reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.4 - Insurance Continuation Act › Section 27-20.4-8. - Penalties.

§ 27-20.4-8. Penalties.
Whenever the director shall have cause to believe that a violation of this chapter or the regulations promulgated pursuant to this chapter has occurred, the director may, in accordance with the requirements of the Administrative Procedures Act, chapter 35 of title 42, revoke or suspend a license; levy an administrative penalty in an amount not less than five hundred dollars ($500) nor more than five thousand dollars ($5,000); order the violator to cease marketing any health benefit plans in the state; require the violator to take any actions necessary to comply with the provisions of law; or any combination of these actions.
History of Section.
P.L. 1992, ch. 387, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.4 - Insurance Continuation Act › Section 27-20.4-9. - Limited benefit policy — Exclusion.

§ 27-20.4-9. Limited benefit policy — Exclusion.
Any long-term care insurance policy and any accident and sickness insurance policy whose benefits are limited to income protection or the furnishing of disability income or a limited health benefit coverage are excluded from the provisions of this chapter. A limited benefit policy, for the purposes of this section, is any accident or sickness policy that covers one or more specified risks including, but not limited to, accidental death or injury or specified disease.
History of Section.
P.L. 1992, ch. 387, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.5 - Participation of Medical Service Providers › Section 27-20.5-1. - Restriction on participation prohibited.

§ 27-20.5-1. Restriction on participation prohibited.
It shall be unlawful for any nonprofit medical service corporation, hospital service corporation, health maintenance organization, or any other insurer offering and/or insuring health services on a prepaid basis as defined in § 42-62-4(7), or any other person, to provide that providers of medical services defined in § 27-20-1 shall render those services exclusively to subscribers of any one particular nonprofit or for-profit medical service corporation, hospital service corporation, health maintenance organization, insurers, or any other person in order for the provider to be a participant in the nonprofit or for-profit medical service corporation, hospital service corporation, health maintenance organization, or any other person; provided, that this section shall not apply to medical service providers who voluntarily agree to render those services on a full-time basis to a health maintenance organization.
History of Section.
P.L. 1986, ch. 456, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.6 - Healthcare Insurers — Coordination of Benefits › Section 27-20.6-1. - Definitions.

§ 27-20.6-1. Definitions.
As used in this chapter, the following terms shall have the following meanings:
(1)
“Insurer” means every nonprofit medical service corporation, hospital service corporation, health maintenance organization, or other insurer offering and/or insuring health services; the term shall in addition include any entity defined as an insurer under § 42-62-4.
(2)
“Primary insurer” means the insurer primarily liable in accordance with the anti-duplication provisions established by regulations promulgated by the director of business regulation.
History of Section.
P.L. 1989, ch. 373, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.6 - Healthcare Insurers — Coordination of Benefits › Section 27-20.6-2. - Coordination of information.

§ 27-20.6-2. Coordination of information.
Every insurer issuing contracts for healthcare coverage that contain a provision for the coordination of benefits shall exchange information with respect to those contracts with other insurers as may be necessary to coordinate benefits in order to avoid duplication of payments for the same healthcare services rendered.
History of Section.
P.L. 1989, ch. 373, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.6 - Healthcare Insurers — Coordination of Benefits › Section 27-20.6-3. - Reimbursement.

§ 27-20.6-3. Reimbursement.
Each primary insurer, to the extent of its contractual liability, shall reimburse any other insurer any amounts actually paid by the other insurer for healthcare services rendered; provided, no insurer shall reimburse for any benefit or coverages in excess of those specified in the contract.
History of Section.
P.L. 1989, ch. 373, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.6 - Healthcare Insurers — Coordination of Benefits › Section 27-20.6-4. - Failure to comply.

§ 27-20.6-4. Failure to comply.
The failure of any insurer to comply with a written request for reimbursement within forty-five (45) days of receipt of the request shall result in the imposition of interest upon the amount of money due at the rate of one percent (1%) per month from the date the request for reimbursement was made until the date payment is made.
History of Section.
P.L. 1989, ch. 373, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.6 - Healthcare Insurers — Coordination of Benefits › Section 27-20.6-5. - Arbitration.

§ 27-20.6-5. Arbitration.
(a)
Whenever there exists a dispute between insurers under the provisions of this chapter, the dispute shall be submitted for resolution to an impartial, independent arbitrator who has no affiliation with either party to the dispute. The arbitrator shall be mutually agreed upon by the parties to the dispute. In the event that no mutual agreement can be reached, the arbitrator shall be appointed by the director of the department of business regulation from the list established under subsection (b) of this section. The fees of the arbitrator shall be paid by the losing party.
(b)
The director of the department of business regulation shall establish a list of authorized arbitrators, each of whom shall be a member in good standing of the Rhode Island Bar Association, for use pursuant to the provisions of this section.
History of Section.
P.L. 1989, ch. 373, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.6 - Healthcare Insurers — Coordination of Benefits › Section 27-20.6-6. - Rules and regulations.

§ 27-20.6-6. Rules and regulations.
The director of the department of business regulation shall promulgate rules and regulations, using the National Association of Insurance Commissioners (NAIC) coordination of benefits model regulations as a guideline, that shall address: (1) The necessity or reasonableness, or both, of administrative penalties by entities subject to this chapter; (2) Other procedures that may be necessary to carry out the provisions of this chapter.
History of Section.
P.L. 1989, ch. 373, § 1; P.L. 2002, ch. 292, § 42.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-1. - Short title.

§ 27-20.7-1. Short title.
This chapter shall be known as “The Third-Party Health Insurance Administrators Act.”
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-3. - Written agreement.

§ 27-20.7-3. Written agreement.
(a)
No administrator shall act as an administrator without a written agreement between the administrator and the insurer, and the written agreement shall be retained as part of the official records of both the insurer and the administrator for the duration of the agreement and for five (5) years after this. The agreement shall contain all provisions required by this section, except insofar as those requirements do not apply to the functions performed by the administrator.
(b)
The written agreement shall include a statement of duties that the administrator is expected to perform on behalf of the insurer and the lines, classes, or types of insurance for which the administrator is to be authorized to administer. The agreement shall make provisions with respect to underwriting or other standards pertaining to the business underwritten by the insurer.
(c)
The insurer or administrator may, with written notice, terminate the written agreement for cause as provided in the agreement. The insurer may suspend the underwriting authority of the administrator during the pendency of any dispute regarding the cause for termination of the written agreement. The insurer shall fulfill any lawful obligations with respect to policies affected by the written agreement, regardless of any dispute between the insurer and the administrator.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-4. - Payments to administrator.

§ 27-20.7-4. Payments to administrator.
If an insurer utilizes the services of an administrator, the payment to the administrator of any premiums or charges for insurance by or on behalf of the insured party shall be deemed to have been received by the insurer, and the payment of return premiums or claim payments forwarded by the insurer to the administrator shall not be deemed to have been paid to the insured party or claimant until the payments are received by the insured party or claimant. Nothing in this section limits any right of the insurer against the administrator resulting from the failure of the administrator to make payments to the insurer, insured parties, or claimants.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-6. - Approval of advertising.

§ 27-20.7-6. Approval of advertising.
An administrator may use only advertising pertaining to the business underwritten by an insurer that has been approved in writing by the insurer in advance of its use.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-7. - Responsibilities of the insurer.

§ 27-20.7-7. Responsibilities of the insurer.
(a)
If an insurer utilizes the services of an administrator, the insurer shall be responsible for determining the benefits, premium rates, underwriting criteria, and claims payment procedures applicable to the coverage and for securing reinsurance, if any. The rules pertaining to these matters must be provided, in writing, by the insurer to the administrator. The responsibilities of the administrator as to any of these matters shall be set forth in the written agreement between the administrator and the insurer.
(b)
It is the sole responsibility of the insurer to provide for competent administration of its programs.
(c)
In cases where an administrator administers benefits for more than one hundred (100) certificate holders on behalf of an insurer, the insurer shall, at least semi-annually, conduct a review of the operations of the administrator. At least one of these reviews shall be an on-site audit of the operations of the administrator.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-8. - Premium collection and payment of claims.

§ 27-20.7-8. Premium collection and payment of claims.
(a)
All insurance charges or premiums collected by an administrator on behalf of or for an insurer or insurers, and the return of premiums received from that insurer or insurers, shall be held by the administrator in a fiduciary capacity. The funds shall be immediately remitted to the person or persons entitled to them or shall be deposited promptly in a fiduciary account established and maintained by the administrator in a federally or state insured financial institution. The written agreement between the administrator and the insurer shall provide for the administrator to periodically render an accounting to the insurer detailing all transactions performed by the administrator pertaining to the business underwritten by the insurer.
(b)
If charges or premiums deposited in a fiduciary account have been collected on behalf of or for one or more insurers, the administrator shall keep records clearly recording the deposits in and withdrawals from the account on behalf of each insurer. The administrator shall keep copies of all the records and, upon request of an insurer, shall furnish the insurer with copies of the records pertaining to the deposits and withdrawals.
(c)
The administrator shall not pay any claim by withdrawals from a fiduciary account in which premiums or charges are deposited. Withdrawals from the account shall be made as provided in the written agreement between the administrator and the insurer. The written agreement shall address, but not be limited to, the following:
(1)
Remittance to an insurer entitled to remittance;
(2)
Deposit in an account maintained in the name of the insurer;
(3)
Transfer to and deposit in a claims paying account, with claims to be paid as provided for in subsection (d) of this section;
(4)
Payment to a group policyholder for remittance to the insurer entitled to the remittance;
(5)
Payment to the administrator of its commissions, fees, or charges; and
(6)
Remittance of return premium to the person or persons entitled to the return premium.
(d)
All claims paid by the administrator from funds collected on behalf of or for an insurer shall be paid only on drafts or checks of and as authorized by the insurer.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-9. - Compensation to the administrator.

§ 27-20.7-9. Compensation to the administrator.
(a)
An administrator shall not enter into an agreement or understanding with an insurer in which the effect is to make the amount of the administrator’s commissions, fees, or charges contingent upon savings effected in the adjustment, settlement, and payment of losses covered by the insurer’s obligations. This provision shall not prohibit an administrator from receiving performance-based compensation for providing hospital or other auditing services.
(b)
This section shall not prevent the compensation of an administrator from being based on premiums or charges collected or the number of claims paid or processed.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-10. - Notice and disclosure of charges and fees.

§ 27-20.7-10. Notice and disclosure of charges and fees.
(a)
When the services of an administrator are utilized, the administrator shall provide a written notice approved by the insurer to covered individuals advising them of the identity of, and relationship among, the administrator, the policyholder, and the insurer.
(b)
When an administrator collects funds, the reason for collection of each item must be identified to the insured party and each item must be shown separately from any premium. Additional charges may not be made for services to the extent the services have been paid for by the insurer.
(c)
The administrator shall disclose to the insurer all charges, fees, and commissions received from all services in connection with the provision of administrative services for the insurer, including any fees or commissions paid by insurers providing reinsurance.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-11. - Delivery of materials.

§ 27-20.7-11. Delivery of materials.
Any policies, certificates, booklets, termination notices, or other written communications delivered by the insurer to the administrator for delivery to insured parties or covered individuals shall be delivered by the administrator promptly after receipt of instructions from the insurer to deliver them.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-13. - Waiver of application for certification.

§ 27-20.7-13. Waiver of application for certification.
Upon request from an administrator, the commissioner may waive the application requirements of § 27-20.7-12(b) if the administrator has a valid certificate of authority as an administrator issued in a state which has standards for administrators that are at least as stringent as those contained in the model statute for third-party administrators of the National Association of Insurance Commissioners.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-14. - Annual report and filing fee.

§ 27-20.7-14. Annual report and filing fee.
(a)
Each administrator shall file an annual report for the preceding calendar year with the commissioner on or before March 1 of each year, or within any extension of time for filing as the commissioner for good cause may grant. The report shall be in the form and contain any matters that the commissioner prescribes.
(b)
The annual report shall include the complete names and addresses of all insurers with which the administrator had an agreement during the preceding fiscal year.
(c)
At the time of filing its annual report, the administrator shall pay a filing fee as required by the commissioner.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1; P.L. 2014, ch. 91, § 4; P.L. 2014, ch. 94, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.7 - Third-Party Health Insurance Administrators › Section 27-20.7-16. - Unauthorized third-party administrator business.

§ 27-20.7-16. Unauthorized third-party administrator business.
The unauthorized conduct of the business of an administrator shall be treated as unauthorized insurance business and shall be subject to the same penalties as provided in § 27-16-1.3 for violation of § 27-16-1.2.
History of Section.
P.L. 2001, ch. 83, § 1; P.L. 2001, ch. 242, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.8 - Prescription Drug Benefits › Section 27-20.8-1. - Definitions.

§ 27-20.8-1. Definitions.
For the purposes of this chapter, the following terms shall mean:
(1)
“Director” shall mean the director of the department of business regulation.
(2)
“Health plan” shall mean an insurance carrier as defined in chapters 18, 19, 20, and 41 of this title.
(3)
“Insured” shall mean any person who is entitled to have pharmacy services paid by a health plan pursuant to a policy, certificate, contract, or agreement of insurance or coverage including those administered for the health plan under a contract with a third-party administrator that manages pharmacy benefits or pharmacy network contracts.
History of Section.
P.L. 2004, ch. 370, § 1; P.L. 2004, ch. 442, § 1; P.L. 2008, ch. 475, § 86.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.8 - Prescription Drug Benefits › Section 27-20.8-2. - Pharmacy benefit, limits and copayments.

§ 27-20.8-2. Pharmacy benefit, limits and copayments.
Any health plan that offers pharmacy benefits shall comply with the following:
(a)
When a health plan’s pharmacy benefit has a dollar limit, the insured’s use of such benefit shall be determined based on the health plan’s contracted rate to purchase the drug minus the enrollee’s applicable copayment for covered drugs. The balance will apply towards the enrollee’s dollar limit.
(b)
When a health plan charges a copayment for covered prescription drugs that is based on a percent of the drug cost, the health plan shall disclose within the group policy or individual policy benefits description statement whether the copayment is based on the plan’s contracted rate to purchase the drug or some other cost basis such as retail price.
History of Section.
P.L. 2004, ch. 370, § 1; P.L. 2004, ch. 442, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.8 - Prescription Drug Benefits › Section 27-20.8-3. - Copay cap for prescription insulin.

§ 27-20.8-3. Copay cap for prescription insulin.
(a)
As used in this section, unless the context otherwise requires, “prescription insulin drug” means a prescription drug, as defined in § 21-31-2, that contains insulin and is used to treat diabetes.
(b)
A health plan that provides coverage for prescription insulin drugs pursuant to the terms of a health coverage plan the health plan offers shall cap the total amount that a covered person is required to pay for a covered prescription insulin drug at an amount not to exceed forty dollars ($40.00), per thirty-day (30) supply of insulin. Coverage for prescription insulin drugs shall not be subject to any deductible.
(c)
Nothing in this section prevents a health plan from reducing a covered person’s cost sharing to an amount less than the amount specified in subsection (b) of this section.
(d)
The office of the health insurance commissioner may use any of its enforcement powers to obtain a health plan’s compliance with this section.
(e)
The office of the health insurance commissioner may promulgate rules and regulations as necessary to implement and administer this section and to align with federal requirements.
History of Section.
P.L. 2021, ch. 110, § 1, effective January 1, 2022; P.L. 2021, ch. 163, § 1, effective January 1, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.8 - Prescription Drug Benefits › Section 27-20.8-4. - Price disclosure.

§ 27-20.8-4. Price disclosure.
A plan sponsor, health insurance carrier, or pharmacy benefits manager shall not prohibit a pharmacist from providing an insured information regarding the amount of the insured’s cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower-priced drug to the insured if one is available.
History of Section.
P.L. 2021, ch. 164, § 1, effective July 6, 2021; P.L. 2021, ch. 165, § 1, effective July 6, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.9 - Contract with Healthcare Providers › Section 27-20.9-1. - Healthcare contracts — Required provisions — Definitions.

§ 27-20.9-1. Healthcare contracts — Required provisions — Definitions.
(a)
On and after January 1, 2008, a health insurer that contracts with a healthcare provider shall comply with the provisions of this chapter and shall include the provisions required by this chapter in the healthcare contract. A contract in existence prior to January 1, 2008, that is renewed or renews by its terms shall comply with the provisions of this chapter no later than December 31, 2008.
(b)
As used in this chapter, unless the context otherwise requires:
(1)
“Healthcare contract” means a contract entered into or renewed between a health insurer and a healthcare provider for the delivery of healthcare services to others.
(2)
“Healthcare provider” means a person licensed or certified in this state to practice medicine, pharmacy, chiropractic, nursing, physical therapy, podiatry, dentistry, optometry, occupational therapy, or other healing arts.
(3)
“Health insurer” means every nonprofit medical service corporation, hospital service corporation, health maintenance organization, or other insurer offering and/or insuring health services; the term shall in addition include any entity defined as an insurer under § 42-62-4 and any third-party administrator when interacting with healthcare providers and enrollees on behalf of such an insurer.
History of Section.
P.L. 2007, ch. 86, § 1; P.L. 2007, ch. 215, § 1; P.L. 2008, ch. 475, § 87.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.9 - Contract with Healthcare Providers › Section 27-20.9-2. - Credentialing — Insurers shall notify providers of initial credentialing within ten business days of approval by the insurer credentialing committee.

§ 27-20.9-2. Credentialing — Insurers shall notify providers of initial credentialing within ten business days of approval by the insurer credentialing committee.
The health insurer shall reimburse the healthcare provider for covered services rendered by the healthcare provider to the health insurer’s subscribers or members following the first business day after the credentialing committee’s approval, provided that the healthcare provider returns a signed healthcare contract within fifteen (15) business days of receipt from the health insurer.
History of Section.
P.L. 2007, ch. 86, § 1; P.L. 2007, ch. 215, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.9 - Contract with Healthcare Providers › Section 27-20.9-3. - Pay-for-performance guidelines.

§ 27-20.9-3. Pay-for-performance guidelines.
A health insurer shall not require a physician, as a condition of contracting, to participate in any financial or reimbursement incentive program, commonly referred to as pay-for-performance programs, unless such program meets the principles and guidelines for pay-for-performance programs endorsed by the national quality forum and adopted by the AQA Alliance or the hospital quality alliance, or similar principles and guidelines for pay-for-performance programs approved by the office of the health insurance commissioner.
History of Section.
P.L. 2007, ch. 86, § 1; P.L. 2007, ch. 215, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.10 - Rental Network Contract Arrangements › Section 27-20.10-2. - Scope.

§ 27-20.10-2. Scope.
(a)
This chapter shall apply to health insurance corporations subject to chapter 1 of this title, nonprofit hospital or medical service corporations subject to chapter 19 or 20 of this title, and health maintenance organizations incorporated or resident in the state of Rhode Island.
(b)
This chapter shall not apply to provider network contracts for services provided to Medicaid, Medicare, or state children’s health insurance program (SCHIP) beneficiaries.
(c)
This chapter shall not apply in circumstances where access to the provider network contract is granted to an entity operating under common control with or under the same brand licensee program as the contracting entity (“affiliate entities”). Contracting entities shall, however, make the list of such affiliate entities available on a website or by other means. The affiliate entities shall have the same rights and responsibilities under the provider network contracts as the contracting entities.
(d)
This chapter shall not apply to a contract between a contracting entity and a discount medical plan organization.
(e)
This chapter shall not apply to any entity, such as employers, church plans, or government plans, receiving administrative services from the contracting entity or an affiliate entity. Such exempt entities shall have the same rights and responsibilities under the provider network contracts as the contracting entities, except the exempt entities shall not grant access to a provider’s healthcare services and contractual discounts to any other entity.
History of Section.
P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.10 - Rental Network Contract Arrangements › Section 27-20.10-3. - Registration.

§ 27-20.10-3. Registration.
(a)
Any person that commences business as a contracting entity shall register with the department within thirty (30) days of commencing business in the state of Rhode Island unless such person is licensed by the department as an insurer. Upon passage of this chapter, each person not licensed by the department as a contracting entity shall register with the department within ninety (90) days of the effective date of this chapter.
(1)
Registration shall consist of the submission of the following information:
(i)
The official name of the contracting entity, including any d/b/a designations used in this state;
(ii)
The mailing address and main telephone number for the contracting entity’s main headquarters; and
(iii)
The name and telephone number of the contracting entity’s representative who shall serve as the primary contact with the department.
(2)
The information required by this section shall be submitted in written or electronic format, as prescribed by the department.
(b)
The department may collect a reasonable fee for the purpose of administering the registration process.
History of Section.
P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1; P.L. 2023, ch. 395, art. 1, § 6, effective December 31, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.10 - Rental Network Contract Arrangements › Section 27-20.10-5. - Third-party rights and responsibilities.

§ 27-20.10-5. Third-party rights and responsibilities.
(a)
A third party, having itself been granted access to a provider’s healthcare services and contractual discounts pursuant to a provider network contract, that subsequently grants access to another third party is obligated to comply with the rights and responsibilities imposed on contracting entities under §§ 27-20.10-4 and 27-20.10-6.
(b)
A third party that enters into a contract with another third party to access a provider’s healthcare services and contractual discounts pursuant to a provider network contract is obligated to comply with the rights and responsibilities imposed on third parties under this § 27-20.10-5.
(c)(1)
A third party will provide to the contracting entity the location of a website, or identify another readily available mechanism such as a toll-free telephone number, which the contracting entity will make available to the providers under the provider network contract accessed through the contracting entity. The website or other readily available mechanism will identify the name of the person or entity to which the third party subsequently grants access to the provider’s healthcare services and contractual discounts pursuant to the provider network contract.
(2)
The website will allow the providers under the contracting entity’s provider network contract access to the information referenced in subsection (c)(1) above, and will be updated on a routine basis as additional persons or entities are granted access. The website must be updated to reflect all current persons and entities with access every ninety (90) days. Upon request, a contracting entity shall make updated access information available to a provider via telephone or through direct notification.
History of Section.
P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.10 - Rental Network Contract Arrangements › Section 27-20.10-6. - Unauthorized access to provider network contracts.

§ 27-20.10-6. Unauthorized access to provider network contracts.
(a)
It is an unfair insurance practice for the purposes of chapter 29 of this title to knowingly access or utilize a provider’s contractual discount pursuant to a provider network contract without a contractual relationship with the provider, contracting entity, or third party, as specified in this chapter.
(b)
Contracting entities and third parties are obligated to comply with § 27-20.10-4(b)(2) or § 27-20.10-5(c)(1) and (2) concerning the services referenced on a remittance advice (RA) or explanation of payment (EOP). A provider may refuse the discount taken on the RA or EOP if the discount is taken without a contractual basis or in violation of these sections. However, an error in the RA or EOP may be corrected within thirty (30) days following notice by the provider.
(c)
A contracting entity may not lease, rent, or otherwise grant to a third party, access to a provider network contract unless the third party accessing the healthcare contract is:
(1)
A payer or third-party administrator or another entity that administers or processes claims on behalf of the payer;
(2)
A preferred provider organization or preferred provider network, including a physician organization or physician-hospital organization; or
(3)
An entity engaged in the electronic claims transport between the contracting entity and the payer that does not provide access to the provider’s services and discount to any other third party.
History of Section.
P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.10 - Rental Network Contract Arrangements › Section 27-20.10-7. - Enforcement.

§ 27-20.10-7. Enforcement.
Enforcement of this model will follow that of chapter 29 of this title, “Unfair Competition and Practices.”
History of Section.
P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.11 - Autism Spectrum Disorders › Section 27-20.11-1. - Mandatory coverage for autism spectrum disorders.

§ 27-20.11-1. Mandatory coverage for autism spectrum disorders.
(a)
Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2012, shall provide coverage for autism spectrum disorders; provided, however, the provisions of this chapter shall not apply to contracts, plans or group policies subject to the Small Employer Health Insurance Availability Act, chapter 50 of this title, Medical Assistance, chapter 8 of title 40, or subject to the Individual Health Insurance Coverage Act, chapter 18.5 of this title.
History of Section.
P.L. 2011, ch. 159, § 1; P.L. 2011, ch. 175, § 1; P.L. 2012, ch. 371, § 1; P.L. 2012, ch. 397, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.11 - Autism Spectrum Disorders › Section 27-20.11-2. - Definitions.

§ 27-20.11-2. Definitions.
As used in this chapter:
(1)
“Applied behavior analysis” means the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvements in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.
(2)
“Autism spectrum disorders” means any of the pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association.
(3)
“Health insurance carrier” or “carrier” means any entity subject to the insurance laws and regulations of this state, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including, without limitation, an insurance company offering accident and sickness insurance, a health maintenance organization, a nonprofit hospital, medical service corporation, or any other entity subject to chapter 18, 19, 20, or 41 of this title, providing a plan of health insurance, health benefits, or health services.
History of Section.
P.L. 2011, ch. 159, § 1; P.L. 2011, ch. 175, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.11 - Autism Spectrum Disorders › Section 27-20.11-3. - Scope of coverage.

§ 27-20.11-3. Scope of coverage.
(a)
Benefits under this section shall include coverage for pharmaceuticals, applied behavior analysis, physical therapy, speech therapy, psychology, psychiatric and occupational therapy services for the treatment of autism spectrum disorders, as defined in the most recent edition of the DSM. Provided, however:
(1)
Coverage for physical therapy, speech therapy, and occupational therapy and psychology, psychiatry, and pharmaceutical services shall be, to the extent such services are a covered benefit for other diseases and conditions under such policy; and
(2)
Applied behavior analysis.
(b)
Benefits under this section shall continue until the covered individual reaches age fifteen (15).
(c)
The healthcare benefits outlined in this chapter apply only to services delivered within the state of Rhode Island; provided, that all health insurance carriers shall be required to provide coverage for those benefits mandated by this chapter outside of the state of Rhode Island where it can be established through a pre-authorization process that the required services are not available in the state of Rhode Island from a provider in the health insurance carrier’s network.
History of Section.
P.L. 2011, ch. 159, § 1; P.L. 2011, ch. 175, § 1; P.L. 2012, ch. 371, § 1; P.L. 2012, ch. 397, § 1; P.L. 2015, ch. 141, art. 5, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.11 - Autism Spectrum Disorders › Section 27-20.11-4. - Medical necessity and appropriateness of treatment.

§ 27-20.11-4. Medical necessity and appropriateness of treatment.
(a)
Upon request of the reimbursing health insurance carrier, all providers shall furnish medical records or other necessary data which substantiates that initial or continued treatment is at all times medically necessary and appropriate.
(b)
Medical necessity criteria may be based in part on evidence of continued improvement as a result of treatment. 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.
(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 of title 23 [repealed].
(d)
A health insurance carrier may require submission of a treatment plan, including the frequency and duration of treatment, signed by a child psychiatrist, a behavioral developmental pediatrician, a child neurologist, or a licensed psychologist with training in child psychology, that the treatment is medically necessary for the patient and is consistent with nationally recognized treatment standards for the condition such as those set forth by the American Academy of Pediatrics. An insurer may require an updated treatment plan no more frequently than on a quarterly basis.
History of Section.
P.L. 2011, ch. 159, § 1; P.L. 2011, ch. 175, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.11 - Autism Spectrum Disorders › Section 27-20.11-5. - Limits on cost sharing.

§ 27-20.11-5. Limits on cost sharing.
Benefits for services under this chapter shall be reimbursed in accordance with the respective principles and mechanisms of reimbursement for each health insurance carrier. Except as otherwise provided in this section, any policy, contract, or certificate that provides coverage for services under this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles, and exclusions to the extent that these provisions are no more extensive than coverage provided for other conditions or illnesses. Coverage for autism spectrum disorders is otherwise subject to the same terms and conditions of the policy as any other condition or illness.
History of Section.
P.L. 2011, ch. 159, § 1; P.L. 2011, ch. 175, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.11 - Autism Spectrum Disorders › Section 27-20.11-6. - Educational and other services provided to children diagnosed with autism spectrum disorders.

§ 27-20.11-6. Educational and other services provided to children diagnosed with autism spectrum disorders.
Nothing in this section shall be construed to alter any obligation of a school district or the state of Rhode Island to provide services to an individual under an individualized family service plan or an individualized education program, as required under the federal Individuals with Disabilities Education Act, or the provision of services to an individual under any other federal or state law. A health insurance carrier assessed for services provided under § 42-12-29, children’s health account, shall not be required to provide duplicative coverage for the same beneficiary for the same or similar services mandated under this section.
History of Section.
P.L. 2011, ch. 159, § 1; P.L. 2011, ch. 175, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.11 - Autism Spectrum Disorders › Section 27-20.11-7. - Credentials.

§ 27-20.11-7. Credentials.
(a)
Any individual providing or supervising applied behavior analysis treatment under this section shall be:
(1)
Individually licensed by the department of health as a licensed applied behavior analyst; or a licensed applied behavior assistant analyst acting under supervision; or
(2)
Licensed by the department of health as a psychologist with equivalent experience or a psychologist practicing within their scope of practice.
(b)
Nothing in this chapter shall be construed to require a change in the credentialing or contracting practices of health insurers for mental health or substance abuse providers.
History of Section.
P.L. 2011, ch. 159, § 1; P.L. 2011, ch. 175, § 1; P.L. 2012, ch. 371, § 1; P.L. 2012, ch. 397, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.11 - Autism Spectrum Disorders › Section 27-20.11-8. - Exclusions.

§ 27-20.11-8. Exclusions.
This chapter 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. 2011, ch. 159, § 1; P.L. 2011, ch. 175, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-25 - Rhode Island Fraternal Code › Section 27-25-1. - Fraternal benefit societies.

§ 27-25-1. Fraternal benefit societies.
Any incorporated society, order, or supreme lodge, without capital stock, including one exempted under the provisions of § 27-25-38(a)(2), whether incorporated or not, conducted solely for the benefit of its members and their beneficiaries and not for profit, operated on a lodge system with ritualistic form of work, having a representative form of government, and which provides benefits in accordance with this chapter, is declared to be a fraternal benefit society.
History of Section.
P.L. 1984, ch. 201, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-25 - Rhode Island Fraternal Code › Section 27-25-2. - Lodge system.

§ 27-25-2. Lodge system.
(a)
A society is operating on the lodge system if it has a supreme governing body and subordinate lodges into which members are elected, initiated, or admitted in accordance with its laws, rules, and ritual. Subordinate lodges shall be required by the laws of the society to hold regular meetings at least once in each month in furtherance of the purposes of the society.
(b)
A society may, at its option, organize and operate lodges for children under the minimum age for adult membership. Membership and initiation in local lodges shall not be required of the children, nor shall they have a voice or vote in the management of the society.
History of Section.
P.L. 1984, ch. 201, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-25 - Rhode Island Fraternal Code › Section 27-25-3. - Representative form of government.

§ 27-25-3. Representative form of government.
A society has a representative form of government when:
(1)
It has a supreme governing body constituted in one of the following ways:
(i)
Assembly. The supreme governing body is an assembly composed of delegates elected directly by the members or at intermediate assemblies or conventions of members or their representatives, together with other delegates as may be prescribed in the society’s laws. A society may provide for the election of delegates by mail. The elected delegates shall constitute a majority in number and shall not have less than two-thirds (⅔) of the votes and not less than the number of votes required to amend the society’s laws. The assembly shall be elected and shall meet at least once every four (4) years and shall elect a board of directors to conduct the business of the society between meetings of the assembly. Vacancies on the board of directors between elections may be filled in the manner prescribed by the society’s laws; or
(ii)
Direct election. The supreme governing body is a board composed of persons elected by the members, either directly or by their representatives in intermediate assemblies, and any other persons prescribed in the society’s laws. A society may provide for the election of the board by mail. Each term of a board member may not exceed four (4) years. Vacancies on the board between elections may be filled in the manner prescribed by the society’s laws. Those persons elected to the board shall constitute a majority in number and not less than the number of votes required to amend the society’s laws. A person filling the unexpired term of an elected board member shall be considered an elected member. The board shall meet at least quarterly to conduct the business of the society;
(2)
The officers of the society are elected either by the supreme governing body or by the board of directors;
(3)
Only benefit members are eligible for election to the supreme governing body, the board of directors, or any intermediate assembly; and
(4)
Each voting member shall have one vote; no vote may be cast by proxy.
History of Section.
P.L. 1984, ch. 201, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-25 - Rhode Island Fraternal Code › Section 27-25-4. - Definitions.

§ 27-25-4. Definitions.
Whenever used in this chapter:
(1)
“Benefit contract” means the agreement for provision of benefits authorized by § 27-25-16, as that agreement is described in § 27-25-19(a).
(2)
“Benefit member” means an adult member who is designated by the laws or rules of the society to be a benefit member under a benefit contract.
(3)
“Certificate” means the document issued as written evidence of the benefit contract.
(4)
“Laws” means the society’s articles of incorporation, constitution, and bylaws, however designated.
(5)
“Lodge” means subordinate member units of the society, known as camps, courts, councils, branches, or by any other designation.
(6)
“Premiums” means premiums, rates, dues, or other required contributions by whatever name known, that are payable under the certificate.
(7)
“Rules” means all rules, regulations, or resolutions adopted by the supreme governing body or board of directors that are intended to have general application to the members of the society.
(8)
“Society” means fraternal benefit society, unless otherwise indicated.
History of Section.
P.L. 1984, ch. 201, § 2.