L. 1981, ch. 412, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-27. - Adoptive children.

§ 27-18-27. Adoptive children.
Subscribers to any accident and sickness insurance plan who have satisfied the continuous membership requirement of the plan and who adopt children under the guardianship and custody of the director of the department of children, youth, and families shall be afforded coverage under the plan for an adopted child without any waiting period, notwithstanding the fact that the adopted child may have any preexisting medical condition.
History of Section.
P.L. 1982, ch. 183, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-28. - [Repealed.]

§ 27-18-28. [Repealed.]
History of Section.
P.L. 1983, ch. 212, § 1; Repealed by P.L. 2019, ch. 27, § 7, effective June 19, 2019.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-29. - Changing coverage.

§ 27-18-29. Changing coverage.
No group health insurer subject to the provisions of this chapter shall change contract provisions as specified in the group plan master contract during the term of that contract without prior written agreement of the employer, except for changes mandated under state or federal legislative enactment and changes resulting from a labor management collective bargaining agreement, or changes necessary to meet insurance regulations promulgated by the department of business regulation.
History of Section.
P.L 1988, ch. 384, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-30. - Health insurance contracts — Infertility.

§ 27-18-30. Health insurance contracts — Infertility.
(a)
Any health insurance contract, plan, or policy delivered or issued for delivery or renewed in this state, except contracts providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a health insurance contract provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, the tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years; provided, that a subscriber co-payment not to exceed twenty percent (20%) may be required for those programs and/or procedures the sole purpose of which is the treatment of infertility.
(b)
For purposes of this section, “infertility” means the condition of an otherwise presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.
(c)
For purposes of this section, “standard fertility-preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organizations.
(d)
For purposes of this section, “iatrogenic infertility” means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
(e)
For purposes of this section, “may directly or indirectly cause” means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organizations.
(f)
Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, this section shall apply to blanket or group policies of insurance.
(g)
The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).
History of Section.
P.L. 1989, ch. 478, § 1; P.L. 1991, ch. 96, § 1; P.L. 2002, ch. 292, § 33; P.L. 2006, ch. 246, art. 34, § 1; P.L. 2007, ch. 411, § 1; P.L. 2017, ch. 132, § 1; P.L. 2017, ch. 150, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-31. - Insurance coverage for services of licensed midwives.

§ 27-18-31. Insurance coverage for services of licensed midwives.
(a)
For the purposes of this section, “licensed midwives” means any midwife licensed under § 23-13-9.
(b)
Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for the services of licensed midwives in accordance with each health insurers’ respective principles and mechanisms of reimbursement credentialing and contracting if the services are within the licensed midwives’ area of professional competence as defined by regulations promulgated pursuant to § 23-13-9, and are currently reimbursed when rendered by any other licensed health care provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other health care provider as a condition of reimbursement, except when those requirements are also applicable to other categories of health care providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a licensed midwife and any other health care provider. Direct payment for licensed midwives will be contingent upon services rendered in a licensed health care facility and for services rendered in accordance with rules and regulations promulgated by the department of health; provided, that this provision shall not prohibit payment for services pursuant to § 42-62-26 or for other services reimbursed by third party payors.
History of Section.
P.L. 1990, ch. 168, § 1; P.L. 2002, ch. 292, § 33.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-32. - Discontinuance of coverage — Chronic disabilities.

§ 27-18-32. Discontinuance of coverage — Chronic disabilities.
Notwithstanding the provisions of § 27-18-19, no group health insurer shall discontinue reimbursement or providing services for covered health care services for chronic disabilities, unless the patient has exhausted benefits to which he or she is entitled under the basic subscriber agreement, or unless it is at the end of the open enrollment period provided notice of the discontinuation of the services is sent to subscribers who have been reimbursed for or utilized the services in the past three (3) years. The notice shall be mailed at least sixty (60) days prior to the beginning of the open enrollment period. For the purposes of this section, “chronic disability” means an impairment or illness that is likely to continue indefinitely.
History of Section.
P.L. 1991, ch. 127, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-33. - Drug coverage.

§ 27-18-33. Drug coverage.
No group health insurer subject to the provisions of this chapter that provides coverage for prescription drugs under a group plan master contract delivered, issued for delivery, or renewed in this state may require any person covered under the contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for the drugs.
History of Section.
P.L. 1991, ch. 345, § 1; P.L. 2002, ch. 292, § 33.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-33.1. - Insurance coverage for post-partum hospital stays.

§ 27-18-33.1. Insurance coverage for post-partum hospital stays.
(a)
Every individual or group hospital or medical services plan contract delivered, issued for delivery, as renewed in this state which provides maternity benefits shall provide coverage for a forty-eight (48) hour time period in a hospital after a vaginal birth and ninety-six (96) hours after a Cesarean section for a mother and her newly born child. Any decision to shorten this minimum coverage shall be made by the attending health care provider in consultation with the mother. The decision shall be made in accordance with the standards for guidelines for perinatal care published by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics. The standards shall be relative to early discharge, defined as less than forty-eight (48) hours for a vaginal delivery and ninety-six (96) for a Cesarean delivery. In the case of early discharge, post-delivery care shall include: home visits, parent education, assistance and training in breast or bottle feeding and the performance of any necessary and appropriate clinical tests or any other tests or services consistent with these guidelines.
(b)
For the purposes of this section, “attending health care provider” includes the attending obstetrician, pediatrician, family practitioner, general practitioner or certified nurse midwife attending the mother and newly born child.
(c)
Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.
History of Section.
P.L. 1996, ch. 246, § 2; P.L. 1996, ch. 260, § 2; P.L. 2002, ch. 292, § 33.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-35. - Certified counselors in mental health and therapists in marriage and family practice.

§ 27-18-35. Certified counselors in mental health and therapists in marriage and family practice.
Every health insurance contract plan or policy delivered, issued for delivery or renewed in this state, except policies which only provide coverage for specified diseases, fix indemnity, Medicare supplement long term care disability income, or other limited benefit policies, shall provide coverage for the services of counselors in mental health licensed pursuant to § 5-63.2-9 and therapists in marriage and family practice licensed pursuant to § 5-63.2-10 excluding marital and family therapy unless the individual is diagnosed with a mental disorder.
History of Section.
P.L. 1994, ch. 89, § 1; P.L. 2002, ch. 292, § 33.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-36. - Repealed.

§ 27-18-36. Repealed.
History of Section.
P.L. 1994, ch. 301, § 1; P.L. 1997, ch. 51, §§ 1, 5; P.L. 1997, ch. 92, §§ 1, 5; P.L. 2002, ch. 292, § 33; Repealed by P.L. 2012, ch. 256, § 14; P.L. 2012, ch. 262, § 14, effective July 15, 2013.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-36.1. - Repealed.

§ 27-18-36.1. Repealed.
History of Section.
P.L. 1994, ch. 301, § 1; Repealed by P.L. 2012, ch. 256, § 14; P.L. 2012, ch. 262, § 14, effective July 15, 2013.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-36.2. - Repealed.

§ 27-18-36.2. Repealed.
History of Section.
P.L. 1994, ch. 301, § 1; P.L. 1997, ch. 51, §§ 1, 5; P.L. 1997, ch. 92, §§ 1, 5; P.L. 1999, ch. 118, § 1; P.L. 1999, ch. 134, § 1; Repealed by P.L. 2012, ch. 256, § 14; P.L. 2012, ch. 262, § 14, effective July 15, 2013.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-36.3. - Repealed.

§ 27-18-36.3. Repealed.
History of Section.
P.L. 1994, ch. 301, § 1; Repealed by P.L. 2012, ch. 256, § 14; P.L. 2012, ch. 262, § 14, effective July 15, 2013.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-38. - Diabetes treatment.

§ 27-18-38. Diabetes treatment.
(a)
Every individual or group health insurance contract, plan, or policy delivered, issued for delivery or renewed in this state which provides medical coverage that includes coverage for physician services in a physician’s office, and every policy which provides major medical or similar comprehensive-type coverage, except for supplemental policies which only provide coverage for specified diseases and other supplemental policies, shall include coverage for the following equipment and supplies for the treatment of insulin treated diabetes, non-insulin treated diabetes, and gestational diabetes, if medically appropriate and prescribed by a physician: blood glucose monitors and blood glucose monitors for the legally blind, test strips for glucose monitors and/or visual reading, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances to the pumps, insulin infusion devices, and oral agents for controlling blood sugar and therapeutic/molded shoes for the prevention of amputation.
(b)
Upon the approval of new or improved diabetes equipment and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a physician. These policies shall also include coverage, when medically necessary, for diabetes self-management education to ensure that persons with diabetes are instructed in the self-management and treatment of their diabetes, including information on the nutritional management of diabetes. The coverage for self-management education and education relating to medical nutrition therapy shall be limited to medically necessary visits upon the diagnosis of diabetes, where a physician diagnoses a significant change in the patient’s symptoms or conditions which necessitate changes in a patient’s self-management, or where reeducation or refresher training is necessary. This education when medically necessary and prescribed by a physician, may be provided only by the physician or, upon his or her referral to an appropriately licensed and certified health care provider and may be conducted in group settings. Coverage for self-management education and education relating to medical nutrition therapy shall also include home visits when medically necessary.
(c)
Benefit plans offered by an insurer may impose co-payment and/or deductibles for the benefits mandated by this chapter; however, in no instance shall the co-payment or deductible amount be greater than the co-payment or deductible amount imposed for other supplies, equipment or physician office visits. Benefits for services under this section shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each insurer, hospital, or medical service corporation, or health maintenance organization.
History of Section.
P.L. 1996, ch. 106, § 1; P.L. 2002, ch. 292, § 33.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-40. - Insurance coverage for mastectomy hospital stays.

§ 27-18-40. Insurance coverage for mastectomy hospital stays.
(a)
The Rhode Island general assembly recognizes that breast cancer is a unique illness with both a physical and emotional impact on patients. Except as otherwise provided, every individual or group hospital or medical services plan contract delivered, issued for delivery, as renewed in this state shall provide coverage for a minimum forty-eight (48) hour time period in a hospital after the surgical procedures known as a mastectomy, and a minimum twenty-four (24) hours after an axillary node dissection.
(b)
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. Any decision to shorten these minimum coverages shall be made by the attending physician in consultation with and upon agreement by the patient. If the patient participates in an early discharge, defined as in-patient care following a mastectomy that is less than forty-eight (48) hours and in-patient care following an axillary node dissection that is less than twenty-four (24) hours, coverage shall include a minimum of one home visit conducted by a physician or registered nurse.
(c)
Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with regulations of the department of health, which have been promulgated pursuant to chapter 17.12 of title 23. No policy or plan covered under this chapter shall terminate the services, reduce capitation payment, or penalize an attending physician or other health care provider who orders care consistent with the provisions of this section.
(d)
All plans subject to this section shall provide notice to each enrollee:
(1)
In the next mass mailing made by the plan to the employee; or
(2)
As part of any informational packet sent to the enrollee.
History of Section.
P.L. 1997 ch. 24, § 1; P.L. 1997, ch. 25, § 1; P.L. 2002, ch. 292, § 33.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-42. - Mammograms — Quality assurance standards.

§ 27-18-42. Mammograms — Quality assurance standards.
A mammogram eligible for reimbursement under § 27-18-41 shall be reimbursed only if the facility in which the mammogram has been taken and processed, and the licensed physician interpreting the mammogram, both meet state approved quality assurance standards for taking, processing, and interpreting mammograms. The director of health shall have the authority to promulgate rules and regulations necessary to carry out the provisions of this section.
History of Section.
P.L. 1997, ch. 76, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-43. - Pap smears — Quality assurance standards.

§ 27-18-43. Pap smears — Quality assurance standards.
A pap smear eligible for reimbursement under § 27-18-41 shall be reimbursed only if the laboratory in which the pap smear is processed is licensed by the department of health specifically to perform cervical cytology, or is accredited by the American Society of Cytology, or is accredited by the College of American Pathologists, or is a hospital accredited by the joint commission on accreditation health care organizations or the American Osteopathic Association at the time the pap smear is processed.
History of Section.
P.L. 1997, ch. 76, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-44.1. - Hysterectomy or myomectomy treatment.

§ 27-18-44.1. Hysterectomy or myomectomy treatment.
Commencing January 1, 2023, any insurer or healthcare plan, nonprofit health medical service plan, or nonprofit hospital service plan that provides coverage for obstetric and gynecological care for issuance or delivery in the state to any group or individual on an expense-incurred basis, including a health plan offered by a health insurance carrier or a health maintenance organization, shall provide coverage for a hysterectomy, myomectomy and laparoscopic removal of uterine fibroids, including uterine artery embolization, intraoperative ultrasound guidance and monitoring and radiofrequency ablation.
History of Section.
P.L. 2022, ch. 370, § 1, effective June 29, 2022; P.L. 2022, ch. 371, § 1, effective June 29, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-45. - Whistleblowers protection.

§ 27-18-45. Whistleblowers protection.
No accident and sickness insurer pursuant to this chapter, or any other insurer offering and/or insuring health services on a prepaid basis as defined in § 42-62-4(7), shall engage in any retaliation or retribution, directly or indirectly, or shall terminate or modify the terms of a medical service agreement that it maintains with a physician or other medical services provider, because the physician or other provider reports or is about to report verbally or in writing, to a public body, a regulatory agency, a subscriber or member of the insured, the family or heirs or personal representative of the subscriber or member or to any other person or public or private agency a violation by the insurer of a subscriber or membership agreement, a law, rule or regulation promulgated under the laws of this state.
History of Section.
P.L. 1997, ch. 167, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-46. - Penalties and remedies.

§ 27-18-46. Penalties and remedies.
(a)
Any person, firm, corporation, association or other legal entity who or which shall violate the provisions of § 27-18-45 shall be guilty of a misdemeanor, and upon conviction, shall be fined in an amount of not more than one thousand dollars ($1,000), imprisonment for up to one year, or by both fine and imprisonment.
(b)
In addition to the criminal sanctions set forth in subsection (a) of this section, any person, firm, corporation, association or other legal entity who or which shall willfully or negligently violate any provision of this chapter shall be subject to a civil penalty, to be assessed by the insurance commissioner, in the maximum amount of five thousand dollars ($5,000) for each violation, and each violation shall constitute a separate and distinct offense under this section.
History of Section.
P.L. 1997, ch. 167, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-47. - Additional relief and damages — Reinstatement.

§ 27-18-47. Additional relief and damages — Reinstatement.
(a)
A physician or other medical provider who alleges a violation of this act may bring a civil action for appropriate injunctive relief, actual and punitive damages and costs including reasonable attorney fees.
(b)
An action commenced pursuant to this chapter may be brought in the superior court for the county where the alleged violation occurred, the county where the complainant resides or the county in which the insurer maintains its principal place of business.
(c)
The court rendering a judgment in an action under this act shall order, as the court considers appropriate, reinstatement of the provider agreement.
History of Section.
P.L. 1997, ch. 167, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-48. - Third party reimbursement for services of certain healthcare workers.

§ 27-18-48. Third party reimbursement for services of certain healthcare workers.
(a)
Every individual or group hospital or medical services plan contract delivered, issued or renewed by an insurer or nonprofit or for-profit health service corporation that provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a certified registered nurse anesthetist designated as a certified registered nurse anesthetist by the board of nurse registration and nursing education; provided, that the following conditions are met:
(1)
The certified registered nurse anesthetist adheres to the practice of certified registered nurse anesthesia as defined by, and in accordance with, § 5-34.2-2.
(2)
The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and
(3)
The certified registered nurse anesthetist is not a salaried employee of the licensed hospital or facility for which the accident and sickness insurer has an alternative contractual relationship to fund the services of a certified registered nurse anesthetist.
(b)
It shall remain within the sole discretion of the health maintenance organization as to which certified registered nurse anesthetists it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, that no health maintenance organization may be required to pay for duplicative services actually rendered by a certified registered nurse anesthetist and any other healthcare provider. Nothing contained in this section shall preclude the health maintenance organization from conducting managed care, medical necessity, or utilization review.
(c) Providers.
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that provider’s license or certification under applicable state law. This section shall not require that a group health plan or health insurance issuer contract with any healthcare provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan or a health insurance issuer from establishing varying reimbursement rates based on quality or performance measures.
History of Section.
P.L. 1997, ch. 345, § 1; P.L. 1997, ch. 365, § 1; P.L. 2002, ch. 292, § 33; P.L. 2015, ch. 205, § 1; P.L. 2015, ch. 223, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-48.1. - Third party reimbursement for services of registered nurse first assistants.

§ 27-18-48.1. Third party reimbursement for services of registered nurse first assistants.
(a)
Every individual or group hospital or medical services plan contract delivered, issued or renewed by an insurer or nonprofit health service corporation which provides benefits to individual subscribers and members within the state, or to all group members having a principal place of employment within the state, shall provide benefits for services rendered by a registered nurse first assistant designated as a registered nurse first assistant provided, however, that the following conditions are met:
(1)
The registered nurse first assistant provides certain health care services under the supervision of a licensed physician; is currently licensed as a registered nurse in Rhode Island; has successfully completed a course in preparing the registered nurse as a first assistant in accordance with the Association of Operating Room Nurses core curriculum guide for the registered nurse first assistant and includes a minimum of one academic year in a college or university with didactic instruction and clinical internship programs; and is certified in perioperative nursing by the Certification Board Perioperative Nursing (minimum of two years perioperative experience);
(2)
The policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the state; and
(3)
The registered nurse first assistant is not a salaried employee of the licensed hospital or facility for which the accident and sickness insurer has an alternative contractual relationship to fund the services of a registered nurse first assistant.
(b)
It shall remain within the sole discretion of the accident and sicknesses insurer as to which registered nurse first assistant it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the health maintenance organization; provided, however, that no accident and sicknesses insurer may be required to provide direct reimbursement, or pay for duplicative services actually rendered by a registered nurse first assistant and any other health care provider. Nothing contained in this section shall preclude the health maintenance organization from conducting managed care, medical necessity or utilization review.
(c)
This section shall not apply to insurance coverage providing benefits for: (1) hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare supplement; (6) limited benefit health; (7) specified disease indemnity; (8) sickness or bodily injury or death by accident or both; and (9) other limited benefit policies.
History of Section.
P.L. 1999, ch. 509, § 1; P.L. 2002, ch. 292, § 33.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-49. - Human leukocyte antigen testing.

§ 27-18-49. Human leukocyte antigen testing.
(a)
Every individual or group hospital or medical services plan contract delivered or renewed in this state shall include coverage of the cost for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B, and DR antigens for utilization in bone marrow transplantation. The testing must be performed in a facility that is accredited by the American Association of Blood Banks or its successors, and is licensed under the Clinical Laboratory Improvement Act, 42 U.S.C. § 263a, as it may be from time to time amended. At the time of the testing, the person being tested must complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program. The group hospital or medical services plan contract may limit each subscriber to one of these testings per lifetime.
(b)
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. 1998, ch. 8, § 1; P.L. 1998, ch. 9, § 1; P.L. 2002, ch. 292, § 33.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-50.1. - Medication synchronization.

§ 27-18-50.1. Medication synchronization.
(a)
An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a thirty (30) days’ supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a thirty (30) days’ supply for the purpose of synchronizing the patient’s medications and the insured’s or enrollee’s maintenance prescription drug(s) to be synchronized meets all of the following requirements:
(1)
Is covered by the policy, certificate, or contract described in this chapter;
(2)
Is used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee;
(3)
Except as otherwise provided in this subparagraph, is not a controlled substance included in schedules II to V;
(4)
Meets all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insured’s or enrollee’s multiple, maintenance-prescription drugs;
(5)
Is of a formulation that can be effectively split over required short-fill periods to achieve synchronization; and
(6)
Does not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insured’s or enrollee’s multiple, maintenance-prescription drugs.
(b)
The plan or policy described in subsection (a) shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insured’s or enrollee’s multiple, maintenance-prescription drugs.
(c)
The plan or policy described in subsection (a) shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.
(d)
A synchronization shall only occur once per year per maintenance-prescription drug.
History of Section.
P.L. 2016, ch. 179, § 1; P.L. 2016, ch. 196, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-18 - Accident and Sickness Insurance Policies › Section 27-18-51. - Restricted annual rate payments prohibited.

§ 27-18-51. Restricted annual rate payments prohibited.
(a)
No policy delivered or issued in this state shall contain a provision for compensating any provider of outpatient mental health and/or substance abuse treatment service by using the restricted annual rate method of payment.
(b)
The restricted annual rate method of payment is defined as any method of payment that sets, as all or part of its payment scheme, a total payment limit for mental health and/or substance abuse treatment services for each person seeking treatment based on a per person per unit of time criterion that disregards the extent of treatment and/or degree of services rendered.
(c)
This prohibition shall not be construed to prohibit or limit capitation or other risk sharing agreements between providers and insurers otherwise permissible by law.
History of Section.
P.L. 1998, ch. 352, § 1.