reglab/statecodes huggingface dataset:
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-52 - Reinsurance Intermediaries › Section 27-52-8. - Prohibited acts.

§ 27-52-8. Prohibited acts.
The RM shall not:
(1)
Cede retrocessions on behalf of the reinsurer, except that the RM may cede facultative retrocessions pursuant to obligatory facultative agreements if the contract with the reinsurer contains reinsurance underwriting guidelines for the retrocessions. The guidelines shall include a list of reinsurers with which the automatic agreements are in effect, and for each reinsurer, the coverages and amounts or percentages that may be reinsured, and commission schedules;
(2)
Commit the reinsurer to participate in reinsurance syndicates;
(3)
Appoint any producer without assuring that the producer is lawfully licensed to transact the type of reinsurance for which he or she is appointed;
(4)
Without prior approval of the reinsurer, pay or commit the reinsurer to pay a claim, net of retrocessions, that exceeds the lesser of an amount specified by the reinsurer or one percent (1%) of the reinsurer’s policyholder’s surplus as of December 31 of the last complete calendar year;
(5)
Collect any payment from a retrocessionaire or commit the reinsurer to any claim settlement with a retrocessionaire, without prior approval of the reinsurer. If prior approval is given, a report must be promptly forwarded to the reinsurer;
(6)
Jointly employ an individual who is employed by the reinsurer unless the RM is under common control with the reinsurer subject to chapter 35 of this title; and
(7)
Appoint a sub-RM.
History of Section.
P.L. 1992, ch. 445, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-52 - Reinsurance Intermediaries › Section 27-52-9. - Duties of reinsurers utilizing the services of a reinsurance intermediary manager.

§ 27-52-9. Duties of reinsurers utilizing the services of a reinsurance intermediary manager.
(a)
A reinsurer shall not engage the services of any person, firm, association, or corporation to act as a RM on its behalf unless that person is licensed as required by the provisions of this chapter.
(b)
The reinsurer shall annually obtain a copy of statements of the financial condition of each RM that the reinsurer has engaged prepared by an independent certified accountant in a form acceptable to the commissioner.
(c)
If a RM establishes loss reserves, the reinsurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the RM. This opinion shall be in addition to any other required loss reserve certification.
(d)
Binding authority for all retrocessional contracts or participation in reinsurance syndicates shall rest with an officer of the reinsurer who shall not be affiliated with the RM.
(e)
Within thirty (30) days of the termination of a contract with a RM, the reinsurer shall provide written notification of the termination to the commissioner.
(f)
A reinsurer shall not appoint to its board of directors any officer, director, employee, controlling shareholder, or subproducer of its RM. This subsection shall not apply to relationships governed by the Insurance Holding Systems Act, chapter 35 of this title.
History of Section.
P.L. 1992, ch. 445, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-52 - Reinsurance Intermediaries › Section 27-52-10. - Examination authority.

§ 27-52-10. Examination authority.
(a)
A reinsurance intermediary shall be subject to examination by the commissioner. The commissioner shall have access to all books, bank accounts, and records of the reinsurance intermediary in a form usable to the commissioner. The cost of the examination shall be paid by the insurer in the same manner as the cost of examination of an insurer pursuant to chapter 13 of this title.
(b)
A RM may be examined as if it were the reinsurer.
History of Section.
P.L. 1992, ch. 445, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-52 - Reinsurance Intermediaries › Section 27-52-11. - Penalties and liabilities.

§ 27-52-11. Penalties and liabilities.
(a)
A reinsurance intermediary, insurer, or reinsurer found by the commissioner, after a hearing conducted in accordance with the Administrative Procedures Act, chapter 35 of title 42, to be in violation of any provision(s) of this chapter, shall:
(1)
For each separate violation, pay a penalty in an amount not exceeding five thousand dollars ($5,000);
(2)
Be subject to revocation or suspension of its license; and
(3)
If a violation was committed by the reinsurance intermediary, the reinsurance intermediary shall make restitution to the insurer, reinsurer, rehabilitator, or liquidator for the net losses incurred by the insurer or reinsurer attributable to the violation.
(b)
The decision, determination, or order of the commissioner pursuant to subsection (a) of this section shall be subject to judicial review pursuant to the Administrative Procedures Act, chapter 35 of title 42.
(c)
Nothing contained in this section shall affect the right of the commissioner to impose any other penalties provided in the insurance law.
(d)
Nothing contained in this chapter is intended to or shall in any manner limit or restrict the rights of policyholders, claimants, creditors, or other third parties or confer any rights to those persons.
History of Section.
P.L. 1992, ch. 445, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-52 - Reinsurance Intermediaries › Section 27-52-12. - Rules and regulations.

§ 27-52-12. Rules and regulations.
The commissioner may adopt reasonable rules and regulations for the implementation and administration of the provisions of this chapter.
History of Section.
P.L. 1992, ch. 445, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-53.1 - Assumption Reinsurance › Section 27-53.1-1. - Purpose.

§ 27-53.1-1. Purpose.
This chapter provides for the regulation of the transfer and novation of contracts of insurance by way of assumption reinsurance. It defines assumption reinsurance and establishes notice and disclosure requirements that protect and define the rights and obligations of policyholders, regulators, and the parties to assumption reinsurance agreements.
History of Section.
P.L. 1996, ch. 188, § 21.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-53.1 - Assumption Reinsurance › Section 27-53.1-2. - Scope.

§ 27-53.1-2. Scope.
(a)
This chapter applies to any insurer authorized in this state that either assumes or transfers the obligations or risks, or both, on contracts of insurance pursuant to an assumption reinsurance agreement.
(b)
This chapter does not apply to:
(1)
Any reinsurance agreement or transaction in which the ceding insurer continues to remain directly liable for its insurance obligations or risks, or both, under the contracts of insurance subject to the reinsurance agreement;
(2)
The substitution of one insurer for another upon the expiration of insurance coverage pursuant to statutory or contractual requirements and the issuance of a new contract of insurance by another insurer;
(3)
The transfer of contracts of insurance pursuant to mergers or consolidations of two (2) or more insurers to the extent that those transactions are regulated by statute;
(4)
Any insurer subject to a judicial order of liquidation or rehabilitation;
(5)
Any reinsurance agreement or transaction to which a state insurance guaranty association is a party, provided that policyholders do not lose any rights or claims afforded under their original policies pursuant to chapters 34, 34.1 [repealed], and 34.3 of this title;
(6)
The transfer of liabilities from one insurer to another under a single group policy upon the request of the group policyholder; or
(7)
The transfer of liabilities from one insurer to another under chapter 14.5 of this title.
History of Section.
P.L. 1996, ch. 188, § 21; P.L. 2002, ch. 381, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-53.1 - Assumption Reinsurance › Section 27-53.1-3. - Definitions.

§ 27-53.1-3. Definitions.
(a)
“Assuming insurer” means the insurer that acquires an insurance obligation or risk, or both, from the transferring insurer pursuant to an assumption reinsurance agreement.
(b)
“Assumption reinsurance agreement” means any contract that both:
(1)
Transfers insurance obligations or risks, or both, of existing or in-force contracts of insurance from a transferring insurer to an assuming insurer; and
(2)
Is intended to effect a novation of the transferred contract of insurance with the result that the assuming insurer becomes directly liable to the policyholders of the transferring insurer and the transferring insurer’s insurance obligations or risks, or both, under the contracts are extinguished.
(c)
“Contract of insurance” means any written agreement between an insurer and policyholder pursuant to which the insurer, in exchange for premium or other consideration, agrees to assume an obligation or risk, or both, of the policyholder or to make payments on behalf of, or to, the policyholder or its beneficiaries; it shall include all property, casualty, life, health, accident, surety, title insurance transacted by insurers not domiciled in Rhode Island and annuity business authorized to be written pursuant to the insurance laws of this state.
(d)
“Home service business” means insurance business on which premiums are collected on a weekly or monthly basis by an agent of the insurer.
(e)
“Notice of transfer” means the written notice to policyholders required by § 27-53.1-4(a).
(f)
“Policyholder” means any individual or entity who or that has the right to terminate or otherwise alter the terms of a contract of insurance. It includes any certificate holder whose certificate is in force on the proposed effective date of the assumption, if the certificate holder has the right to keep the certificate in force without change in benefit following termination of the group policy. The right to keep the certificate in force referred to in this section shall not include the right to elect individual coverage under the Consolidated Omnibus Budget Reconciliation Act (“COBRA”), Section 601 et seq., of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1161 et seq.
(g)
“Transferring insurer” means the insurer that transfers an insurance obligation or risk, or both, to an assuming insurer pursuant to an assumption reinsurance agreement.
History of Section.
P.L. 1996, ch. 188, § 21.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-53.1 - Assumption Reinsurance › Section 27-53.1-5. - Policyholder rights.

§ 27-53.1-5. Policyholder rights.
(a)
Policyholders shall have the right to reject the transfer and novation of their contracts of insurance. Policyholders electing to reject the assumption transaction shall return to the transferring insurer the pre-addressed, postage-paid response card or other written notice and indicate on it that the assumption is rejected (collectively referred to as the “Response Card”).
(b)
Payment of any premium to the assuming company during the twenty-four month (24) period after notice is received shall be deemed to indicate the policyholder’s acceptance of the transfer to the assuming insurer and a novation shall be deemed to have been effected, provided that the premium notice clearly states that payment of the premium to the assuming insurer shall constitute acceptance of the transfer. The premium notice shall also provide a method for the policyholder to pay the premium while reserving the right to reject the transfer. With respect to any home service business or any other business not using premium notices, the disclosures and procedural requirements of this subsection are to be set forth in the notice of transfer required by § 27-53.1-4 and in the assumption certificate.
(c)
After no fewer than twenty-four (24) months from the mailing of the initial notice of transfer required under § 27-53.1-4(a), if positive consent to, or rejection of, the transfer and assumption has not been received or consent has not been deemed to have occurred under subsection (b) of this section, the transferring company shall send to the policyholder a second and final notice of transfer as specified in § 27-53.1-4(a). If the policyholder does not accept or reject the transfer during the one-month period immediately following the date on which the transferring insurer mails the second and final notice of transfer, the policyholder’s consent will be deemed to have occurred and novation of the contract will be effected. With respect to the home service business, or any other business not using premium notices, the twenty-four (24) and one-month periods shall be measured from the date of delivery of the notice of transfer pursuant to § 27-53.1-4(a)(1).
(d)
The transferring insurer will be deemed to have received the response card on the date it is postmarked. A policyholder may also send its response card by facsimile or other electronic transmission or by registered mail, express delivery, or courier service, in which case the response card shall be deemed to have been received by the assuming insurer on the date of actual receipt by the transferring insurer.
History of Section.
P.L. 1996, ch. 188, § 21.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-53.1 - Assumption Reinsurance › Section 27-53.1-6. - Effect of consent.

§ 27-53.1-6. Effect of consent.
If a policyholder consents to the transfer pursuant to § 27-53.1-5, or if the transfer is effected under § 27-53.1-7, there shall be a novation of the contract of insurance subject to the assumption reinsurance agreement with the result that the transferring insurer shall be relieved of all insurance obligations or risks, or both, transferred under the assumption reinsurance agreement, and the assuming insurer shall become directly and solely liable to the policyholder for those insurance obligations or risks or both.
History of Section.
P.L. 1996, ch. 188, § 21.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-53.1 - Assumption Reinsurance › Section 27-53.1-7. - Commissioner’s discretion.

§ 27-53.1-7. Commissioner’s discretion.
If an insurer domiciled in this state or in a jurisdiction having a substantially similar law is deemed by the domiciliary commissioner to be in hazardous financial condition or an administrative proceeding has been instituted against it for the purpose of reorganizing or conserving the insurer, and the transfer of the obligations and/or risks on contracts of insurance issued to or owned by residents of this state is in their best interest as determined by the Rhode Island commissioner, a transfer and novation may be effected notwithstanding the provisions of this chapter. This may include a form of implied consent and adequate notification to the policyholder of the circumstances requiring the transfer as approved by the commissioner.
History of Section.
P.L. 1996, ch. 188, § 21.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-1. - Crimes by or affecting persons engaged in the business of insurance.

§ 27-54-1. Crimes by or affecting persons engaged in the business of insurance.
(a)
Any person who knowingly and with intent to deceive the director of business regulation (referred to in this section as “director”) about the financial condition of an insurance company, makes any false statement, representation, or report to the director concerning an insurance company; or who knowingly and with intent to deceive the director about the financial condition of the company testifies or affirms falsely under oath or affirmation to any material fact relative to an insurance company in any matter that would materially affect the financial condition of the company; or who knowingly and with intent to deceive the director about the financial condition of the company makes any false entry or memorandum upon any book, paper, report, or statement of any insurance company; or who knowingly and with intent to deceive the director or his or her designee or any agent appointed to examine the affairs of an insurance company, or knowingly and with intent to deceive, defraud, or injure the stockholders, policyholders, or any officer or director of an insurance company about the financial condition of the company makes a statement, representation, or report to the director or the director’s designee that the individual knows materially overvalues any asset, property, or security of an insurance company; or who knowingly and with intent to deceive the director about the financial condition of the company fails to disclose material information; and any person who, with like intent, aids or abets another in any violation of any provision of this section, shall, upon conviction, be fined not exceeding fifty thousand dollars ($50,000) or imprisoned not exceeding twenty (20) years, or both.
History of Section.
P.L. 1994, ch. 86, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-2. - Civil penalties.

§ 27-54-2. Civil penalties.
In addition to the criminal penalties set forth in § 27-54-1, the attorney general or the director or the director’s designee may bring a civil action against any person who engages in conduct constituting an offense under this chapter and, upon proof of that conduct by a preponderance of the evidence, the person shall be subject, for each violation, to a civil penalty not exceeding fifty thousand dollars ($50,000) or the amount of damages caused by that conduct, whichever is greater. If the insurance company is placed in conservation, rehabilitation, or liquidation, the conservator or receiver shall also be entitled to bring a civil action, and the penalty shall be paid to the conservator or receiver for the benefit of the policyholders, claimants, and creditors of the insurer. The imposition of a civil penalty under this section does not preclude any other criminal or civil statutory, common law, or administrative remedy, that is available by law to the state of Rhode Island or any other person.
History of Section.
P.L. 1994, ch. 86, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-3. - Investigations.

§ 27-54-3. Investigations.
(a)
Pursuant to chapter 13.1 of this title, the director, or the director’s designee, may conduct investigations as he or she deems necessary in order to ascertain whether any person has violated or is violating any provision of this chapter.
(b)
Whenever the director, or the director’s designee, has reason to believe that a provision of this chapter has been violated, he or she may report the violation of law to the attorney general who may bring an action in the court of appropriate jurisdiction. Within one hundred twenty (120) days of receipt of the director’s report, the attorney general shall inform the director, or the director’s designee, as to the status of the reported violations. Where the affected insurer has become the subject of a court order for conservation, rehabilitation, or liquidation, the director, or the director’s designee may also refer the matter to the receiver for action under § 27-54-2.
History of Section.
P.L. 1994, ch. 86, § 1; P.L. 2002, ch. 292, § 93; P.L. 2009, ch. 310, § 9.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-4. - Duty to notify.

§ 27-54-4. Duty to notify.
(a)
Whenever an officer or director of an insurance company knows that a material false statement or representation has been made to the director, or the director’s designee, or that false testimony has been given, or that a material false entry has been made in the books of the insurance company, or that the assets, property, or securities of an insurance company have been materially overvalued, or that material information has been withheld from the director, or the director’s designee, in violation of § 27-54-1, he or she shall notify the director, or the director’s designee, of those matters as soon as reasonably possible but in no event later than ten (10) days after the officer or director knows or has reasons to know of those matters. Failure to report as such will subject the violator to a fine of up to one thousand dollars ($1,000) and imprisonment of up to one year, or both.
(b)
The director, or the director’s designee, shall review each report and undertake any further investigations he or she deems necessary and proper to determine the validity of the allegations.
History of Section.
P.L. 1994, ch. 86, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-5. - Disqualification of officer and directors.

§ 27-54-5. Disqualification of officer and directors.
No person may serve as a director, officer, or senior management official of an insurance company who has been convicted of a felony involving fraud, dishonesty, or a breach of trust.
History of Section.
P.L. 1994, ch. 86, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-6. - Injunctions.

§ 27-54-6. Injunctions.
If the attorney general or the director, or his or her designee, has reason to believe that a person is engaged in conduct prohibited by this chapter, he or she may petition an appropriate court for an order prohibiting that person from further engaging in that conduct. The filing of a petition under this section does not preclude any other remedy that is available by law.
History of Section.
P.L. 1994, ch. 86, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-7. - Whistleblower protections.

§ 27-54-7. Whistleblower protections.
(a) Prohibition against discrimination.
No person subject to the provisions of this chapter may discharge, demote, threaten, or otherwise discriminate against any person or employee with respect to compensation, terms, conditions, or privileges of employment as a reprisal because the person or employee (or any person acting pursuant to the request of the employee) provided or attempted to provide information to the director, or the director’s designee, regarding possible violation of this chapter.
(b) Enforcement.
Any person or employee or former employee subject to the provisions of this chapter who believes that he or she has been discharged or discriminated against in violation of subsection (a) of this section may file a civil action within three (3) years of the date of the discharge or discrimination.
(c) Remedies.
If the court determines that a violation has occurred, the court may order the person who committed the violation to:
(1)
Reinstate the employee to the employee’s former position;
(2)
Pay compensatory damages, costs of litigation, and attorneys’ fees; and/or
(3)
Take other appropriate actions to remedy any past discrimination.
(d) Limitation.
The protections of this section shall not apply to any person or employee who:
(1)
Deliberately causes or participates in the alleged violation of law or regulation; or
(2)
Knowingly or recklessly provides substantially false information to the director or the director’s designee.
History of Section.
P.L. 1994, ch. 86, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-8. - Disclosure of arson conviction.

§ 27-54-8. Disclosure of arson conviction.
(a)
Every insurance provider doing business within this state shall require applicants for property insurance, real or personal, to disclose whether or not the applicant or applicants have been convicted of any degree of the crime of arson as described in chapter 4 of title 11 within ten (10) years of the application date.
(b)
An insurance provider may use the existence of an arson conviction within ten (10) years as a reason to deny coverage.
(c)
Failure to disclose the existence of an arson conviction when requested upon an insurance application shall be a misdemeanor punishable by a sentence of not more than one year imprisonment.
(d)
The insurance application form shall indicate the existence of a criminal penalty for failure to disclose a conviction for arson.
(e)
For the purpose of this section, “applicant” means a natural person, trust, partnership, association, corporation, or other form of business organization; provided, that if the applicant is a trust, the beneficiaries of the trust shall be included, and if the applicant is a partnership, association, corporation, or other form of business organization, each member, director, shareholder owning more than twenty percent (20%) of the common stock issued by the corporation, and the principal officer of the corporation shall be included.
(f)
The provisions of this section do not apply to any policy with respect to highly protected risks. A “highly protected risk” means a fire resistive building that meets the highest standards of fire safety according to insurance company underwriting requirements.
History of Section.
P.L. 1995, ch. 63, § 2; P.L. 1997, ch. 226, § 1; G.L. 1956, § 27-54-11; P.L. 2005, ch. 175, § 3; P.L. 2005, ch. 410, § 13.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-9. - Other law enforcement authority, powers, and duties not affected or impaired.

§ 27-54-9. Other law enforcement authority, powers, and duties not affected or impaired.
This chapter shall not:
(1)
Preempt the authority or relieve the duty of other law enforcement agencies to investigate and prosecute suspected violations of the law.
(2)
Limit any of the powers granted elsewhere in this title or other laws granting authority to the director, or the director’s designee, to investigate possible violations of this chapter and take appropriate action against wrongdoers.
History of Section.
P.L. 1994, ch. 86, § 1; G.L. 1956, § 27-54-8.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-10. - Limitation on actions.

§ 27-54-10. Limitation on actions.
The statute of limitations for offenses under this chapter shall be ten (10) years.
History of Section.
P.L. 1994, ch. 86, § 1; G.L. 1956, § 27-54-9.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54 - Insurance Fraud Prevention Act › Section 27-54-11. - Severability.

§ 27-54-11. Severability.
If any provision of this chapter or the application of this chapter to any person or circumstances is held invalid or unconstitutional, the invalidity or unconstitutionality shall not affect other provisions or applications of this chapter which can be given effect without the invalid or unconstitutional provision or application, and to this end, the provisions of this chapter are declared to be severable.
History of Section.
P.L. 1994, ch. 86, § 1; G.L. 1956, § 27-54-10.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54.1 - Anti-Fraud Act › Section 27-54.1-2. - Fraudulent insurance acts, interference, and participation of convicted felons prohibited.

§ 27-54.1-2. Fraudulent insurance acts, interference, and participation of convicted felons prohibited.
(a)
A person shall not commit a fraudulent insurance act.
(b)
A person shall not knowingly or intentionally interfere with the enforcement of the provisions of this chapter or investigations of suspected or actual violations of this chapter.
(c)(1)
A person convicted of a felony involving dishonesty or breach of trust shall not participate in the business of insurance without the written consent of the commissioner.
(2)
A person in the business of insurance shall not knowingly or intentionally permit a person convicted of a felony involving dishonesty or breach of trust to participate in the business of insurance without the written consent of the commissioner.
History of Section.
P.L. 2010, ch. 54, § 1; P.L. 2010, ch. 71, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54.1 - Anti-Fraud Act › Section 27-54.1-3. - Fraud warning required.

§ 27-54.1-3. Fraud warning required.
(a)
Notwithstanding any similar requirements in title 28, every claim form and application for insurance, regardless of the form of transmission, shall contain the following statement or a substantially similar statement:
“Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.”
(b)
The lack of a statement as required in subsection (a) of this section does not constitute a defense in any prosecution for a fraudulent insurance act.
(c)
The requirements of this section shall not apply to reinsurance claims forms or reinsurance applications.
(d)
The requirements of this section shall not apply to any claim form for health insurance that is on a form promulgated by the Centers for Medicare & Medicaid Services or in electronic format pursuant to 45 C.F.R. Part 162.
History of Section.
P.L. 2010, ch. 54, § 1; P.L. 2010, ch. 71, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54.1 - Anti-Fraud Act › Section 27-54.1-4. - Other law enforcement or regulatory authority.

§ 27-54.1-4. Other law enforcement or regulatory authority.
This chapter shall not:
(1)
Preempt the authority or relieve the duty of other law enforcement or regulatory agencies to investigate, examine and prosecute suspected violations of law;
(2)
Prevent or prohibit a person from disclosing voluntarily information concerning insurance fraud to a law enforcement or regulatory agency; or
(3)
Limit the powers granted elsewhere by the laws of this state to investigate and examine possible violations of law and to take appropriate action against wrongdoers.
History of Section.
P.L. 2010, ch. 54, § 1; P.L. 2010, ch. 71, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54.1 - Anti-Fraud Act › Section 27-54.1-5. - Insurer antifraud initiatives.

§ 27-54.1-5. Insurer antifraud initiatives.
(a)
Insurers shall have antifraud initiatives reasonably calculated to detect, report, prosecute, and prevent fraudulent insurance acts. Antifraud initiatives may include:
(1)
Fraud investigators, who may be insurer employees or independent contractors; or
(2)
An antifraud plan.
(b)
A person engaged in the business of insurance having knowledge or a reasonable belief that a fraudulent insurance act is being, will be, or has been committed shall provide such information to the governmental unit responsible for investigation of such act, or if no such unit exists, to the commissioner.
History of Section.
P.L. 2010, ch. 54, § 1; P.L. 2010, ch. 71, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-54.1 - Anti-Fraud Act › Section 27-54.1-6. - Penalties.

§ 27-54.1-6. Penalties.
A person who violates this chapter is subject to suspension or revocation of license or certificate of authority or administrative penalties per § 42-14-16 or both. Suspension or revocation of license or certificate of authority and imposition of administrative penalties shall be pursuant to an order of the commissioner issued under § 42-35-9 and/or § 42-35-12. The commissioner’s order may require a person found to be in violation of this chapter to make restitution to persons aggrieved by violations of this chapter.
History of Section.
P.L. 2010, ch. 54, § 1; P.L. 2010, ch. 71, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-55 - Off-Label Uses of Prescription Drugs › Section 27-55-1. - Definitions.

§ 27-55-1. Definitions.
For the purpose of this chapter, the following words and terms have the following meanings:
(1)
“Drug” or “drugs” means any substance prescribed by a licensed healthcare provider acting within the scope of the provider’s license that is intended for use in the diagnosis, mitigation, treatment, or prevention of disease that is taken by mouth; injected into a muscle, the skin, a blood vessel, or cavity of the body; applied to the skin; or otherwise assimilated by the body. The term includes only those substances that are approved by the FDA for at least one indication.
(2)
“FDA” means the federal Food and Drug Administration.
(3)
“Health insurer” means all persons, firms, corporations, or other organizations offering and assuring health services on a prepaid or primarily expense-incurred basis including, but not limited to, policies of accident or sickness insurance, as defined in chapter 18 of this title, nonprofit hospital or medical service plans, whether organized under chapter 19 or 20 of this title or under any public law or by special act of the general assembly, health maintenance organizations, and any other entity that insures or reimburses for diagnostic, therapeutic, or preventive services to a determined population on the basis of a periodic premium.
(4)
“Medical literature” means published scientific studies published in at least two (2) articles from major peer-reviewed medical journals that present data supporting the proposed off-label use, or uses, as generally safe and effective unless there is clear and convincing contradictory evidence presented in a major peer-reviewed medical journal.
(5)
“Peer-reviewed medical journals” means a published study in a journal or other publication in which original manuscripts have been critically reviewed for scientific accuracy, validity, and reliability by unbiased independent experts, and that has been determined by the International Committee of Medical Journal Editors to have met its Uniform Requirements for Manuscripts Submitted to Biomedical Journals. It does not include publications or supplements to publications that are sponsored to a significant extent by a pharmaceutical manufacturing company or any health insurer, healthcare center, hospital service corporation, medical service corporation, or fraternal benefit society that delivers, issues for delivery, renews, amends, or continues a health insurance policy in this state.
(6)
“Standard reference compendia” means: (i) The United States Pharmacopoeia drug information, (ii) The American Medical Association drug evaluations, or (iii) The American Hospital Formulary Service drug information.
History of Section.
P.L. 1994, ch. 339, § 1; P.L. 2016, ch. 95, § 1; P.L. 2016, ch. 105, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-55 - Off-Label Uses of Prescription Drugs › Section 27-55-2. - Prescription drug coverage.

§ 27-55-2. Prescription drug coverage.
(a)
No health insurer issuing a policy that provides coverage for prescription drugs shall exclude coverage of any drug used for the treatment of cancer or disabling or life-threatening chronic disease on the grounds that the drug has not been approved by the FDA for that indication; provided that the drug is recognized for treatment of that indication in one of the standard reference compendia, or in the medical literature. It is the responsibility of the prescribing physician to submit to the insurer documentation supporting the proposed off-label use or uses, if requested by the issuer.
(b)
Any coverage of a drug that serves as the primary treatment required by this chapter shall also include medically necessary services associated with the administration of the drug.
(c)
No coverage is required under this chapter: (1) For any drug that has not been fully licensed or approved by the FDA; (2) For the use of any drug when the FDA has determined that use to be contraindicated; or (3) For any experimental drug not approved for any indication by the FDA. The provisions of this section apply to drugs used in the treatment for cancer or disabling or life-threatening chronic disease only and nothing in this section is construed to create, impair, alter, limit, modify, enlarge, abrogate, or prohibit reimbursement for medications used in the treatment of any other disease or condition.
(d)
Nothing in this section is construed to prevent the application of contractual deductibles or copayment provisions or managed care review.
History of Section.
P.L. 1994, ch. 339, § 1; P.L. 2016, ch. 95, § 1; P.L. 2016, ch. 105, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-55 - Off-Label Uses of Prescription Drugs › Section 27-55-3. - Advisory panel on off-label uses of prescription drugs.

§ 27-55-3. Advisory panel on off-label uses of prescription drugs.
The director of the department of health shall appoint an advisory panel of seven (7) medical experts. The purpose of the advisory panel is to make recommendations to the director regarding whether a particular off-label use is medically appropriate, whenever a particular dispute about payment for this off-label use is referred to the director of the department of health. Parties seeking to refer a dispute to the director shall do so in writing within thirty (30) days of the denial of coverage of the drug. The members of the panel shall include seven (7) licensed Rhode Island physicians, including: (1) A physician appointed by a hospital or medical service corporation; (2) A physician appointed by the Rhode Island Medical Society; (3) Three (3) medical oncologists appointed by the Society of Rhode Island Clinical Oncologists; (4) A physician appointed by the Rhode Island Association of Health Maintenance Organizations from a member plan; and (5) A Rhode Island physician appointed by the Health Insurance Association of America. The members of the advisory panel shall serve at the pleasure of the director of the department of health and shall receive no compensation for their service on this advisory panel.
History of Section.
P.L. 1994, ch. 339, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-56 - Disclosure of Material Transactions Act › Section 27-56-1. - Report.

§ 27-56-1. Report.
(a)
Every insurer domiciled in this state shall file a report with the commissioner disclosing material acquisitions and dispositions of assets or material nonrenewals, cancellations, or revisions of ceded reinsurance agreements unless the acquisitions and dispositions of assets or material nonrenewals, cancellations, or revisions of ceded reinsurance agreements have been submitted to the commissioner for review, approval, or information purposes pursuant to other provisions of the insurance code, laws, regulations, or other requirements.
(b)
The report required in subsection (a) of this section is due within fifteen (15) days after the end of the calendar month in which any of the foregoing transactions occur.
(c)
One complete copy of the report, including any exhibits or other attachments, shall be filed with:
(1)
The insurance department of the insurer’s state of domicile; and
(2)
The National Association of Insurance Commissioners.
(d)
All reports obtained by or disclosed to the commissioner pursuant to this chapter shall be given confidential treatment and shall not be subject to subpoena and shall not be made public by the commissioner, the National Association of Insurance Commissioners, or any other person, except to insurance departments of other states, without the prior written consent of the insurer to which it pertains unless the commissioner, after giving the insurer who would be affected notice and an opportunity to be heard, determines that the interest of policyholders, shareholders, or the public will be served by publication, in which event the commissioner may publish all or any part in the manner the commissioner may deem appropriate.
History of Section.
P.L. 1995, ch. 113, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-56 - Disclosure of Material Transactions Act › Section 27-56-2. - Acquisitions and dispositions of assets.

§ 27-56-2. Acquisitions and dispositions of assets.
(a) Materiality.
No acquisitions or dispositions of assets need to be reported pursuant to § 27-56-1 if the acquisitions or dispositions are not material. For the purposes of this chapter, a material acquisition (or the aggregate of any series of related acquisitions during any thirty-day (30) period) or disposition (or the aggregate of any series of related dispositions during any thirty-day (30) period) is one that is non-recurring and not in the ordinary course of business and involves more than five percent (5%) of the reporting insurer’s total admitted assets as reported in its most recent statutory statement filed with the insurance department of the insurer’s state of domicile.
(b) Scope.
(1)
Asset acquisitions subject to this chapter include every purchase, lease, exchange, merger, consolidation, succession, or other acquisition other than the construction or development of real property by or for the reporting insurer or the acquisition of materials for that purpose.
(2)
Asset dispositions subject to this chapter include every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, assignment (whether for the benefit of creditors or otherwise), abandonment, destruction, or other disposition.
(c) Information to be reported.
(1)
The following information is required to be disclosed in any report of a material acquisition or disposition of assets:
(i)
Date of the transaction;
(ii)
Manner of acquisition or disposition;
(iii)
Description of the assets involved;
(iv)
Nature and amount of the consideration given or received;
(v)
Purpose of, or reason for, the transaction;
(vi)
Manner by which the amount of consideration was determined;
(vii)
Gain or loss recognized or realized as a result of the transaction; and
(viii)
Name(s) of the person(s) from whom the assets were acquired or to whom they were disposed.
(2)
Insurers are required to report material acquisitions and dispositions on a non-consolidated basis unless the insurer is part of a consolidated group of insurers which utilizes a pooling arrangement or one hundred percent (100%) reinsurance agreement that affects the solvency and integrity of the insurer’s reserves and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than one million dollars ($1,000,000) total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement, and the net income of the business not subject to the pooling arrangement represents less than five percent (5%) of the insurer’s capital and surplus.
History of Section.
P.L. 1995, ch. 113, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-57 - Child Support Intercept Act › Section 27-57-2. - Notice provided to obligors of interception of insurance settlements.

§ 27-57-2. Notice provided to obligors of interception of insurance settlements.
In any case where the department of human services, office of child support services, child support enforcement unit has intercepted an insurance payment, the department shall notify the obligor parent of this action upon crediting the obligor’s account.
[See § 12-1-15 of the General Laws.]
History of Section.
P.L. 1995, ch, 370, art. 29, § 7; P.L. 1995, ch. 374, § 7; P.L. 1997, ch. 170, § 20; P.L. 2012, ch. 241, art. 11, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-57 - Child Support Intercept Act › Section 27-57-3. - Certain liens not affected.

§ 27-57-3. Certain liens not affected.
Nothing in this chapter affects the validity or priority of liens or written notices of healthcare providers, attorney fees, holders of security interests, or the assignment of rights under § 40-6-9 which may exist. Funds subject to liens, written notices, or security interests shall be paid to the lien or interest holder.
[See § 12-1-15 of the General Laws.]
History of Section.
P.L. 1995, ch. 370, art. 29, § 7; P.L. 1995, ch. 374, § 7; P.L. 2000, ch. 378, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-57 - Child Support Intercept Act › Section 27-57-4. - Information to be provided by the department of human services, office of child support services, child support enforcement.

§ 27-57-4. Information to be provided by the department of human services, office of child support services, child support enforcement.
(a)
The department shall periodically within each year furnish the insurance companies and insurers subject to this section with a list or compilation of names of individuals, with last known addresses, who as of the date of the list or compilation owe past-due support in excess of five hundred dollars ($500) as shown on the Rhode Island family court/department of human services, office of child support services, child support enforcement computer system (“CSE system”). For the purposes of this section, the terms used in this section have the meaning and definitions specified in § 15-16-2.
(b)
In order to facilitate the efficient and prompt reporting of those arrearages in one centralized location, it is the duty and responsibility of the insurance companies doing business in the state to utilize one centralized database to which the department shall report and administer.
[See § 12-1-15 of the General Laws.]
History of Section.
P.L. 1995, ch. 370, art. 29, § 7; P.L. 1995, ch. 374, § 7; P.L. 1997, ch. 170, § 20; P.L. 1998, ch. 370, § 5; P.L. 2012, ch. 241, art. 11, § 2.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-57.1 - Medical Assistance Intercept Act › Section 27-57.1-2. - Notice of interception of insurance settlements.

§ 27-57.1-2. Notice of interception of insurance settlements.
In any case where the executive office of health and human services has intercepted an insurance payment, that office shall notify the recipient.
History of Section.
P.L. 2012, ch. 241, art. 11, § 1.
2023 Rhode Island General Laws › Title 27 - Insurance › Chapter 27-57.1 - Medical Assistance Intercept Act › Section 27-57.1-3. - Certain liens not affected.

§ 27-57.1-3. Certain liens not affected.
Nothing in this chapter affects the validity or priority of liens or written notices of healthcare providers, attorney fees, holders of security interests, or the assignment of rights under § 40-6-9 or § 40-6-10. Funds subject to liens, written notices, or security interests shall be paid to the lien or interest holder. Funds available to be paid pursuant to chapter 57 of this title for the payment of child support shall supersede any payment made pursuant to this chapter.
History of Section.
P.L. 2012, ch. 241, art. 11, § 1.