reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-69. - Post-payment audits.

§ 27-41-69. Post-payment audits.
(a)
Except as otherwise provided herein, any review, audit, or investigation by a health maintenance organization of a healthcare provider’s claims that results in the recoupment or set-off of funds previously paid to the healthcare provider in respect to such claims shall be completed no later than eighteen (18) months after the completed claims were initially paid, except that the period for recoupment or set-off for claims submitted by a mental health and/or substance use disorder provider, for those services, licensed by this state, and participating with the health insurer or health plan, shall be no later than twelve (12) months. This section shall not restrict any review, audit, or investigation regarding claims that are submitted fraudulently; are known, or should have been known, by the healthcare provider to be a pattern of inappropriate billing according to the standards for provider billing of their respective medical or dental specialties; are related to coordination of benefits; are duplicate claims; or are subject to any federal law or regulation that permits claims review beyond the period provided herein.
(b)
No healthcare provider shall seek reimbursement from a payer for underpayment of a claim later than eighteen (18) months from the date the first payment on the claim was made, except if the claim is the subject of an appeal properly submitted pursuant to the payer’s claims appeal policies or the claim is subject to continual claims submission.
(c)
For the purposes of this section, “healthcare provider” means an individual clinician, either in practice independently or in a group, who provides healthcare services, and any healthcare facility, as defined in § 27-41-2, including any mental health and/or substance abuse treatment facility, physician, or other licensed practitioner identified to the review agent as having primary responsibility for the care, treatment, and services rendered to a patient.
(d)
Except for those contracts where the health insurer or plan has the right to unilaterally amend the terms of the contract, the parties shall be able to negotiate contract terms that allow for different time frames than are prescribed herein.
History of Section.
P.L. 2006, ch. 86, § 5; P.L. 2006, ch. 97, § 5; P.L. 2013, ch. 251, § 4; P.L. 2013, ch. 395, § 4; P.L. 2014, ch. 201, § 4; P.L. 2014, ch. 214, § 4; P.L. 2017, ch. 368, § 4; P.L. 2017, ch. 375, § 4; P.L. 2022, ch. 157, § 4, effective June 27, 2022; P.L. 2022, ch. 158, § 4, effective June 27, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-70. - Tobacco cessation programs.

§ 27-41-70. Tobacco cessation programs.
(a)
Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2010, that provides medical coverage that includes coverage for physician services in a physician’s office, and every policy that provides major medical or similar comprehensive-type coverage, shall include coverage for smoking cessation treatment, provided that if the medical coverage does not include prescription drug coverage, the contract, plan, or policy shall not be required to include coverage for FDA approved smoking cessation medications.
(b)
As used in this section, smoking cessation treatment includes the use of an over-the-counter (OTC) or prescription U.S. Food and Drug Administration (FDA) approved smoking cessation medication, when used in accordance with FDA approval, for not more than two (2) courses of medication of up to fourteen (14) weeks each, annually, when recommended and prescribed by a prescriber who holds prescriptive privileges in the state in which they are licensed, and used in combination with an annual outpatient benefit of sixteen (16) one-half (½) hour evidence-based smoking cessation counseling sessions provided by a qualified practitioner for each covered individual. Smoking cessation treatment may be redefined through regulation promulgated by the health insurance commissioner in accordance with the most current clinical practice guidelines sponsored by the United States Department of Health and Human Services or its component agencies.
(c)
Health insurance contracts, plans, or policies to which this section applies, may impose copayments or deductibles, or both, for the benefits mandated by this section consistent with the contracts’, plans’, or policies’ copayments or deductibles, or both, for physician services and medications. Nothing contained in this section shall impact the reimbursement, medical necessity or utilization review, managed care, or case management practices of these health insurance contracts, plans, or policies.
(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. 2006, ch. 262, § 4; P.L. 2006, ch. 293, § 4; P.L. 2008, ch. 475, § 94; P.L. 2009, ch. 187, § 4; P.L. 2009, ch. 291, § 4; P.L. 2023, ch. 395, art. 1, § 14, effective December 31, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-71. - Mandatory coverage for scalp hair prosthesis.

§ 27-41-71. 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 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, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-73. - Licensed ambulance service.

§ 27-41-73. 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, § 4; P.L. 2008, ch. 70, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-74. - Enteral nutrition products.

§ 27-41-74. 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 health maintenance organization 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, § 4; P.L. 2014, ch. 269, § 4; P.L. 2014, ch. 519, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-75. - Prohibition on rescission of coverage.

§ 27-41-75. Prohibition on rescission of coverage.
(a)(1)
Coverage under a health 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 rescinded 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 maintenance organization.
(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)
For purposes of this section, “to rescind” means to cancel or to discontinue coverage with retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.
(d)
This section applies to grandfathered health plans.
History of Section.
P.L. 2012, ch. 256, § 10; P.L. 2012, ch. 262, § 10.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-78. - Medical loss ratio reporting and rebates.

§ 27-41-78. Medical loss ratio reporting and rebates.
(a)
A health maintenance organization 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 Patient Protection and Affordable Care Act [42 U.S.C. § 300gg-18], in accordance with regulations adopted thereunder.
(b)
Health maintenance organizations required to report medical loss ratio and rebate calculations and any other medical loss ratio or 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, § 10; P.L. 2012, ch. 262, § 10.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-80. - Internal and external appeal of adverse benefit determinations.

§ 27-41-80. 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 within 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, § 10; P.L. 2012, ch. 262, § 10.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-81. - Prohibition on preexisting condition exclusions.

§ 27-41-81. 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 or chapter, or both:
(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, § 10; P.L. 2012, ch. 262, § 10.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-82. - Primary care provider designation requirement.

§ 27-41-82. 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, § 4; P.L. 2012, ch. 202, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-83. - Discretionary clauses.

§ 27-41-83. Discretionary clauses.
(a)
No new or existing policy or certificate may contain any provision:
(1)
Purporting to reserve sole discretion to the insurance company to determine eligibility for benefits or interpret the terms of a policy or certificate; or
(2)
Specifying or affecting a standard of review upon which a court may review denial of a claim or any other decision made by an insurance company with respect to a policyholder or certificate holder.
(b)
Any such clause or language included in a contract, policy, or certificate issued to or covering a resident of this state that is contrary to or inconsistent with the provisions of this section is void and unenforceable.
(c)
Nothing in this section prohibits an insurer from including a provision in a contract that informs an insured that as part of its routine operations the insurer applies the terms of its contracts for making decisions, including making determinations regarding eligibility, receipt of benefits and claims, or explaining policies, procedures, and processes, so long as the provision could not give rise to a deferential standard of review by any reviewing court.
History of Section.
P.L. 2013, ch. 85, § 7; P.L. 2013, ch. 94, § 7.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-84. - Orally administered anticancer medication — Cost-sharing requirement.

§ 27-41-84. 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, § 4; P.L. 2013, ch. 405, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-85. - Consumer notification.

§ 27-41-85. Consumer notification.
Every health maintenance organization 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, § 5; P.L. 2013, ch. 479, § 5.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-86. - Opioid antagonists.

§ 27-41-86. 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, § 4; P.L. 2016, ch. 192, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-88. - Unfair discrimination prohibited.

§ 27-41-88. Unfair discrimination prohibited.
Notwithstanding any provision of any policy of insurance, certificate, or service contract issued in this state, whenever the insurance policy, certificate, or service contract provides for reimbursement for any services that may be legally performed by any person licensed under the provisions of chapters 29, 30, 35, and 37 of title 5, reimbursement under the insurance policy, certificate, or service contract shall be based upon a determination of medical necessity and shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair discrimination against particular individuals or persons licensed under chapters 29, 30, 35, and 37 of title 5.
History of Section.
P.L. 2017, ch. 165, § 4; P.L. 2017, ch. 314, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-89. - Health insurance contracts — Full year coverage for contraception.

§ 27-41-89. 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, § 7; P.L. 2018, ch. 234, § 7.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-90. - Prohibition on discrimination in organ transplants.

§ 27-41-90. Prohibition on discrimination in organ transplants.
Pursuant to chapter 95 of title 23, any health maintenance organization that provides coverage 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, § 6, effective June 30, 2021; P.L. 2021, ch. 133, § 6, effective June 30, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-91. - Health insurance contracts — Copayments exemption for COVID-19 vaccinations.

§ 27-41-91. 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, § 4, effective July 3, 2021; P.L. 2021, ch. 161, § 4, effective July 3, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-92. - Perinatal doulas.

§ 27-41-92. 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, § 5, effective July 1, 2022; P.L. 2021, ch. 321, § 5, effective July 1, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-93. - Gender rating.

§ 27-41-93. 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, § 4, effective January 1, 2023; P.L. 2021, ch. 89, § 4, effective January 1, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-96. - 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.]

§ 27-41-96. 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, § 4, effective January 1, 2024.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-97. - Expedited prior authorization. [Effective January 1, 2024.]

§ 27-41-97. Expedited prior authorization. [Effective January 1, 2024.]
To the extent a prior authorization is permitted and applied, then it shall be conducted in an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-18.9-6(a)(1).
History of Section.
P.L. 2023, ch. 254, § 4, effective January 1, 2024.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-41 - Health Maintenance Organizations › Section 27-41-99. - Epinephrine injectors.

§ 27-41-99. 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, § 4, effective June 22, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Healthcare Benefits › Section 27-42-1. - Purpose.

§ 27-42-1. Purpose.
The purpose of this chapter is to give this state “jurisdiction to determine jurisdiction” of providers of healthcare benefits; to indicate how each provider of healthcare benefits may show under what jurisdiction it falls; to allow for examinations by this state if the provider of healthcare benefits is unable to show it is subject to another jurisdiction; to make a provider of healthcare benefits subject to the laws of this state if it cannot show that it is subject to another jurisdiction; and to disclose to purchasers of healthcare benefits whether or not the plans are fully insured.
History of Section.
P.L. 1984, ch. 177, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Healthcare Benefits › Section 27-42-2. - Authority and jurisdiction of director of business regulation.

§ 27-42-2. Authority and jurisdiction of director of business regulation.
Notwithstanding any other provision of law, and except as provided in this section and in § 27-16-1.2(a)(5), any person or other entity that provides coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether that coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject to the jurisdiction of the director of business regulation, unless the person or other entity shows that while providing the services it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government.
History of Section.
P.L. 1984, ch. 177, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Healthcare Benefits › Section 27-42-3. - How to show jurisdiction.

§ 27-42-3. How to show jurisdiction.
A person or entity may show that it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government, by providing to the director of business regulation the appropriate certificate, license, or other document issued by the other governmental agency that permits or qualifies it to provide those services.
History of Section.
P.L. 1984, ch. 177, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Healthcare Benefits › Section 27-42-4. - Examination.

§ 27-42-4. Examination.
Any person or entity who or that is unable to show the person or entity is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government, shall submit to an examination by the director to determine the organization and solvency of the person or the entity, and to determine whether or not the person or entity complies with the applicable provisions of this title and chapter 62 of title 42.
History of Section.
P.L. 1984, ch. 177, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Healthcare Benefits › Section 27-42-5. - Subject to state laws.

§ 27-42-5. Subject to state laws.
Any person or entity unable to show that the person or entity is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government, shall be subject to all appropriate provisions of this title and of chapter 62 of title 42, regarding the conduct of the person or entity’s business.
History of Section.
P.L. 1984, ch. 177, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-42 - Jurisdiction to Determine Jurisdiction of Providers of Healthcare Benefits › Section 27-42-6. - Disclosure.

§ 27-42-6. Disclosure.
Any production agency or administrator including, but not limited to, any insurance producer licensed under chapter 2.4 of this title, that advertises, sells, transacts, or administers the coverage in this state described in § 27-42-2 and that, under § 27-42-4, is unable to show that it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government shall, if that coverage is not fully insured or fully covered by a domestic insurance company incorporated by the general assembly and subject to chapter 1 of this title, or a foreign insurance company licensed to do business in Rhode Island and subject to chapter 2 of this title, nonprofit service corporation, as defined in chapters 19, 20, 20.1, or 20.2 of this title, or nonprofit health service corporation incorporated by the general assembly or a health maintenance organization licensed under chapter 41 of this title, advise every purchaser, prospective purchaser, and covered person of the lack of insurance or other coverage. Any administrator that advertises or administers the coverage in this state described in § 27-42-2 and that, under § 27-42-4, is unable to show it is subject to the jurisdiction of another department of this state, any subdivision of this state, or the federal government, shall advise any production agency of the elements of the coverage including the amount of “stop loss” insurance in effect.
History of Section.
P.L. 1984, ch. 177, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-43 - Captive Insurance Companies › Section 27-43-4. - Minimum capital.

§ 27-43-4. Minimum capital.
(a)
No subsidiary captive insurance company, association captive insurance company incorporated as a stock insurance company, or industrial insured captive insurance company incorporated as a stock insurance company shall be issued a license unless it possesses and after this maintains unimpaired paid in capital of:
(1)
In the case of a subsidiary captive insurance company, not less than one hundred thousand dollars ($100,000);
(2)
In the case of an association captive insurance company incorporated as a stock insurance company, not less than four hundred thousand dollars ($400,000); and
(3)
In the case of an industrial insured captive insurance company incorporated as a stock insurance company, not less than two hundred thousand dollars ($200,000). The capital may be in the form of cash or an irrevocable letter of credit issued by a bank chartered by the state of Rhode Island or a member bank of the Federal Reserve System and approved by the commissioner.
(b)
The commissioner may prescribe additional capital based upon the type, volume, and nature of insurance business transacted, which capital may be in the form of an irrevocable letter of credit issued by a bank chartered by the state of Rhode Island, or a member bank of the Federal Reserve System.
(c)
No captive insurance company may pay a dividend out of, or other distribution with respect to, capital or surplus, in excess of the limitations set forth in § 27-43-12, without the prior approval of the commissioner. Approval of an ongoing plan for the payment of dividends or other distributions shall be conditioned upon the retention, at the time of each payment, of the capital or surplus in excess of amounts specified by, or determined in accordance with formulas approved by, the commissioner.
History of Section.
P.L. 1988, ch. 76, § 1; P.L. 1996, ch. 232, § 1; P.L. 1996, ch. 256, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-43 - Captive Insurance Companies › Section 27-43-5. - Minimum surplus.

§ 27-43-5. Minimum surplus.
(a)(1)
No captive insurance company shall be issued a license unless it shall possess and after this maintain free surplus of:
(i)
In the case of a subsidiary captive insurance company, not less than one hundred fifty thousand dollars ($150,000);
(ii)
In the case of an association captive insurance company incorporated as a stock insurance company, not less than three hundred fifty thousand dollars ($350,000);
(iii)
In the case of an industrial insured captive insurance company incorporated as a stock insurance company, not less than three hundred thousand dollars ($300,000);
(iv)
In the case of an association captive insurance company incorporated as a mutual insurance company, not less than seven hundred fifty thousand dollars ($750,000); and
(v)
In the case of an industrial insured captive insurance company incorporated as a mutual insurance company, not less than five hundred thousand dollars ($500,000).
(2)
The surplus may be in the form of cash or an irrevocable letter of credit issued by a bank chartered by the state of Rhode Island or a member bank of the Federal Reserve System and approved by the commissioner.
(b)
The commissioner may prescribe additional surplus based upon the type, volume, and nature of insurance business transacted, which surplus may be in the form of a irrevocable letter of credit issued by a bank chartered by the state of Rhode Island, or a member bank of the Federal Reserve System.
(c)
No captive insurance company may pay a dividend out of, or other distribution with respect to, surplus, in excess of the limitations set forth in § 27-43-12, without the prior approval of the commissioner. Approval of an ongoing plan for the payment of dividends or other distributions shall be conditioned upon the retention, at the time of each payment, of the capital or surplus in excess of amounts specified by, or determined in accordance with formulas approved by, the commissioner.
History of Section.
P.L. 1988, ch. 76, § 1; P.L. 1996, ch. 232, § 1; P.L. 1996, ch. 256, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-43 - Captive Insurance Companies › Section 27-43-6. - Reports, statements, examinations, and investigations.

§ 27-43-6. Reports, statements, examinations, and investigations.
(a)
Captive insurance companies shall annually file a statement of condition as provided in § 27-12-1; provided, that the commissioner may by regulation modify the required filing and content of the statements of captive insurance companies. Captive insurance companies are also subject to the further provisions of chapter 12 of this title; provided, that statements filed pursuant to this section, except for those reports filed by industrial insured captive insurance companies insuring the risks of industrial insured groups as defined in § 27-43-1(8)(ii), are not subject to the public inspection provisions of § 27-12-1(b).
(b)
The commissioner, either personally or by a committee appointed by him or her, consisting of one or more persons not directors or officers of any captive insurance company doing business in this state, may, at any time, examine the affairs of any captive insurance company incorporated by or doing business in this state. The officers of the company shall exhibit its books to the commissioner or committee, and facilitate the examination, and the commissioner or the committee may examine, under oath, the officers of the company in relation to its affairs, and the commissioner shall, if he or she deems it advisable, publish the result of the investigation in one or more newspapers published in the state. The total cost of the examinations shall be borne by the examined companies and shall be one hundred fifty percent (150%) of the total salaries paid to the examining personnel of the insurance division engaged in the examinations, less any salary reimbursements, and shall be paid to the commissioner to and for the use of the insurance division. The assessment shall be in addition to any taxes and fees payable to the state.
(c)
Whenever it shall appear to the commissioner, from the statements, or from an examination of the affairs of any captive insurance company, that the company is insolvent, or is in an unsound financial condition, or that its business policies are unsound or improper, or that its condition or management is such as to render its further transaction of business hazardous to the public or its policyholders, or that the amount of its funds, net cash, or contingent assets is deficient, or that its capital is impaired, or that it is conducting its business fraudulently or refuses or neglects to comply with the laws of the state relating to captive insurance companies, it shall be the duty of the commissioner, after notice and hearing, to revoke the license issued to the company and the licenses issued to all of its insurance producers, or he or she may revoke the licenses or suspend them for a period not exceeding the unexpired terms of the licenses.
History of Section.
P.L. 1988, ch. 76, § 1; P.L. 1991, ch. 348, § 9; P.L. 2000, ch. 176, § 1; P.L. 2000, ch. 373, § 1.