reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-44.1. - Genetic information.

§ 27-19-44.1. Genetic information.
(a)
Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and include to whom the disclosure is being made. An exception shall exist for those participating in research settings governed by the federal policy for the protection of human research subjects (also known as “The Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.
(b)
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 every policy that provides major medical or similar comprehensive-type coverage excluding disability income, long-term care and insurance supplemental policies which only provide coverage for specified diseases or other supplemental policies, shall:
(1)
Use genetic information or request for genetic information or the results of genetic information or other genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or otherwise affect a group or an individual’s health insurance policy, contract, or plan;
(2)
Request or require genetic information for the purpose of determining whether or not to issue or renew an individual’s health benefits coverage, to set reimbursement/copay levels, or determine covered benefits and services;
(3)
Release the results of genetic information without the prior written authorization of the individual from whom the information was obtained, except in a format by which individual identifiers are removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient of information pursuant to this section may use or disclose the information solely to carry out the purpose for which the information was disclosed. Authorization shall be required for each redisclosure. An exception shall exist for participation in research settings governed by the federal policy for the protection of human research subjects (also known as “The Common Rule”);
(4)
Request or require information as to whether an individual has genetic information, or participated in genetic information of any kind, whether for clinical or research purposes.
(c)
For the purposes of this section, “genetic information” is information about genes, gene product, or inherited characteristics that may derive from the individual or a family member.
History of Section.
P.L. 2001, ch. 38, § 4; P.L. 2001, ch. 54, § 4; P.L. 2002, ch. 292, § 37.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-47. - Acupuncture services.

§ 27-19-47. Acupuncture services.
(a)
Every group health insurance contract, plan, or group policy delivered, issued for delivery, or renewed in this state that provides medical coverage, and every group policy that provides for treatment of persons for the prevention, cure, or correction of any illness or physical or mental condition, shall provide, as an optional rider, coverage for the services of a doctor of acupuncture as a provider of acupuncture services.
(b)
For the purposes of this section:
(1)
“Coverage for the services of a doctor of acupuncture as a provider of acupuncture services” means coverage for acupuncture as defined in § 5-37.2-2(1).
(2)
“Doctor of acupuncture” means a practitioner licensed under chapter 37.2 of title 5.
(c)
It remains within the sole discretion of the nonprofit hospital service corporation as to which doctor of acupuncture it shall contract with. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation; provided, that no nonprofit hospital service corporation is required to pay for duplicative services actually rendered by a doctor of acupuncture and any other healthcare provider. Nothing contained in this section precludes the nonprofit hospital service corporations from conducting managed care, medical necessity, or utilization review.
History of Section.
P.L. 1999, ch. 288, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-48. - FDA approved prescription contraceptive drugs and devices.

§ 27-19-48. FDA approved prescription contraceptive drugs and devices.
(a)
Every individual or group health insurance contract, plan, or policy that provides prescription coverage and is delivered, issued for delivery, or renewed in this state shall provide coverage for FDA approved contraceptive drugs and devices requiring a prescription. Provided, that nothing in this subsection shall be deemed to mandate or require coverage for the prescription drug RU 486.
(b)
Notwithstanding any other provision of this section, any hospital service corporation may issue to a religious employer an individual or group health insurance contract, plan, or policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer’s bona fide religious tenets.
(c)
As used in this section, “religious employer” means an employer that is a “church or a qualified church-controlled organization” as defined in 26 U.S.C. § 3121.
(d)
Every religious employer that invokes the exemption provided under this section shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the contraceptive healthcare services the employer refuses to cover for religious reasons.
(e)
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. 2000, ch. 120, § 2; P.L. 2000, ch. 126, § 2; P.L. 2002, ch. 292, § 37; P.L. 2018, ch. 230, § 4; P.L. 2018, ch. 234, § 4.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-49. - Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.

§ 27-19-49. Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act.
(a)
Subscribers to any nonprofit hospital service corporation plan shall be afforded coverage under the plan for prostate and colorectal examinations and laboratory tests for cancer for any nonsymptomatic person covered under the policy or plan. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal.
(b)
An insurer or the corporation may not impose cost sharing on the coverage required by subsection (a) when the services are delivered within the health insurer’s provider network.
History of Section.
P.L. 2000, ch. 125, § 2; P.L. 2000, ch. 345, § 2; P.L. 2021, ch. 7, § 3, effective April 29, 2021; P.L. 2021, ch. 8, § 3, effective April 29, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-51. - Hearing aids.

§ 27-19-51. Hearing aids.
(a)(1)
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, 2006, shall provide coverage for one thousand five hundred dollars ($1,500) per individual hearing aid, per ear, every three (3) years for anyone under the age of nineteen (19) years, and shall provide coverage for seven hundred dollars ($700) per individual hearing aid per ear, every three (3) years for anyone of the age of nineteen (19) years and older.
(2)
Every group health insurance contract 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, 2006, shall provide, as an optional rider, additional hearing aid coverage. Provided, the provisions of this paragraph shall not apply to contracts, plans, or group policies subject to the small employer health insurance availability act, chapter 50 of this title.
(b)
For the purposes of this section, “hearing aid” means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices, including, but not limited to, FM systems.
(c)
It shall remain within the sole discretion of the nonprofit hospital service corporation as to the provider of hearing aids with which they choose to contract. Reimbursement shall be provided according to the respective principles and policies of the nonprofit hospital service corporation. Nothing contained in this section precludes the nonprofit hospital service corporation from conducting managed care, medical necessity, or utilization review.
History of Section.
P.L. 2000, ch. 461, § 2; P.L. 2004, ch. 539, § 2; P.L. 2004, ch. 550, § 2; P.L. 2005, ch. 374, § 2; P.L. 2005, ch. 395, § 2; P.L. 2006, ch. 595, § 2; P.L. 2006, ch. 614, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-53. - Mandatory coverage for certain lyme disease treatments.

§ 27-19-53. Mandatory coverage for certain lyme disease treatments.
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, 2004, shall provide coverage for diagnostic testing and long-term antibiotic treatment of chronic lyme disease when determined to be medically necessary and ordered by a physician acting in accordance with chapter 37.5 of title 5 entitled “lyme disease diagnosis and treatment” after making a thorough evaluation of the patient’s symptoms, diagnostic test results, and response to treatment. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because the treatment may be characterized as unproven, experimental, or investigational in nature.
History of Section.
P.L. 2003, ch. 113, § 4; P.L. 2003, ch. 114, § 4; P.L. 2004, ch. 34, § 3; P.L. 2004, ch. 35, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-54. - Dental insurance assignment of benefits.

§ 27-19-54. Dental insurance assignment of benefits.
Every entity providing a contract of insurance subject to this chapter shall allow, as a provision in a group or individual policy, contract, or health benefit plan for coverage of dental services, any person insured by the entity to direct, in writing, that benefits from a health benefit plan, policy, or contract be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by the entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to the entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving the payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.
History of Section.
P.L. 2004, ch. 268, § 2; P.L. 2004, ch. 386, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-55. - Coverage for early intervention services.

§ 27-19-55. Coverage for early intervention services.
(a)
Every individual or group hospital or medical expense insurance policy or contract providing coverage for dependent children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of early intervention services which coverage shall take effect no later than January 1, 2005. The coverage shall be limited to a benefit of five thousand dollars ($5,000) per dependent child per policy or calendar year and shall not be subject to deductibles and coinsurance factors. Any amount paid by an insurer under this section for a dependent child shall not be applied to any annual or lifetime maximum benefit contained in the policy or contract. For the purpose of this section, “early intervention services” means, but is not limited to: speech and language therapy, occupational therapy, physical therapy, evaluation, case management, nutrition, service plan development and review, nursing services, and assistive technology services and devices for dependents from birth to age three (3) who are certified by the department of human services as eligible for services under part C of the Individuals with Disabilities Education Act (20 U.S.C. § 1431 et seq.).
(b)
Subject to the annual limits provided in this section, insurers shall reimburse certified early intervention providers, who are designated as such by the department of human services, for early intervention services as defined in this section at rates of reimbursement equal to or greater than the prevailing integrated state/Medicaid rate for early intervention services as established by the department of human services.
(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. 2004, ch. 595, art. 22, § 2; P.L. 2004, ch. 598, § 3; P.L. 2005, ch. 97, § 2; P.L. 2005, ch. 99, § 2; P.L. 2008, ch. 475, § 83; P.L. 2023, ch. 395, art. 1, § 4, effective December 31, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-56. - Post-payment audits.

§ 27-19-56. Post-payment audits.
(a)
Except as otherwise provided herein, any review, audit, or investigation by a nonprofit hospital service corporation 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 § 27-18-1.1, 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, § 2; P.L. 2006, ch. 97, § 2; P.L. 2013, ch. 251, § 2; P.L. 2013, ch. 395, § 2; P.L. 2014, ch. 201, § 2; P.L. 2014, ch. 214, § 2; P.L. 2017, ch. 368, § 2; P.L. 2017, ch. 375, § 2; P.L. 2022, ch. 157, § 2, effective June 27, 2022; P.L. 2022, ch. 158, § 2, effective June 27, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-57. - Tobacco cessation programs.

§ 27-19-57. 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 and/or deductibles 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, § 2; P.L. 2006, ch. 293, § 2; P.L. 2008, ch. 475, § 83; P.L. 2009, ch. 187, § 2; P.L. 2009, ch. 291, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-59. - Mandatory coverage for scalp hair prosthesis.

§ 27-19-59. 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, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-60. - Licensed ambulance service.

§ 27-19-60. 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, § 2; P.L. 2008, ch. 70, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-61. - Enteral nutrition products.

§ 27-19-61. 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 hospital 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, § 2; P.L. 2014, ch. 269, § 2; P.L. 2014, ch. 519, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-62. - Prohibition on rescission of coverage.

§ 27-19-62. 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 carrier.
(b)
At least thirty (30) days’ advance written notice shall be provided to each health benefit 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, § 6; P.L. 2012, ch. 262, § 6.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-65. - Medical loss ratio reporting and rebates.

§ 27-19-65. Medical loss ratio reporting and rebates.
(a)
A nonprofit hospital 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)
Health insurance carriers required to report medical loss ratio and rebate calculations and 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, § 6; P.L. 2012, ch. 262, § 6.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-67. - Internal and external appeal of adverse benefit determinations.

§ 27-19-67. 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, § 6; P.L. 2012, ch. 262, § 6.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-68. - Prohibition on preexisting condition exclusions.

§ 27-19-68. 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:
(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, § 6; P.L. 2012, ch. 262, § 6.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-69. - Primary care provider designation requirement.

§ 27-19-69. 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, § 2; P.L. 2012, ch. 202, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-70. - Discretionary clauses.

§ 27-19-70. 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, § 3; P.L. 2013, ch. 94, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-71. - Orally administered anticancer medication — Cost-sharing requirement.

§ 27-19-71. 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, § 2; P.L. 2013, ch. 405, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-72. - Consumer notification.

§ 27-19-72. Consumer notification.
Every nonprofit hospital 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, § 2; P.L. 2013, ch. 479, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-73. - Opioid antagonists.

§ 27-19-73. 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, § 2; P.L. 2016, ch. 192, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-75. - Unfair discrimination prohibited.

§ 27-19-75. 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, § 2; P.L. 2017, ch. 314, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-76. - Health insurance contracts — Full year coverage for contraception.

§ 27-19-76. 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, § 3; P.L. 2018, ch. 234, § 3.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-77. - Prohibition on discrimination in organ transplants.

§ 27-19-77. Prohibition on discrimination in organ transplants.
Pursuant to chapter 95 of title 23, any nonprofit hospital 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, § 4, effective June 30, 2021; P.L. 2021, ch. 133, § 4, effective June 30, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-78. - Health insurance contracts — Copayments exemption for COVID-19 vaccinations.

§ 27-19-78. 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, § 2, effective July 3, 2021; P.L. 2021, ch. 161, § 2, effective July 3, 2021.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-79. - Perinatal doulas.

§ 27-19-79. 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, § 3, effective July 1, 2022; P.L. 2021, ch. 321, § 3, effective July 1, 2022.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-80. - Gender rating.

§ 27-19-80. 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, § 2, effective January 1, 2023; P.L. 2021, ch. 89, § 2, effective January 1, 2023.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-83. - 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.]

§ 27-19-83. 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, § 2, effective January 1, 2024.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-19 - Nonprofit Hospital Service Corporations › Section 27-19-84. - Expedited prior authorization. [Effective January 1, 2024.]

§ 27-19-84. 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, § 2, effective January 1, 2024.