reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 13 - Senior Specifications (230-RICR-20-25-13) › Section 230-RICR-20-25-13.3 - Purpose

Current through June 14, 2024
The purpose of this Part is to set forth standards to
					 protect consumers from misleading and fraudulent marketing practices with
					 respect to the use of senior-specific certifications and professional
					 designations in the solicitation, sale or purchase of, or advice made in
					 connection with, a life insurance or annuity product.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 13 - Senior Specifications (230-RICR-20-25-13) › Section 230-RICR-20-25-13.4 - Definitions

Current through June 14, 2024
A. As used in this Part:
1. "Insurance Commissioner" or "Commissioner"
				  means the Director of the Department of Business Regulation or his or her
				  designee.
2. "Insurance producer"
				  means a person required to be licensed under the laws of this State to sell,
				  solicit or negotiate insurance, including annuities.
3. "Life insurance or annuity product" means
				  any policy, plan, certificate, including a fraternal benefit certificate,
				  contract, agreement, statement of coverage, rider or endorsement which provides
				  for life insurance or annuity benefits.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 13 - Senior Specifications (230-RICR-20-25-13) › Section 230-RICR-20-25-13.5 - Prohibited Uses of Senior-Specific Certifications and Professional Designations

Current through June 14, 2024
A. It is an unfair
				  and deceptive act or practice in the business of insurance within the meaning
				  of R.I. Gen. Laws Chapter 27-29 for an insurance producer to use a
				  senior-specific certification or professional designation that indicates or
				  implies in such a way as to mislead a purchaser or prospective purchaser that
				  the insurance producer has special certification or training in advising or
				  servicing seniors in connection with the solicitation, sale or purchase of a
				  life insurance or annuity product or in the provision of advice as to the value
				  of or the advisability of purchasing or selling a life insurance or annuity
				  product, either directly or indirectly through publications or writings, or by
				  issuing or promulgating analyses or reports related to a life insurance or
				  annuity product.
B. The prohibited
				  use of senior-specific certifications or professional designations includes,
				  but is not limited to, the following:
1. Use
				  of a certification or professional designation by an insurance producer who has
				  not actually earned or is otherwise ineligible to use such certification or
				  designation;
2. Use of a
				  nonexistent or self-conferred certification or professional
				  designation;
3. Use of a
				  certification or professional designation that indicates or implies a level of
				  occupational qualifications obtained through education, training or experience
				  that the insurance producer using the certification or designation does not
				  have; and
4. Use of a certification
				  or professional designation that was obtained from a certifying or designating
				  organization that:
a. Is primarily engaged in
				  the business of instruction in sales or marketing;
b. Does not have reasonable standards or
				  procedures for assuring the competency of its certificants or
				  designees;
c. Does not have
				  reasonable standards or procedures for monitoring and disciplining its
				  certificants or designees for improper or unethical conduct; or
d. Does not have reasonable continuing
				  education requirements for its certificants or designees in order to maintain
				  the certificate or designation.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 13 - Senior Specifications (230-RICR-20-25-13) › Section 230-RICR-20-25-13.6 - Severability

Current through June 14, 2024
If any provision of this Part or the application thereof to
					 any person or circumstances is held invalid or unconstitutional, the invalidity
					 or unconstitutionality shall not affect other provisions or applications of
					 this Part which can be given effect without the invalid or unconstitutional
					 provision or application, and to this end the provisions of this Part are
					 severable.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.1 - Authority

Current through June 14, 2024
This Regulation is promulgated in accordance with R.I. Gen.
					 Laws §§
										27-29-1 et seq. and 42-14-17.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.2 - Purpose

Current through June 14, 2024
The purpose of this regulation is to provide rules for life
					 insurance policy illustrations that will protect consumers and foster consumer
					 education. The regulation provides illustration formats, prescribes standards
					 to be followed when illustrations are used, and specifies the disclosures that
					 are required in connection with illustrations. The goals of this regulation are
					 to ensure that illustrations do not mislead purchasers of life insurance and to
					 make illustrations more understandable. Insurers will, as far as possible,
					 eliminate the use of footnotes and caveats and define terms used in the
					 illustration in language that would be understood by a typical person within
					 the segment of the public to which the illustration is
					 directed.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.3 - Applicability and Scope

Current through June 14, 2024
A. This regulation
				  applies to all group and individual life insurance policies and certificates
				  except:
1. Variable life insurance;
2. Individual and group annuity
				  contracts;
3. Credit life
				  insurance; or
4. Life insurance
				  policies with no illustrated death benefits on any individual exceeding
				  $10,000.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.5 - Policies to Be Illustrated

Current through June 14, 2024
A. Each insurer
				  marketing policies to which this regulation is applicable shall notify the
				  commissioner whether a policy form is to be marketed with or without an
				  illustration. For all policy forms being actively marketed on the effective
				  date of this regulation, the insurer shall identify in writing those forms and
				  whether or not an illustration will be used with them. For policy forms filed
				  after the effective date of this regulation, the identification shall be made
				  at the time of filing. Any previous identification may be changed by notice to
				  the commissioner.
B. If the insurer
				  identifies a policy form as one to be marketed without an illustration, any use
				  of an illustration for any policy using that form prior to the first policy
				  anniversary is prohibited.
C. If a
				  policy form is identified by the insurer as one to be marketed with an
				  illustration, a basic illustration prepared and delivered in accordance with
				  this regulation is required, except that a basic illustration need not be
				  provided to individual members of a group or to individuals insured under
				  multiple lives coverage issued to a single applicant unless the coverage is
				  marketed to these individuals. The illustration furnished an applicant for a
				  group life insurance policy or policies issued to a single applicant on
				  multiple lives may be either an individual or composite illustration
				  representative of the coverage on the lives of members of the group or the
				  multiple lives covered.
D.
				  Potential enrollees of non-term group life subject to this regulation shall be
				  furnished a quotation with the enrollment materials. The quotation shall show
				  potential policy values for sample ages and policy years on a guaranteed and
				  non-guaranteed basis appropriate to the group and the coverage. This quotation
				  shall not be considered an illustration for purposes of this regulation, but
				  all information provided shall be consistent with the illustrated scale. A
				  basic illustration shall be provided at delivery of the certificate to
				  enrollees for non-term group life who enroll for more than the minimum premium
				  necessary to provide pure death benefit protection. In addition, the insurer
				  shall make a basic illustration available to any non-term group life enrollee
				  who requests it.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.6 - General Rules and Prohibitions

Current through June 14, 2024
A. An illustration
				  used in the sale of a life insurance policy shall satisfy the applicable
				  requirements of this regulation, be clearly labeled "life insurance
				  illustration" and contain the following basic information:
1. Name of insurer;
2. Name and business address of producer or
				  insurer's authorized representative, if any;
3. Name, age and sex of proposed insured,
				  except where a composite illustration is permitted under this
				  regulation;
4. Underwriting or
				  rating classification upon which the illustration is based;
5. Generic name of policy, the company
				  product name, if different, and form number;
6. Initial death benefit; and
7. Dividend option election or application of
				  non-guaranteed elements, if applicable.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.8 - Standards for Supplemental Illustrations

Current through June 14, 2024
A. A
				  supplemental illustration may be provided so long as:
1. It is appended to, accompanied by or
				  preceded by a basic illustration that complies with this regulation;
2. The non-guaranteed elements shown are not
				  more favorable to the policy owner than the corresponding elements based on the
				  scale used in the basic illustration;
3. It contains the same statement required of
				  a basic illustration that non-guaranteed elements are not guaranteed;
				  and
4. For a policy that has a
				  contract premium, the contract premium underlying the supplemental illustration
				  is equal to the contract premium shown in the basic illustration. For policies
				  that do not require a contract premium, the premium outlay underlying the
				  supplemental illustration shall be equal to the premium outlay shown in the
				  basic illustration.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.9 - Delivery of Illustration and Record Retention

Current through June 14, 2024
A. If a
				  basic illustration is used by an insurance producer or other authorized
				  representative of the insurer in the sale of a life insurance policy and the
				  policy is applied for as illustrated, a copy of that illustration, signed in
				  accordance with this regulation, shall be submitted to the insurer at the time
				  of policy application. A copy also shall be provided to the applicant.
1. If the policy is issued other than as
				  applied for, a revised basic illustration conforming to the policy as issued
				  shall be sent with the policy. The revised illustration shall conform to the
				  requirements of this regulation, shall be labeled "Revised Illustration" and
				  shall be signed and dated by the applicant or policy owner and producer or
				  other authorized representative of the insurer no later than the time the
				  policy is delivered. A copy shall be provided to the insurer and the policy
				  owner.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.10 - Annual Report; Notice to Policy Owners

Current through June 14, 2024
A. In
				  the case of a policy designated as one for which illustrations will be used,
				  the insurer shall provide each policy owner with an annual report on the status
				  of the policy that shall contain at least the following information:
1. For universal life policies, the report
				  shall include the following:
a. The beginning
				  and end date of the current report period;
b. The policy value at the end of the
				  previous report period and at the end of the current report period;
c. The total amounts that have been credited
				  or debited to the policy value during the current report period, identifying
				  each by type (e.g., interest, mortality, expense and riders);
d. The current death benefit at the end of
				  the current report period on each life covered by the policy;
e. The net cash surrender value of the policy
				  as of the end of the current report period;
f. The amount of outstanding loans, if any,
				  as of the end of the current report period; and
g. For fixed premium policies: If, assuming
				  guaranteed interest, mortality and expense loads and continued scheduled
				  premium payments, the policy's net cash surrender value is such that it would
				  not maintain insurance in force until the end of the next reporting period, a
				  notice to this effect shall be included in the report; or
h. For flexible premium policies: If,
				  assuming guaranteed interest, mortality and expense loads, the policy's net
				  cash surrender value will not maintain insurance in force until the end of the
				  next reporting period unless further premium payments are made, a notice to
				  this effect shall be included in the report.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.11 - Annual Certifications

Current through June 14, 2024
A. The board of
				  directors of each insurer shall appoint one or more illustration actuaries.
B. The illustration actuary shall
				  certify that the disciplined current scale used in illustrations is in
				  conformity with the Actuarial Standard of Practice for Compliance with the NAIC
				  Model Regulation on Life Insurance Illustrations promulgated by the Actuarial
				  Standards Board, and that the illustrated scales used in insurer-authorized
				  illustrations meet the requirements of this regulation.
C. The illustration actuary shall:
1. Be a member in good standing of the
				  American Academy of Actuaries;
2.
				  Be familiar with the standard of practice regarding life insurance policy
				  illustrations;
3. Not have been
				  found by the commissioner, following appropriate notice and hearing to have:
a. Violated any provision of, or any
				  obligation imposed by, the insurance law or other law in the course of his or
				  her dealings as an illustration actuary;
b. Been found guilty of fraudulent or
				  dishonest practices;
c.
				  Demonstrated his or her incompetence, lack of cooperation, or untrustworthiness
				  to act as an illustration actuary; or
d. Resigned or been removed as an
				  illustration actuary within the past five (5) years as a result of acts or
				  omissions indicated in any adverse report on examination or as a result of a
				  failure to adhere to generally acceptable actuarial standards;
4. Not fail to notify the
				  commissioner of any action taken by a commissioner of another state similar to
				  that under Paragraph (3) above;
5.
				  Disclose in the annual certification whether, since the last certification, a
				  currently payable scale applicable for business issued within the previous five
				  (5) years and within the scope of the certification has been reduced for
				  reasons other than changes in the experience factors underlying the disciplined
				  current scale. If nonguaranteed elements illustrated for new policies are not
				  consistent with those illustrated for similar in force policies, this must be
				  disclosed in the annual certification. If nonguaranteed elements illustrated
				  for both new and in force policies are not consistent with the nonguaranteed
				  elements actually being paid, charged or credited to the same or similar forms,
				  this must be disclosed in the annual certification; and
6. Disclose in the annual certification the
				  method used to allocate overhead expenses for all illustrations:
a. Fully allocated expenses;
b. Marginal expenses; or
c. A generally recognized expense table based
				  on fully allocated expenses representing a significant portion of insurance
				  companies and approved by the National Association of Insurance Commissioners
				  or by the commissioner.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.2 - Penalties

Current through June 14, 2024
In addition to any other penalties provided by the laws of
					 this state, an insurer or producer that violates a requirement of this
					 regulation shall be guilty of a violation of R.I. Gen. Laws §
										27-29-1 et seq..
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 25 - LIFE AND ANNUITIES › Part 14 - Life Insurance Illustrations (230-RICR-20-25-14) › Section 230-RICR-20-25-14.13 - Severability

Current through June 14, 2024
If any provision of this Regulation or the application
					 thereof to any person or circumstances is held invalid or unconstitutional, the
					 invalidity or unconstitutionality shall not affect other provisions or
					 applications of this Regulation which can be given effect without the invalid
					 or unconstitutional provision or application, and to this end the provisions of
					 this Regulation are severable.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.1 - Purpose and Scope

Current through June 14, 2024
A. The purpose of
				  this Part is to:
1. Provide reasonable
				  standardization and simplification of coverages under health benefits plans, as
				  defined in R.I. Gen. Laws §
											42-62-4;
2. Facilitate consumer understanding and
				  comparisons;
3. Eliminate
				  provisions which may be misleading or unreasonably confusing to the consumer in
				  connection with the purchase of such coverages or with the settlement of
				  claims;
4. Eliminate deceptive
				  practices in connection with the sale of such coverages;
5. Eliminate provisions which may be contrary
				  to the health needs of the public; to make available qualified plans to persons
				  residing in the state who apply therefor regardless of age, sex, race,
				  occupational status, or medical condition;
6. Eliminate coverages which are so limited
				  in scope as to be of no substantial economic value to the holders thereof; and
7. Add coverages, the sale of
				  which is required by the public interest to protect the health of persons
				  residing in the State.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.2 - Authority

Current through June 14, 2024
This Part is promulgated pursuant to R.I. Gen. Laws §
										42-62-12.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.4 - Availability of Qualified Plans

Current through June 14, 2024
The Director shall from time to time consider whether a
					 sufficient number of qualified plans is available to persons residing in the
					 state regardless of age, sex, race, occupational status or medical condition.
					 If he determines that a sufficient number of such plans is not available he may
					 promulgate regulations requiring all insurers or all of a class of insurers to
					 offer qualified plans as a condition of doing business in the
					 state.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.5 - Coverage of Newborn Children

Current through June 14, 2024
A. All health
				  benefit contracts which provide coverage for a family member of the insured or
				  subscriber shall, as to such family member's coverage, also provide that the
				  health benefits applicable for children shall be payable with respect to a
				  newly born child of the insured or subscriber from the moment of birth. In the
				  event that no other children are covered under the contract, benefits for the
				  newborn must be provided to the same extent as those provided to the
				  insured.
B. The coverage for newly
				  born children shall consist of coverage of injury or sickness including the
				  necessary care and treatment of medically diagnosed congenital defects and
				  birth abnormalities. This provision is not intended to imply, and should not be
				  construed so as to imply, the inclusion of coverages for routine well-baby care
				  services.
C. If payment of a
				  specific premium is required to provide coverage for a child, the contract may
				  require that notification of birth of a newly born child and payment of the
				  required premium must be furnished to the insurer within thirty-one (31) days
				  after the date of birth in order to have the coverage continue beyond such
				  thirty-one (31) day period.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.6 - Statements in the Application for Health Benefit Contracts

Current through June 14, 2024
A. No application designed to elicit
				  information regarding the applicant's physical condition or that of his
				  dependents shall be used in this state in connection with any health benefit
				  contract which by its terms permits the insurer to reduce or deny a claim or
				  avoid the contract on the grounds that misstatements were made by the insured
				  in the application unless a statement is made which satisfies the requirements
				  of §
										1.6(A)(1) or (2)   of this Part.
1. A
				  statement contained in the application to be signed by the applicant which
				  states that he has read or has had read to him all questions and answers
				  contained in the application and that any misstatements made by him may allow
				  the insurer to reduce or deny a claim or avoid the contract within the
				  contestable period.
a. The following
				  statement is acceptable:
(1) I hereby certify
				  that I have read the above statements or that they have been read to me and
				  that the above statements are true and complete to the best of my knowledge and
				  belief. I understand that any misrepresentation contained herein relied on by
				  the Company may be used to reduce or deny a claim or void the contract within
				  the contestable period if such misrepresentation materially affects the
				  acceptance of the risk.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.9 - Group or "Group-Type" Coverage Discontinuance and Replacement

Current through June 14, 2024
1.9.1
Scope
§
										1.9   of this
				  Part is applicable to all health benefit contracts issued or provided by an
				  insurance company or a non-profit service corporation on a group or group-type
				  basis covering persons as employees of employers or as members of unions or
				  associations.
1.9.2
Effective Date of Discontinuance for Non-Payment of Premium or
				  Subscription Charges
A. If a contract
				  subject to §
											1.9   of this Part provides for automatic discontinuance of the
				  contract after a premium or subscription charge has remained unpaid through the
				  grace period allowed for such payment, the insurer shall be liable for valid
				  claims for covered losses incurred prior to the end of the grace
				  period.
B. If the actions of the
				  insurer after the end of the grace period indicate that it considers the
				  contract as continuing in force beyond the end of the grace period (such as, by
				  continuing to recognize claims subsequently incurred except to the extent that
				  specific limited coverage may be provided after termination by the terms of the
				  contract), the insurer shall be liable for valid claims for losses beginning
				  prior to the effective date of written notice of discontinuance to the master
				  contractholder or other entity responsible for making payments or submitting
				  subscription charges to the insurer. The effective date of discontinuance shall
				  not be prior to midnight at the end of the third scheduled work day after the
				  date upon which the notice is delivered.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.10 - Group Anti-Duplication Provision

Current through June 14, 2024
A. If a group
				  health benefit contract contains a provision restricting benefit payments on
				  account of the benefit paid by another plan, such provision shall be at least
				  as favorable to the insured as the following:
1. Provision for Co-Ordination Between This
				  Contract and Other Benefits
a. Benefits
				  Subject to This Program
(1) All of the
				  benefits provided under this contract are subject to this provision.
(2) (Note: When contract provides both
				  integrated Major Medical Expense Benefits and the underlying Basic Benefits,
				  but provision applies to Major Medical only, use the following alternate
				  wording: Only the Major Medical Expense Benefits under this contract are
				  subject to this provision).
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.11 - Filing of Forms and Rates

Current through June 14, 2024
1.11.1
Approval of Director
A. No health
				  benefit contract shall be issued or delivered to any person in this state nor
				  shall any application, rider, endorsement, individual certificate, subscriber
				  contract or group master contract to be used in connection therewith be issued
				  or delivered until a copy of the form thereof and of the classification of
				  risks and the premium rates or the rating formula have been approved by the
				  Director of Business Regulation. This requirement shall take effect two hundred
				  seventy (270) days after promulgation of this Part, subject to the following
				  conditions and exceptions:
1. No forms
				  submitted to the Director for approval after the promulgation of this Part
				  shall be approved unless such forms are in compliance with this Part.
2. Forms filed and approved under R.I. Gen.
				  Laws Chapters 27-18 and 27-2 or otherwise approved in writing by the Director
				  of Business Regulation may be issued or delivered without re-filing, provided
				  that such forms are in compliance with this Part.
3. Forms filed and approved under R.I. Gen.
				  Laws Chapter 27-18 or otherwise approved in writing by the Director of Business
				  Regulation but which are not in compliance with this Part may be issued or
				  delivered provided that such forms are amended by appropriate riders or
				  endorsements designed to bring them into compliance. Such amendment forms must
				  be approved by the Director of Business Regulation prior to use.
4. Forms filed and approved under R.I. Gen.
				  Laws Chapter 27-18 or otherwise approved in writing by the Director of Business
				  Regulation may be issued or delivered for up to three hundred sixty (360) days
				  after promulgation of this Part provided that appropriate riders endorsements
				  or revisions designed to bring such forms into compliance have been submitted
				  to the Director for approval within two hundred seventy (270) days after
				  promulgation of this Part.
5. Rates
				  not previously submitted for approval and rates "received for filing" and not
				  affirmatively approved by the Director may not be used in connection with
				  contracts issued or delivered and placed in force in the state more than two
				  hundred seventy (270) days after promulgation of this Part.
6. Rates affirmatively approved by the
				  Director under R.I. Gen. Laws §§
												27-2-10,
				  27-19-6,
				  27-20-6,
				  27-20.1-3 or 42-16-13 remain
				  approved without re-filing, subject to the terms and conditions of such
				  approval.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.12 - Advertising Rules and Guidelines for Interpretation

Current through June 14, 2024
1.12.1
Purpose
A. The purpose of §
											1.12   of this Part is
				  to assure truthful and adequate disclosure of all material and relevant
				  information in the advertising of health benefits. This purpose is to be
				  accomplished by the establishment of, and adherence to, certain minimum
				  standards and guidelines of conduct in the advertising of health benefits in a
				  manner which prevents unfair competition among insurers and is conducive to the
				  accurate presentation and description to the public of such benefits offered
				  through various advertising media.
B. Guideline 1
1. Disclosure is one of the principal
				  objectives of these rules and §
												1.12.1   of this Part states specifically
				  that the rules shall assure "truthful and adequate disclosure of all material
				  and relevant information". These rules specifically prohibit some previous
				  advertising techniques.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.13 - Review of Approvals or Disapprovals

Current through June 14, 2024
Notwithstanding anything to the contrary in R.I. Gen. Laws
					 Chapter 27-18 any request for a review of any approval or disapproval by the
					 Director under this Part shall be treated as a contested case and shall be
					 subject to the rules and procedures set forth in R.I. Gen. Laws Chapter 42-35
					 for the handling of contested cases and to all other rules and regulations
					 appropriate thereto.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.14 - Severability

Current through June 14, 2024
If any provisions of this Part, or the application thereof
					 to any person or circumstance, is held invalid, such invalidity shall not
					 affect other provisions or applications of this Part which can be given effect
					 without the invalid provision or application, and to that end the provisions of
					 this Part are severable.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 1 - Minimum Standards for Health Benefit Plans (230-RICR-20-30-1) › Section 230-RICR-20-30-1.15 - Insurance Coverage for Serious Mental Illness

Current through June 14, 2024
1.15.1
Statutory Authority
This addition of §
										1.15   of this Part is promulgated
					 pursuant to RI. Gen. Laws §§
										42-14-17 and
					 42-62-12 to implement R.I. Gen.
					 Laws Chapter 27-38.2 ("Insurance Coverage for Serious Mental Illness" referred
					 to herein as the "Act").
1.15.2
Definitions
A. Unless otherwise
				  defined in the Act, for purposes of the Act and this §
											1.15   of this Part,
				  the following terms shall have the following meanings:
1. "Director" means the Director of the
				  Department.
2. "ERISA" means the
				  Employee Retirement Income Security Act of 1974 (including but not limited to
				  Section  514   thereof, 29
				  U.S.C. §
													1144), as amended from time to
				  time.
3. "Health care insurers"
				  shall have the meaning given to "Health insurers" in R.I. Gen. Laws §
												27-38.2-2(a).
4. "Plan" means a health benefits
				  plan as defined in R.I. Gen. Laws §
												42-62   - 4(d) provided, however, that
				  the term does not include federal employee health benefit programs or services
				  provided to self-insured employers subject to ERISA.
5. "Serious Mental Illness" shall have the
				  meaning given to "Serious Mental Illness" in R.I. Gen. Laws §
												27-38.2-2(b).
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 2 - Coordination of Benefits (formerly Insurance Regulation 48) (230-RICR-20-30-2) › Section 230-RICR-20-30-2.1 - Authority

Current through June 14, 2024
This Part is adopted and promulgated pursuant to R.I. Gen.
					 Laws §
										27-20.6-6.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 2 - Coordination of Benefits (formerly Insurance Regulation 48) (230-RICR-20-30-2) › Section 230-RICR-20-30-2.2 - Purpose

Current through June 14, 2024
A. This Part applies to all plans that are
				  issued on or after the effective date of this part. The purpose of this Part is
				  to:
1. Establish a uniform order of benefit
				  determination under which plans pay their claims;
2. Reduce duplication of benefits by
				  permitting a reduction of the benefits to be paid by plans that, pursuant to
				  rules established by this Part, do not have to pay their benefits first;
				  and
3. Provide greater efficiency
				  in the processing of claims when a person is covered under more than one
				  plan
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 2 - Coordination of Benefits (formerly Insurance Regulation 48) (230-RICR-20-30-2) › Section 230-RICR-20-30-2.4 - Applicability and Scope

Current through June 14, 2024
This Part applies to all plans that are issued on or after
					 the effective date of this Part which is October 1, 1990.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 2 - Coordination of Benefits (formerly Insurance Regulation 48) (230-RICR-20-30-2) › Section 230-RICR-20-30-2.5 - Model COB Contract Provisions

Current through June 14, 2024
A. Appendix A
				  provided in a bulletin issued for that purpose, contains a model COB provision
				  for use in Secondary Plan contracts. That use is subject to the provisions of
				  §§
										2.5(B), (C) and (D)   of this Part and to the provisions of §
										2.6    of this Part.
B. Appendix B
				  provided in a bulletin issued for that purpose, is a plain language description
				  of the COB process that explains to the covered person how Secondary Plans will
				  implement coordination of benefits. It is not intended to replace or change the
				  provisions that are set forth in the contract. Its purpose is to explain the
				  process by which the two (2) or more plans will pay for or provide
				  benefits.
C. The COB provision
				  contained in Appendix A provided in a bulletin issued for that purpose, and the
				  plan language explanation in Appendix B provided in a bulletin issued for that
				  purpose, do not have to use the specific words and format shown in Appendix A
				  provided in a bulletin issued for that purpose. Changes may be made to fit the
				  language and style of the rest of the group contract or to reflect the
				  differences among plans that provide services, that pay benefits for expenses
				  incurred, and that indemnify. No substantive changes are permitted.
D. A COB provision may not be used that
				  permits a plan to reduce its benefits on the basis that:
1. Another plan exists and the covered person
				  did not enroll in that plan;
2. A
				  person is or could have been covered under another plan, except with respect to
				  Part B of Medicare; or
3. A person
				  has elected an option under another plan providing a lower level of benefits
				  than another option that could have been elected.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 2 - Coordination of Benefits (formerly Insurance Regulation 48) (230-RICR-20-30-2) › Section 230-RICR-20-30-2.6 - Rules for Coordination of Benefits

Current through June 14, 2024
A. When a person
				  is covered by two (2) or more plans, the rules for determining the order of
				  benefit payments are as follows:
1. The
				  Primary Plan shall pay or provide its benefits as if the Secondary Plan or
				  Plans did not exist;
2. If the
				  primary plan is a closed panel plan and the secondary plan is not a closed
				  panel plan, the secondary plan shall pay or provide benefits as if it were the
				  primary plan when a covered person uses a non-panel provider, except for
				  emergency services or authorized referrals that are paid or provided by the
				  primary plan
3. When multiple
				  contracts providing coordinated coverage are treated as a single plan under
				  this of this Part, this section applies only to the plan as a whole, and
				  coordination among the component contracts is governed by the terms of the
				  contracts. If more than one carrier pays or provides benefits under the plan,
				  the carrier designated as primary within the plan shall be responsible for the
				  plan's compliance with this of this Part.
4. If a person is covered by more than one
				  secondary plan, the order of benefit determination rules of this of this Part
				  decide the order in which secondary plans benefits are determined in relation
				  to each other. Each secondary plan shall take into consideration the benefits
				  of the primary plan or plans and the benefits of any other plan, which, under
				  the rules of this of this Part, has its benefits determined before those of
				  that secondary plan.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 2 - Coordination of Benefits (formerly Insurance Regulation 48) (230-RICR-20-30-2) › Section 230-RICR-20-30-2.7 - Procedure to be followed by Secondary Plan to Calculate Benefits and Pay a Claim

Current through June 14, 2024
In determining the amount to be paid by the secondary plan
					 on a claim, should the plan wish to coordinate benefits, the secondary plan
					 shall calculate the benefits it would have paid on the claim in the absence of
					 other health care coverage and apply that calculated amount to any allowable
					 expense under its plan that is unpaid by the primary plan. The secondary plan
					 may reduce its payment by the amount so that, when combined with the amount
					 paid by the primary plan, the total benefits paid or provided by all plans for
					 the claim do not exceed 100 percent of the total allowable expense for that
					 claim. In addition, the secondary plan shall credit to its plan deductible any
					 amounts it would have credited to its deductible in the absence of other health
					 care coverage.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 2 - Coordination of Benefits (formerly Insurance Regulation 48) (230-RICR-20-30-2) › Section 230-RICR-20-30-2.8 - Notice to Covered Persons

Current through June 14, 2024
A plan, other than automobile contracts, shall, in its
					 explanation of benefits provided to covered persons, include the following
					 language: "If you are covered by more than one health benefit plan, you should
					 file all your claims with each plan.".
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 2 - Coordination of Benefits (formerly Insurance Regulation 48) (230-RICR-20-30-2) › Section 230-RICR-20-30-2.9 - Miscellaneous Provisions

Current through June 14, 2024
A. A Secondary Plan
				  which provides benefits in the form of services may recover the reasonable cash
				  value of the services from the Primary Plan, to the extent that benefits for
				  the services are covered by the Primary Plan and have not already been paid or
				  provided by the Primary Plan. Nothing in this provision shall be interpreted to
				  require a plan to reimburse a covered person in cash for the value of services
				  provided by a plan which provides benefits in the form of services.
B. Compliant and Non-Compliant Plans
1. A plan with order of benefit determination
				  rules that comply with this of this Part. (Complying Plan) may coordinate its
				  benefits with a plan which is "excess" or "always secondary" or that uses order
				  of benefit determination rules that are inconsistent with those contained in
				  this of this Part. (Noncomplying Plan) on the following basis:
a. If the Complying Plan is the Primary Plan,
				  it shall pay or provide its benefits first;
b. If the Complying Plan is the Secondary
				  Plan, it shall pay or provide its benefits first, but the amount of the
				  benefits payable shall be determined as if the Complying Plan were the
				  Secondary Plan. In such a situation, the payment shall be the limit of the
				  Complying Plan's liability; and
c.
				  If the Noncomplying Plan does not provide the information needed by the
				  Complying Plan to determine its benefits within a reasonable time after it is
				  requested to do so, the Complying Plan shall assume that the benefits of the
				  Noncomplying Plan are identical to its own, and shall pay its benefits
				  accordingly. If, within two (2) years of payment, the complying plan receives
				  information as to the actual benefits of the non-complying plan, it shall
				  adjust payments accordingly.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 2 - Coordination of Benefits (formerly Insurance Regulation 48) (230-RICR-20-30-2) › Section 230-RICR-20-30-2.10 - Effective Date for Existing Contracts

Current through June 14, 2024
A. A contract
				  that provides health care benefits and that was issued before the effective
				  date of this of this Part shall be brought into compliance with this Part by
1. The later of:
a. The next anniversary date or renewal date
				  of the contract; or
b. Twelve
				  months (12) following June 1, 2014; or
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 3 - Health Insurance Reserves (230-RICR-20-30-3) › Section 230-RICR-20-30-3.1 - Introduction

Current through June 14, 2024
A. Scope.
1. These standards apply to all individual
				  and group accident and sickness insurance coverages credit insurance.
2. When an insurer determines that adequacy
				  of its health insurance reserves requires reserves in excess of the minimum
				  standards specified herein, such increased reserves shall be held and shall be
				  considered the minimum reserves for that insurer.
3. With respect to any block of contracts, or
				  with respect to an insurer's health business as a whole, a prospective gross
				  premium valuation is the ultimate test of reserve adequacy as of a given
				  valuation date. Such a gross premium valuation will take into account, for
				  contracts in force, in a claims status, or in a continuation of benefits status
				  on the valuation date, the present value as of the valuation date of: all
				  expected benefits unpaid, all expected expenses unpaid, and all unearned or
				  expected premiums, adjusted for future premium increases reasonably expected to
				  be put into effect.
4. Such a
				  gross premium valuation is to be performed whenever a significant doubt exists
				  as to reserve adequacy with respect to any major block of contracts, or with
				  respect to the insurer's health business as a whole. In the event inadequacy is
				  found to exist, immediate loss recognition shall be made and the reserves
				  restored to adequacy. Adequate reserves (inclusive of claim, premium and
				  contract reserves, if any) shall be held with respect to all contracts,
				  regardless of whether contract reserves are required for such contracts under
				  these standards.
5. Whenever
				  minimum reserves, as defined in these standards, exceed reserve requirements as
				  determined by a prospective gross premium valuation, such minimum reserves
				  remain the minimum requirement under these standards.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 3 - Health Insurance Reserves (230-RICR-20-30-3) › Section 230-RICR-20-30-3.2 - Claim Reserves

Current through June 14, 2024
A. General
1. Claim reserves are required for all
				  incurred but unpaid claims on all health insurance policies.
2. Appropriate claim expense reserves are
				  required with respect to the estimated expense of settlement of all incurred
				  but unpaid claims.
3. All such
				  reserves for prior valuation years are to be tested for adequacy and
				  reasonableness along the lines of claim runoff schedules in accordance with the
				  statutory financial statement including consideration of any residual unpaid
				  liability.