reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-54. - Mandatory coverage for scalp hair prosthesis.

§ 27-20-54. Mandatory coverage for scalp hair prosthesis.
(a)
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 on or after January 1, 2007, that provides coverage for any other prosthesis shall provide coverage for expenses for scalp hair prosthesis worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia; provided, however, that the coverage shall be subject to the same limitations and guidelines as other prosthesis, and that coverage shall not exceed an amount of three hundred fifty dollars ($350) per covered member per year, exclusive of any deductible.
(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. 2006, ch. 538, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-55. - Licensed ambulance service.

§ 27-20-55. Licensed ambulance service.
(a)
No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide for a copayment for ground ambulance services in excess of fifty dollars ($50.00).
(b)
As used in this section, the term “ground ambulance services” shall mean those services provided by an ambulance service licensed to operate in Rhode Island in accordance with § 23-4.1-6. The term excludes air and water ambulance services and ambulance services provided outside of Rhode Island.
(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. 2008, ch. 68, § 3; P.L. 2008, ch. 70, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-56. - Enteral nutrition products.

§ 27-20-56. Enteral nutrition products.
(a)
Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and that are medically necessary for the treatment of malabsorption caused by Crohn’s disease, ulcerative colitis, gastroesophageal reflux, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein and shall extend to all recipients regardless of age.
(b)
Benefit plans offered by a medical service corporation may impose a copayment or deductible, or both, for the benefits mandated by this section, however, in no instance shall the copayment or deductible amount be greater than the copayment or deductible amount imposed for prescription enteral formulas or nutritional aids. Benefits for services under this chapter 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. Reimbursement shall be provided according to the respective principles and policies of the accident and sickness insurer. Nothing contained in this section precludes the accident and sickness insurer 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. 2008, ch. 253, § 3; P.L. 2014, ch. 269, § 3; P.L. 2014, ch. 519, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-57. - Prohibition on preexisting condition exclusions.

§ 27-20-57. Prohibition on preexisting condition exclusions.
(a)
A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title and/or chapter:
(1)
Shall not limit or exclude coverage for an individual under the age of nineteen (19) by imposing a preexisting condition exclusion on that individual.
(2)
For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude coverage for any individual by imposing a preexisting condition exclusion on that individual.
(b)
As used in this section:
(1)
“Preexisting condition exclusion” means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition (whether physical or mental) was present before the effective date of coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the effective date of coverage.
(2)
“Preexisting condition exclusion” means any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individual’s health status before the individual’s effective date of coverage, or if the coverage is denied, the date of denial, under the health benefit plan, such as a condition (whether physical or mental) identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period.
(c)
This section shall not apply to grandfathered health plans providing individual health insurance coverage.
(d)
This section shall not apply to insurance coverage providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.
History of Section.
P.L. 2012, ch. 256, § 8; P.L. 2012, ch. 262, § 8.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-58. - Prohibition on rescission of coverage.

§ 27-20-58. Prohibition on rescission of coverage.
(a)(1)
Coverage under a health benefit plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be subject to rescission after the individual is covered under the plan, unless:
(i)
The individual or a person seeking coverage on behalf of the individual, performs an act, practice, or omission that constitutes fraud; or
(ii)
The individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage.
(2)
For purposes of subsection (a)(1)(i), a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health carrier.
(b)
At least thirty (30) days’ advance written notice shall be provided to each plan enrollee or, for individual health insurance coverage, primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of, in the case of group health insurance coverage, whether the rescission applies to the entire group or only to an individual within the group.
(c)
This section applies to grandfathered health plans.
History of Section.
P.L. 2012, ch. 256, § 8; P.L. 2012, ch. 262, § 8.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-61. - Medical loss ratio reporting and rebates.

§ 27-20-61. Medical loss ratio reporting and rebates.
(a)
A nonprofit medical service corporation offering group or individual health insurance coverage of a health benefit plan, including a grandfathered health plan, shall comply with the provisions of Section 2718 of the Public Health Service Act as amended by the federal Patient Protection and Affordable Care Act [42 U.S.C. § 300gg-18], in accordance with regulations adopted thereunder.
(b)
Nonprofit medical service corporations required to report medical loss ratio and rebate calculations and any other medical loss ratio and rebate information to the U.S. Department of Health and Human Services shall concurrently file such information with the commissioner.
History of Section.
P.L. 2012, ch. 256, § 8; P.L. 2012, ch. 262, § 8.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-63. - Internal and external appeal of adverse benefit determinations.

§ 27-20-63. Internal and external appeal of adverse benefit determinations.
(a)
The commissioner shall adopt regulations to implement standards and procedures with respect to internal claims and appeals of adverse benefit determinations, and with respect to external appeals of adverse benefit determinations.
(b)
The regulations adopted by the commissioner shall apply only to those adverse benefit determinations that are not subject to the jurisdiction of the department of health pursuant to § 23-17.12 et seq. (Utilization Review Act) [repealed].
(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. This section also shall not apply to grandfathered health plans.
History of Section.
P.L. 2012, ch. 256, § 8; P.L. 2012, ch. 262, § 8.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-65. - Primary care provider designation requirement.

§ 27-20-65. Primary care provider designation requirement.
Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2013, shall require that the subscriber and each dependent designate a participating primary care provider and the insurer shall collect the designation from the insured. Designation of a primary care provider shall not be a condition of enrollment and failure to designate a primary care provider shall not constitute grounds for cancellation of coverage. For purposes of this section, “primary care provider” means the physician, practice, or other medical provider considered by the insured to be his or her usual source of medical care.
History of Section.
P.L. 2012, ch. 189, § 1; P.L. 2012, ch. 202, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-66. - Discretionary clauses.

§ 27-20-66. Discretionary clauses.
(a)
No new or existing policy or certificate may contain any provision:
(1)
Purporting to reserve sole discretion to the insurer or healthcare entity to determine eligibility for benefits or interpret the terms of a policy or certificate; or
(2)
Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.
(b)
Any such clause or language included in a contract, policy, or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.
(c)
Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility; receipt of benefits and claims; or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.
History of Section.
P.L. 2013, ch. 85, § 4; P.L. 2013, ch. 94, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-67. - Orally administered anticancer medication — Cost-sharing requirement.

§ 27-20-67. Orally administered anticancer medication — Cost-sharing requirement.
(a)
Every individual or group hospital or medical expense insurance policy, or individual or group hospital or medical services plan contract, plan, or certificate of insurance delivered, issued for delivery, or renewed in this state, on or after January 1, 2014, that offers both medical and prescription drug coverage, and provides coverage for intravenously administered anticancer medication, shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section. Notwithstanding the above, the requirements shall not be construed to impose any form of cap on cost sharing.
(b)
This section does 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. 2013, ch. 323, § 3; P.L. 2013, ch. 405, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-68. - Consumer notification.

§ 27-20-68. Consumer notification.
Every nonprofit medical service corporation providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a nonduplication of benefits clause: “NO DUPLICATION OF BENEFITS”.
History of Section.
P.L. 2013, ch. 452, § 3; P.L. 2013, ch. 479, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-69. - Opioid antagonists.

§ 27-20-69. Opioid antagonists.
(a)
Every individual or group health insurance contract, plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended, or renewed in this state on or after January 1, 2017, shall provide coverage for at least one generic opioid antagonist and device. Prior authorization may be required for non-generic forms of opioid antagonists and devices.
(b)
As used in this section:
“Opioid antagonist” means naloxone hydrochloride and any other drug approved by the United States Food and Drug Administration for the treatment of opioid overdose.
(c)
The coverage mandated by this section shall include generic opioid antagonists prescribed or dispensed via standing order or collaborative practice agreement intended for use on patients other than the insured. Prior authorization may be required for non-generic forms of opioid antagonists and devices.
History of Section.
P.L. 2016, ch. 175, § 3; P.L. 2016, ch. 192, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-71. - Unfair discrimination prohibited.

§ 27-20-71. 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 [repealed], 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 [repealed], and 37 of title 5.
History of Section.
P.L. 2017, ch. 165, § 3; P.L. 2017, ch. 314, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-72. - Health insurance contracts — Full year coverage for contraception.

§ 27-20-72. Health insurance contracts — Full year coverage for contraception.
Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to three hundred sixty-five (365) days at a time.
History of Section.
P.L. 2018, ch. 230, § 5; P.L. 2018, ch. 234, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-73. - Prohibition on discrimination in organ transplants.

§ 27-20-73. Prohibition on discrimination in organ transplants.
Pursuant to chapter 95 of title 23, any nonprofit medical service corporation that provides for anatomical gifts, organ transplants, or related treatment and services shall not:
(1)
Deny coverage to a covered person solely on the basis of the person’s disability;
(2)
Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the health benefit plan, solely for the purpose of avoiding the requirements of this section;
(3)
Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide monetary or nonmonetary incentives to an attending provider, to induce the provider to provide care to an insured or enrollee in a manner inconsistent with this section; or
(4)
Reduce or limit coverage benefits to a patient for the medical services or other services related to organ transplantation performed pursuant to this section as determined in consultation with the attending physician and patient.
History of Section.
P.L. 2021, ch. 109, § 5, effective June 30, 2021; P.L. 2021, ch. 133, § 5, effective June 30, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-74. - Health insurance contracts — Copayments exemption for COVID-19 vaccinations.

§ 27-20-74. Health insurance contracts — Copayments exemption for COVID-19 vaccinations.
(a)
Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for COVID-19 related services, including, but not limited to: emergency services, inpatient services, provider office visits, and inpatient hospital stays, as long as the COVID-19 state of emergency remains in effect.
(b)
Any individual or group health insurance plan or policy shall not impose any copayment, coinsurance, or charge any out-of-pocket deductible to the insured for the administration of the COVID-19 vaccine or a COVID-19 test.
(c)
The health insurance commissioner shall promulgate any rules and regulations as the commissioner deems necessary for the efficient administration and enforcement of this section.
History of Section.
P.L. 2021, ch. 145, § 3, effective July 3, 2021; P.L. 2021, ch. 161, § 3, effective July 3, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-75. - Perinatal doulas.

§ 27-20-75. Perinatal doulas.
(a)
As used in this section, “doula” or “perinatal doula” means a trained professional providing continuous physical, emotional, and informational support to a pregnant individual, from antepartum, intrapartum, and up to the first twelve (12) months of the postpartum period. Doulas also provide assistance by referring childbearing individuals to community-based organizations and certified and licensed perinatal professionals in multiple disciplines.
(b)
Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after July 1, 2022, shall provide coverage for the services of perinatal doulas in accordance with each health insurer’s respective principles and mechanisms of reimbursement, credentialing, and contracting, if the services are within the perinatal doulas’ area of professional competence as defined by the doula certification standard developed and maintained by the Rhode Island certification board in collaboration with the department of health, and are currently reimbursed when rendered by any other healthcare provider. No insurer or hospital or medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement, except when those requirements are also applicable to other categories of healthcare providers. No insurer or hospital or medical service corporation or patient may be required to pay for duplicate services actually rendered by both a perinatal doula and any other healthcare provider.
(c)
Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state that is required to cover perinatal doula services, as defined in subsections (a) and (b) of this section, shall report utilization and cost information related to perinatal doula services to the office of the health insurance commissioner on or before July 1, 2023, and each July 1 thereafter. The office of the health insurance commissioner shall define the utilization and cost information required to be reported.
(d)
This section shall not apply to insurance coverage providing benefits for:
(1)
Hospital confinement indemnity;
(2)
Disability income;
(3)
Accident only;
(4)
Long-term care;
(5)
Medicare supplement;
(6)
Limited benefit health;
(7)
Specified disease indemnity;
(8)
Sickness or bodily injury or death by accident or both; and
(9)
Other limited benefit policies.
History of Section.
P.L. 2021, ch. 209, § 4, effective July 1, 2022; P.L. 2021, ch. 321, § 4, effective July 1, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-76. - Gender rating.

§ 27-20-76. Gender rating.
(a)
No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state, that provides medical coverage that includes coverage for physician services in a physician’s office, and no policy that provides major medical or similar comprehensive-type coverage, excluding disability income, long-term care, and insurance supplemental policies that only provide coverage for specified diseases or other supplemental policies, shall vary the premium rate for a health coverage plan based on the gender of the individual policyholders, enrollees, subscribers, or members.
(b)
This section shall not apply to insurance coverage providing benefits for any of the following:
(1)
Hospital confinement indemnity;
(2)
Disability income;
(3)
Accident only;
(4)
Long-term care;
(5)
Medicare supplement;
(6)
Limited benefit health;
(7)
Specified disease indemnity;
(8)
Sickness of bodily injury or death by accident or both; and
(9)
Other limited benefit policies.
History of Section.
P.L. 2021, ch. 88, § 3, effective January 1, 2023; P.L. 2021, ch. 89, § 3, effective January 1, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-79. - Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective January 1, 2024.]

§ 27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. [Effective January 1, 2024.]
(a)
Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis (“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall constitute a separate method of administration. A health insurer is not required to cover any pre-exposure prophylaxis drug or post-exposure prophylaxis drug dispensed or administered by an out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network pharmacy benefit.
(b)
The healthcare benefits outlined in this chapter apply only to services delivered within the health insurer’s provider network; provided that, all health insurers shall be required to provide coverage for those benefits mandated by this chapter outside of the health insurer’s provider network where it can be established that the required services are not available from a provider in the health insurer’s network.
History of Section.
P.L. 2023, ch. 254, § 3, effective January 1, 2024.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-80. - Expedited prior authorization. [Effective January 1, 2024.]

§ 27-20-80. Expedited prior authorization. [Effective January 1, 2024.]
To the extent a prior authorization is permitted and applied, then it shall be conducted in an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant § 27-18.9-6(a)(1).
History of Section.
P.L. 2023, ch. 254, § 3, effective January 1, 2024.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20 - Nonprofit Medical Service Corporations › Section 27-20-82. - Epinephrine injectors.

§ 27-20-82. Epinephrine injectors.
(a)
The Rhode Island general assembly recognizes that epinephrine cartridges and injectors are life-saving devices that must be administered quickly to be effective. Such administration is often done by persons who are not healthcare professionals, and is done in an emergency situation. Accordingly, it is in the best interests of the people of the state to promote the widespread availability of epinephrine cartridges and injectors.
(b)
Every individual or group health insurance contract, plan, or policy that provides prescription coverage and that is delivered, issued for delivery, prescribed, or renewed in this state on or after January 1, 2025, shall provide coverage for at least one type of epinephrine auto-injectors and cartridges. There shall be no copayment required, and no deductible shall need to be met, to obtain a two (2) pack of the epinephrine auto-injectors or cartridges covered by the contract, plan, or policy, once every twelve-month (12) plan year. A deductible may be applied to health plans that are paired with a federally qualified health savings account pursuant to 26 U.S.C. § 223. Nothing in this section would prohibit a health plan from implementing this benefit prior to January 1, 2025.
History of Section.
P.L. 2023, ch. 263, § 3, effective June 22, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-1. - Definitions.

§ 27-20.1-1. Definitions.
As used in this chapter:
(1)
“Dental service” means the professional services rendered by persons duly licensed under the laws of this state to practice dentistry, and prosthetic dentures, bridges, appliances, or other structures to be used and worn as substitutes for natural teeth, prosthetic appliances, orthodontic appliances, precious metal, and ceramic restorations, necessary in connection with the services and supplied by licensed persons, and drugs, medicines, supplies, and nursing care necessary in connection with the services, or expense indemnity for the services, prosthetic dentures, bridges, appliances, or other structures to be used and worn as substitutes for natural teeth, prosthetic appliances, orthodontic appliances, precious metal, and ceramic restorations, drugs, medicines, supplies, and care, as may be specified in any nonprofit dental service plan. Dental service shall not be construed to include hospital services.
(2)
“Nonprofit dental service corporation” means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit dental service plan.
(3)
“Nonprofit dental service plan” means a plan by which specified dental service is provided to subscribers to the plan by a nonprofit dental service corporation.
(4)
“Subscribers” means those persons or groups of persons who contract with a nonprofit dental service corporation for dental service pursuant to a nonprofit dental service plan.
History of Section.
P.L. 1959, ch. 183, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-3. - Contracts.

§ 27-20.1-3. Contracts.
(a)
Each nonprofit dental service corporation may contract with its subscribers for a dental service as may be provided under any nonprofit dental service plan adopted by the corporation.
(b)
The rates charged by the nonprofit dental service corporation to its subscribers shall be consistent with the proper conduct of its business and the interests of the public and shall at all times be subject to the approval of the director of business regulation.
(c)
Nothing contained in this chapter or in any nonprofit dental service plan shall affect the ordinary professional relationship between the person rendering dental services under the plan and the subscriber to whom the services are rendered; and no action based upon or arising out of the relationship or relating to dental services rendered pursuant to a nonprofit dental service plan shall be maintained against the nonprofit dental service corporation operating the plan.
(d)
No contract between a nonprofit dental service corporation and a dentist for the provisions of services to patients may require that the dentist indemnify or hold harmless the nonprofit dental service corporation for any expenses and liabilities, including, without limitation: judgments, settlements, attorneys’ fee, court costs, and any associated charges, incurred in connection with any claim or action brought against the nonprofit dental service corporation based on the nonprofit dental service corporation’s management decisions, or utilization review provisions for any patient.
History of Section.
P.L. 1959, ch. 183, § 1; P.L. 1999, ch. 481, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-4. - Annual and quarterly statements.

§ 27-20.1-4. Annual and quarterly statements.
(a)
Every nonprofit dental service corporation and any nonprofit dental service plan operated by a nonprofit hospital service corporation shall annually, on or before the first day of March in each year, file in the office of the commissioner of insurance a statement, verified by at least two (2) of the principal officers of the corporation, of the condition of the nonprofit dental service corporation or plan on the 31st day of December then next preceding, which statement shall be in general form and context as approved by the National Association of Insurance Commissioners and contain any matters as the director of business regulation shall prescribe, including, but not limited to: premiums earned, claims expense, operating expenses, other income and expenses, net gain or loss, reserves, enrollment, and enrollment changes separately for dental business for the corporations and shall be available for inspection by the public.
(b)
Every nonprofit dental service corporation shall also file quarterly statements with the insurance commissioner, due on or before forty-five (45) days after the quarter ending in accordance with the National Association of Insurance Commissioners’ guidelines and procedures and contain any matters as the director of business regulation shall prescribe, including, but not limited to: premiums earned, claims expense, operating expenses, other income and expenses, net gain or loss, reserves, enrollment, and enrollment changes separately for dental business for the corporations and shall be available for inspection by the public.
(c)
The insurance commissioner shall also require compliance with chapters 12 and 12.1 of this title.
History of Section.
P.L. 1959, ch. 183, § 1; P.L. 1994, ch. 396, § 1; P.L. 1994, ch. 404, § 3; P.L. 1996, ch. 188, § 11.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-5. - Examination of affairs of corporation.

§ 27-20.1-5. Examination of affairs of corporation.
It is the duty of the director of business regulation at least every five (5) years to make an examination of the financial condition and methods of doing business of every nonprofit dental service corporation. The examination shall be performed, and the associated costs shall be borne by the company, in accordance with all provisions of chapter 13.1 of this title.
History of Section.
P.L. 1959, ch. 183, § 1; P.L. 1960, ch. 71, art. 3, § 35; P.L. 1994, ch. 404, § 3; P.L. 2009, ch. 303, § 5; P.L. 2009, ch. 304, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-6. - Commission plans for solicitors or insurance producers.

§ 27-20.1-6. Commission plans for solicitors or insurance producers.
No person shall be engaged to solicit subscribers to any nonprofit dental service plan upon a commission basis or upon any other basis by which the payment of the compensation or expenses of that person shall be conditioned upon the enrollment of subscribers, unless the method of solicitation and rate of compensation shall have had the prior written approval of the director of business regulation.
History of Section.
P.L. 1959, ch. 183, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-7. - Investment standards.

§ 27-20.1-7. Investment standards.
(a)
All nonprofit dental service corporations shall protect the interests of subscribers by promoting company solvency and financial strength through the application of investment standards that facilitate a reasonable balance of the following objectives:
(1)
To preserve principal;
(2)
To ensure reasonable diversification as to type of investment, issuer, and credit quality; and
(3)
To allow the nonprofit medical service corporation to allocate investments in a manner consistent with principles of prudent investment management to achieve an adequate return so that obligations to subscribers are adequately met and financial strength is sufficient to cover reasonably foreseeable contingencies.
(b)
All investments, including, but not limited to, those referred to in this chapter, shall be made and held in accordance with the objectives in subsection (a) subject to the limitations set forth in this chapter and in regulations promulgated pursuant to this chapter. Investments not conforming to this chapter and any regulations promulgated pursuant to this chapter are not considered admitted assets.
History of Section.
P.L. 1959, ch. 183, § 1; P.L. 1999, ch. 45, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-8. - Corporation deemed public charitable institution.

§ 27-20.1-8. Corporation deemed public charitable institution.
Every nonprofit dental service corporation is declared to be, and shall be deemed to be, a charitable institution and shall be subject to the provisions of chapter 6 of title 7, except as otherwise expressly provided in this chapter, and to this chapter.
History of Section.
P.L. 1959, ch. 183, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-9. - Adoption of chapter by hospital service corporation.

§ 27-20.1-9. Adoption of chapter by hospital service corporation.
Any nonprofit hospital service corporation organized pursuant to the provisions of chapter 19 of this title that first obtains authorization to do so by the Rhode Island State Dental Society as evidenced by the affidavit of the president and secretary of the society may amend its articles of association to adopt the provisions of this chapter, and upon the adoption, the corporation shall have and exercise all of the powers and be subject to all of the duties and responsibilities of a nonprofit dental service corporation to the same extent as though it had been incorporated as a nonprofit dental service corporation.
History of Section.
P.L. 1959, ch. 183, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-10. - Nonprofit dental service corporation assessment.

§ 27-20.1-10. Nonprofit dental service corporation assessment.
(a)
Notwithstanding any other provisions of law, each domestic nonprofit dental service corporation shall be charged an assessment to partially support the activities of the division of insurance in the department of business regulation.
(b)
The minimum assessment charged shall be one thousand dollars ($1,000).
History of Section.
P.L. 1990, ch. 65, art. 29, § 4; P.L. 1993, ch. 180, § 18; P.L. 2002, ch. 292, § 133.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-11. - Rehabilitation, liquidation, or conservation.

§ 27-20.1-11. Rehabilitation, liquidation, or conservation.
(a)
Any rehabilitation, liquidations, administrative supervision, or conservation of a nonprofit dental service corporation organized under this chapter shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 of this title. The director of business regulation may apply for an order from the superior court directing the director of business regulation to rehabilitate, liquidate, or conserve a nonprofit dental service corporation upon any one or more of the following grounds:
(1)
That the nonprofit dental service corporation is insolvent; for the purposes of this section, the term “insolvent” means the inability of the nonprofit dental service corporation to meet its debts and financial obligations as they become due;
(2)
That the nonprofit dental service corporation fails or refuses to comply with a lawful order of the director of business regulation reasonably designed to correct unsound business policies or practices that, if uncorrected, could reasonably lead to insolvency as defined in subsection (a)(1); or
(3)
That the nonprofit dental service corporation’s financial condition is such as to render its further transaction of business hazardous to the public or its subscribers or members.
(b)
A claim by a healthcare provider shall not be asserted against any subscriber or member of the nonprofit dental service corporation in the event of the rehabilitation, liquidation, conservation, or administrative supervision of the nonprofit dental service corporation.
History of Section.
P.L. 1993, ch. 180, § 19.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-12. - Holding company systems.

§ 27-20.1-12. Holding company systems.
All of the provisions of chapter 35 of this title apply to corporations organized or licensed pursuant to this chapter. Any approval granted by the director pursuant to chapter 35 of this title shall not supersede any other approval under Rhode Island law relative to mergers or other acquisitions of nonprofit dental service corporations in their capacity as Rhode Island charitable nonprofit corporations.
History of Section.
P.L. 1993, ch. 180, § 19; P.L. 1998, ch. 90, § 3; P.L. 2000, ch. 178, § 5; P.L. 2000, ch. 200, § 15; P.L. 2000, ch. 229, § 15.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-12.1. - No derogation of attorney general.

§ 27-20.1-12.1. No derogation of attorney general.
No provision of this chapter shall derogate from the common law or statutory authority of the attorney general nor shall any provision be construed as a limitation on the common law or statutory authority of the attorney general, including the authority to investigate at any time charitable assets for the purpose of determining and ascertaining whether they are being administered in accordance with law and with the terms and purposes of the charity.
History of Section.
P.L. 1998, ch. 90, § 8.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-13. - Regulations.

§ 27-20.1-13. Regulations.
The director of the department of business regulation may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.
History of Section.
P.L. 1993, ch. 180, § 19.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-14. - Reserves.

§ 27-20.1-14. Reserves.
Any corporation organized under this title shall maintain total reserves for dental services, separate and distinct from reserves for other health services, in a dollar amount sufficient to pay claims for dental services and operating expenses for not less than one month. Those reserves shall be computed as of each March 31, June 30, September 30, and December 31, and a report setting forth the computation shall be submitted to the director of the department of business regulation together with the corporation’s Rhode Island quarterly or annual statement to the insurance commissioner of the state of Rhode Island.
History of Section.
P.L. 1995, ch. 264, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-15. - Drug coverage.

§ 27-20.1-15. Drug coverage.
(a)
Any nonprofit dental service corporation that utilizes a formulary of medications for which coverage is provided under an individual or group plan master contract shall require any physician or other person authorized by the department of health to prescribe medication to prescribe from the formulary. A physician or other person authorized by the department of health to prescribe medication shall be allowed to prescribe medications previously on, or not on, the nonprofit dental service corporation’s formulary if he or she believes that the prescription of the non-formulary medication is medically necessary. A nonprofit dental service corporation shall be required to provide coverage for a non-formulary medication only when the non-formulary medication meets the nonprofit dental service corporation’s medical-exception criteria for the coverage of that medication.
(b)
A nonprofit dental service corporation’s medical-exception criteria for the coverage of non-formulary medications shall be developed in accordance with § 23-17.13-3(c)(3) [repealed].
(c)
Any subscriber who is aggrieved by a denial of benefits to be provided under this section may appeal the denial in accordance with the rules and regulations promulgated by the department of health pursuant to chapter 17.12 of title 23 [repealed].
(d)
Prior to removing a prescription drug from its plan’s formulary or making any change in the preferred or tiered cost-sharing status of a covered prescription drug, a nonprofit dental service corporation must provide at least thirty (30) days’ notice to authorized prescribers by established communication methods of policy and program updates and by updating available references on web-based publications. All adversely affected members must be provided at least thirty (30) days’ notice prior to the date such change becomes effective by a direct notification:
(1)
The written or electronic notice must contain the following information:
(i)
The name of the affected prescription drug;
(ii)
Whether the plan is removing the prescription drug from the formulary, or changing its preferred or tiered cost-sharing status; and
(iii)
The means by which subscribers may obtain a coverage determination or medical exception, in the case of drugs that will require prior authorization or are formulary exclusions respectively.
(2)
A nonprofit dental service corporation may immediately remove from its plan formularies covered prescription drugs deemed unsafe by the nonprofit dental service corporation or the Food and Drug Administration, or removed from the market by their manufacturer, without meeting the requirements of this section.
History of Section.
P.L. 1998, ch. 290, § 4; P.L. 2016, ch. 541, § 4; P.L. 2017, ch. 274, § 4; P.L. 2017, ch. 361, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-20.1 - Nonprofit Dental Service Corporations › Section 27-20.1-16. - Magnetic resonance imaging — Quality assurance standards.

§ 27-20.1-16. Magnetic resonance imaging — Quality assurance standards.
A magnetic resonance imaging examination eligible for reimbursement by a nonprofit dental services corporation licensed pursuant to this chapter shall be reimbursed only if the provider at which the examination has been conducted and processed, and the licensed physician interpreting the results of the magnetic resonance imaging examination, both meet state-approved quality assurance standards for taking, processing, and interpreting magnetic resonance imaging examinations. The director of health has the authority to promulgate rules and regulations necessary to carry out the provisions of this section. The rules and regulations shall be based upon the most current standards of the American College of Radiology, and approved by the director.
History of Section.
P.L. 1999, ch. 169, § 5.