reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.16 - Statements about an Insurer

Current through June 14, 2024
An advertisement shall not contain statements that are
					 untrue in fact, or by implication misleading, with respect to the assets,
					 corporate structure, financial standing, age or relative position of the
					 insurer in the insurance business. An advertisement shall not contain a
					 recommendation by any commercial rating system unless it clearly indicates the
					 purpose of the recommendation and the limitations of the scope and extent of
					 the recommendation.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.17 - Enforcement Procedures

Current through June 14, 2024
A. Advertising
				  File. Each insurer shall maintain at its home or principal office a complete
				  file containing every printed, published or prepared advertisement of its
				  individual policies and typical printed, published or prepared advertisements
				  of its blanket, franchise and group policies hereafter disseminated in this or
				  any other state, whether or not licensed in such other state, with a notation
				  attached to each advertisement that shall indicate the manner and extent of
				  distribution and the form number of any policy advertised. The file shall be
				  available for inspection by the commissioner. All such advertisements shall be
				  maintained in the file for a period of either four (4) years or until the
				  filing of the next regular report of examination of the insurer, whichever is
				  the longer period of time.
B.
				  Certificate of Compliance. Each insurer required to file an Annual Statement
				  which is now or which hereafter becomes subject to the provisions of these
				  rules must file with the commissioner, with its Annual Statement, a Certificate
				  of Compliance executed by an authorized officer of the insurer wherein it is
				  stated that, to the best of his knowledge, information and belief, the
				  advertisements that were disseminated by the insurer during the preceding
				  statement year complied or were made to comply in all respects with the
				  provisions of these rules and the Insurance Laws of this state as implemented
				  and interpreted by these rules.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.18 - Severability Provision

Current through June 14, 2024
If any section or portion of a section of these rules, or
					 its applicability to any person or circumstance is held invalid by a court, the
					 remainder of the rules, or the applicability of the provision to other persons
					 or circumstances, shall not be affected.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.19 - Filing for Prior Review

Current through June 14, 2024
Every insurer, health care service plan or other entity
					 providing Medicare supplement insurance or benefits in this State shall provide
					 a copy of any Medicare supplement advertisement intended for use in this state
					 whether through written, radio or television medium to the commissioner for
					 review or approval by the commissioner to the extent it may be required under
					 state law.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.1 - Authority

Current through June 14, 2024
These rules and regulations are promulgated pursuant to
					 R.I. Gen. Laws §
										27-18.8-1
et
					 seq
., entitled the Health Care Accessibility and Quality Assurance Act
					 (the Act).
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.2 - Purpose and Scope

Current through June 14, 2024
A. It is in the
				  best interest of the public that those individuals and health care entities
				  involved with the delivery of network plan coverage in our state meet the
				  standards set forth in R.I. Gen. Laws §
										27-18.8-1
et seq
.
				  and any regulations promulgated thereunder to ensure accessibility and quality
				  for the state's patients; and
B.
				  Nothing in this Act and these regulations is intended to prohibit a health care
				  entity from forming limited networks of providers.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.3 - Definitions

Current through June 14, 2024
A. As used in this regulation:
1. "Active treatment" means;
a. An ongoing course of treatment for a
				  life-threatening condition;
b. An
				  ongoing course of treatment for an acute medical, behavioral health, dental,
				  vision or other clinical condition;
c. The second or third trimester of what has
				  been documented as a non-high-risk pregnancy; and/or
d. An ongoing course of treatment for a
				  health condition which a treating provider substantiates that discontinuing
				  care by that provider would worsen the condition or clinical outcome of that
				  beneficiary.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.4 - General Requirements - Certification, Recertification, and Material Change

Current through June 14, 2024
A. A health care
				  entity operating a network plan shall:
1. Not
				  enroll consumers into its plan unless the Commissioner has certified the
				  network plan pursuant to the Act and these regulations;
2. Be required to submit a recertification
				  application every two (2) years in form and content consistent with
				  instructions by the Office for that purpose;
3. Notify the Office at least thirty (30)
				  calendar days prior to any substantial systemic change to any of its certified
				  network plans; and
4. Upon a
				  determination by the Office that a substantial systemic change constitutes a
				  material change, file an application consistent with instructions and requests
				  for information issued by the Office for that purpose.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.5 - Delegate Requirements

Current through June 14, 2024
A. A health care
				  entity must provide evidence to the Office of current state certification under
				  the Act for each of its delegates, if any, to which the health care entity has
				  delegated activity as defined in R.I. Gen. Laws Chapters 27-18.9 and/or
				  27-18.8.
B. A health care entity
				  must maintain regular and meaningful oversight of each of its delegates to
				  ensure every such delegate is in compliance with the Act's network plan
				  requirements, including but not limited to the following:
1. For any portion of the health care
				  entity's network plan activity that is delegated, in part or whole, the health
				  care entity shall be responsible for oversight and be held accountable for all
				  activity delegated and for any non-compliance of its delegate with the Act and
				  these regulations.
2. Should the
				  Commissioner determine that any delegated activity is non-compliant with the
				  rules herein or other state and/or federal laws, the health care entity may be
				  required by the Commissioner to re-assume or reassign the performance of the
				  activity delegated.
3. The health
				  care entity shall ensure through its delegation agreement or contract that it
				  and the Office will have direct access to all the information held by the
				  delegate that in its or the Office's determination could contribute to
				  determining compliance with the Act and these regulations.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.6 - Network Plan General Requirements

Current through June 14, 2024
A. For each network
				  plan the health care entity must maintain and submit to the Office its most
				  current grievance and complaint process that adheres to and includes the
				  following minimal requirements:
1. Written
				  processes whereby the beneficiary, a beneficiary's authorized representatives,
				  or health care providers may seek resolution of complaints and other matters of
				  which the health care entity has received oral or written notice;
2. Reasonable timeframes for the resolution
				  of beneficiary, authorized representative of beneficiary, and provider
				  complaints, grievances inquiries of not more than thirty (30) calendar days
				  from the date the health care entity receives the oral or written notice unless
				  granted an extension by the Commissioner;
3. At a minimum, an annual communication from
				  the applicable health care entity to the network plan's beneficiaries and
				  providers that explains the grievance and complaint process for the applicable
				  network plan(s) and provides guidance for distinguishing between a
				  complaint/grievance and a benefit determination appeal and the rights
				  associated with each; and
4.
				  Internal monitoring of complaints and grievances and reporting to the Office on
				  categories of complaints in form and content consistent with instructions
				  issued by the Office for that purpose.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.7 - Network Adequacy Requirements

Current through June 14, 2024
A. For each Network
				  Plan a health care entity must submit to the Office the Network Adequacy
				  policies and procedures that evidence adherence to the following:
1. Each health care entity shall have an
				  ongoing process in place to monitor and assure that its provider network for
				  each of its network plans are sufficient in scope and volume to assure address
				  and monitor its population needs that all covered services for beneficiaries,
				  including children, adults and low-income, medically underserved beneficiaries,
				  children and adults with serious chronic and/or complex health conditions or
				  physical and/or mental disabilities and persons with limited English
				  proficiency are accessible in a timely manner without unreasonable
				  delay.
2. Beneficiaries have access
				  to emergency services twenty-hours (24) hours a day, seven (7) days a
				  week.
3. The health care entity has
				  clear procedures in place that assure its network plan beneficiaries access to
				  a provider in the event that the health care entity fails to maintain
				  sufficient provider contracts, or a network provider is not available to
				  provide covered services to beneficiaries in a timely manner. These procedures
				  must include:
a. A description of the
				  circumstances in which the member is held harmless in the event that a network
				  provider is not available to provide the covered benefit without unreasonable
				  travel or delay;
b. A process to
				  appeal a denial of access to an out of network provider and/or any additional
				  cost shares imposed beyond the beneficiary's in-network coverage, in accordance
				  with R.I. Gen. Laws Chapter 27-18.9;
c. A process to address network inadequacies
				  when the Commissioner has determined that the network plan has not maintained
				  sufficient provider contracts.
4. A documented method to inform and assist
				  beneficiaries on how to:
a. Choose and/or
				  utilize a Network Plan;
b. Select
				  and change a provider;
c. Access an
				  updated provider directory in each network plan; and
d. Inform the beneficiary on the use of
				  tiered networks within a network plan to include changes in beneficiaries'
				  financial liability.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.9 - Provider Contracting and Due Process

Current through June 14, 2024
A. The health
				  care entity must include the following in its network provider contracts:
1. A provision protecting beneficiaries to
				  include:
a. Ensuring the beneficiary is held
				  harmless from any financial liability beyond in-network cost shares
				  attributable to the failure of a referring network provider to adhere to the
				  referral process, including by failing to submit the required network plan's
				  referral documents according to the health care entity requirements when there
				  is evidence that the beneficiary sought and received a referral from the
				  network provider. This section is not applicable in cases where the beneficiary
				  has self-referred.
b. That in no
				  event, including but not limited to non-payment by the health care entity or
				  intermediary, insolvency of the health care entity or one of its delegates or
				  breach of the health care entity's agreement with a network plan provider,
				  shall the network plan provider bill, charge, collect a deposit from, or seek
				  compensation, remuneration or reimbursement from a beneficiary to include but
				  not limited to facility or administrative fees added to a beneficiary for
				  covered services by the provider; and
c. That no beneficiary shall be liable to any
				  provider for charges for covered benefits, except for the amounts due for
				  co-payments, deductibles and/or coinsurance, when provided or made available to
				  enrolled participants by a licensed health maintenance organization, as that
				  term is defined in R.I. Gen. Laws §
												27-41-2(t),
				  during a period in which premiums were paid by or on behalf of the
				  enrollee.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.10 - Reporting

Current through June 14, 2024
A. Each health care entity shall compile and
				  maintain reports in form and content consistent with instructions issued as a
				  bulletin by the Office for that purpose and these reports shall:
1. Include but not be limited to a report
				  that includes all complaints received by the health care entity and its
				  delegates (if applicable) by complaint categories set forth by the Office,
				  which categories may change from time to time at the discretion of the
				  Commissioner; and;
2. Be filed with
				  the Office at least annually on or before March 1st of each calendar
				  year.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.11 - Denial, Suspension, or Revocation of Certification

Current through June 14, 2024
Denial, suspension, or revocation of certification is
					 governed by R.I. Gen. Laws §
										27-18.8-8.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.12 - Penalties and Enforcement

Current through June 14, 2024
Penalties and enforcement is governed by R.I. Gen. Laws
					 §
										27-18.8-9.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.13 - Rules of Governance

Current through June 14, 2024
All hearings and reviews required under the provisions of
					 the Act, as amended, shall be held in accordance with the provisions of Part
					 10-00-2 of this Title.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 9 - Network Plans › Section 230-RICR-20-30-9.14 - Severability

Current through June 14, 2024
If any section, clause, or provision of the Act or these
					 regulations shall be held either unconstitutional or ineffective in whole or in
					 part, to the extent that it is not unconstitutional or ineffective, it shall be
					 valid and effective, and no other section, clause or provision shall on account
					 thereof be termed invalid or ineffective.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.1 - Statement of Authority and Purpose

Current through June 14, 2024
A. This regulation
				  is promulgated pursuant to the authority granted to the health insurance
				  commissioner under R.I. Gen. Laws §§
										27-19-6,
				  27-20-6,
				  27-50-1 et seq., 42-14-5,
				  42-14-17, 42- 14.5-1 et seq., 42-62-12, and 42-62-13.
B. This regulation is intended to implement
				  the provisions of R.I. Gen. Laws Chapter 27-50, the "Small Employer Health
				  Insurance Availability Act" (the "Act"). The purpose of the Act and this
				  regulation is to provide for the availability of health insurance coverage to
				  small employers and their employees and employees' dependents, regardless of
				  health status or claims experience; to regulate insurer rating practices and
				  establish limits on differences in rates between health benefit plans; to
				  provide for uniform annual filing requirements by carriers participating in the
				  small group health insurance market; to ensure renewability of coverage; to
				  establish limitations on underwriting practices, eligibility requirements and
				  the use of preexisting condition exclusions; to direct the basis of market
				  competition away from risk selection and toward the efficient management of
				  health care; to provide for the availability of a wellness health benefit plan;
				  to clarify the rules regarding the availability of individual health insurance
				  policies to self-employed individuals and to improve the overall fairness and
				  efficiency of the small group health insurance market.
C. The Act and this regulation are intended
				  to promote broader spreading of risk in the small employer marketplace and to
				  regulate all health benefit plans sold to small employers, whether sold
				  directly or through associations or other groupings of small employers.
				  Carriers that provide health benefit plans to small employers are intended to
				  be subject to all of the provisions of the Act and this regulation.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.2 - Definitions

Current through June 14, 2024
A. All words or phrases used in this Part
				  already defined in R.I. Gen. Laws §
										27-50-3 shall have the meaning
				  therein. In addition, as used in this Part:
1. "COBRA continuation coverage" means
				  insurance continuation benefits provided under Title X of Pub. L. No. 99-272,
				  as amended.
2. "Case
				  characteristic" means the characteristics of a small employer that are
				  considered by the small employer carrier in the determination of premium rates
				  for the small employer.
3.
				  "Commissioner" shall mean the health insurance commissioner.
4. "Covered employee" means an eligible
				  employee who is or was provided coverage under a group health plan.
5. "Individual health insurance policy" means
				  health insurance coverage offered to an individual in his or her capacity as an
				  individual and not in connection with a group health benefit plan or as a small
				  employer.
6. "New entrant" includes
				  an eligible employee, or the dependent of an eligible employee, who becomes
				  eligible to participate in a health benefit plan sponsored by a small employer
				  in accordance with the special enrollment provisions under R.I. Gen. Laws
				  §
											27-50-7(d)(7) or
				  (8).
7. "OHIC" or "Office" means the Office of the
				  Health Insurance Commissioner.
8.
				  "Qualified beneficiary" means, with respect to a covered employee under a group
				  health plan, an individual who, on the day before the qualifying event for that
				  employee, is a beneficiary under the plan:
a.
				  as the spouse of the covered employee;
b. as the dependent child of the covered
				  employee, or
c. a child who is born
				  to or placed for adoption with the covered employee during the period of COBRA
				  continuation coverage.
9. "Qualifying event" means, with respect to
				  a covered employee, any of the following events that, but for COBRA
				  continuation coverage, would result in the loss of coverage of a qualified
				  beneficiary:
a. the death of the covered
				  employee;
b. the termination,
				  except for the employee's gross misconduct, or reduction of hours, of the
				  covered employee's employment;
c.
				  the divorce or legal separation of the covered employee from the employee's
				  spouse;
d. the covered employee
				  becoming entitled to benefits under Title XVIII of the Social Security Act;
				  or
e. a dependent child ceasing to
				  be a dependent child under the requirements of the health benefit
				  plan.
10. "Risk
				  characteristic" means the health status, claims experience, duration of
				  coverage, or any similar characteristic related to the health status or
				  experience of a small employer group or of any member of a small employer
				  group.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.3 - Applicability and Scope

Current through June 14, 2024
A. Applicability
1. Except as provided in §
											10.3(A)(2) or
				  (3)   and §
											10.11   of this Part, this Part shall apply to any health benefit
				  plan, whether provided on a group or individual basis, that:
a. meets one or more of the conditions set
				  forth in R.I. Gen. Laws §
												27-50-4(a);
				  and
b. provides coverage to one or
				  more employees of a small employer located in this state, without regard to
				  whether the policy or certificate was issued in this state
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.4 - Transition or Assumption of Business from Another Carrier

Current through June 14, 2024
A. Approval required for transfer or
				  assumption insurance risk. A small employer carrier shall not transfer or
				  assume the entire insurance obligation and/or risk of a health benefit plan
				  covering a small employer in this state unless:
1. the transaction has been approved by the
				  insurance commissioner of the state of domicile of the assuming carrier or the
				  OHIC if the assuming carrier is domiciled in Rhode Island;
2. the transaction has been approved by the
				  insurance commissioner of the state of domicile of the ceding carrier or the
				  OHIC if the ceding carrier is domiciled in Rhode Island; and
3. the transaction otherwise meets the
				  requirements of the Act and this regulation.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.5 - Rate Manual and Restrictions Relating to Premium Rates

Current through June 14, 2024
A. Rate manual. A small employer carrier
				  shall develop a rate manual based on an adjusted community rate and may only
				  vary the adjusted community rate for the following case characteristics:
1. age;
2. gender; and
3. family composition.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.7 - Application to Reenter State

Current through June 14, 2024
A. Petition to be
				  reinstated. A carrier that has been prohibited from writing coverage for small
				  employers in this state pursuant to R.I. Gen. Laws §
										27-50-6(c) may
				  not resume offering health benefit plans to small employers in this state until
				  the carrier has filed a petition with the health insurance commissioner seeking
				  to be reinstated as a small employer carrier and the petition has been approved
				  by the commissioner. In reviewing a petition to reinstate, the commissioner may
				  ask for such information and assurances as the commissioner deems reasonable
				  and appropriate.
B. Carrier doing
				  business in only one established geographic service area. In the case of a
				  small employer carrier doing business in only one established geographic
				  service area of the state, if the small employer carrier elects to discontinue
				  offering a health benefit plan under R.I. Gen. Laws §
										27-50-6(a)(5),
				  the small employer carrier shall be prohibited from offering health benefit
				  plans to small employers in any part of the service area for a period of five
				  years beginning on the date the carrier ceased offering new coverage in that
				  established geographic service area of the state. In addition, the small
				  employer carrier shall not offer health benefit plans to small employers in any
				  other geographical area of the state without the prior approval of the health
				  insurance commissioner. In considering whether to grant approval to offer
				  health benefit plans, the commissioner may ask for such information and
				  assurances as the commissioner deems reasonable and appropriate.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.8 - Certification and Disclosure of Prior Creditable Coverage

Current through June 14, 2024
A. Creditable coverage.
1. In general.
a. Small employer carriers shall provide
				  written certification of creditable coverage, as that term is defined in R.I.
				  Gen. Laws §
												27-50-3(i), to
				  individuals in accordance with §
												10.8   of this Part.
b. A small employer carrier shall be deemed
				  to have satisfied the certification requirements of §
												10.8   of this Part if
				  another person provides the certificate, but only to the extent that
				  information relating to the individual's creditable coverage and waiting or
				  affiliation period has been provided by the other person.
c. To the extent coverage under a health
				  benefit plan consists of group health benefit plan coverage, the plan shall be
				  deemed to have satisfied the certification requirements of §
												10.8   of this
				  Part if the small employer carrier offering the coverage is required to provide
				  the certificates of creditable coverage to individuals pursuant to an agreement
				  between the plan and the carrier.
d. A small employer carrier is not required
				  to provide information regarding health benefit plan coverage provided to an
				  individual by another person.
e. If
				  an individual's coverage under a policy ceases before the individual's coverage
				  under the group health plan ceases, the entity that issued the policy shall
				  provide sufficient information to the small employer carrier, or to another
				  person designated by the carrier, to enable the carrier, or other person, to
				  provide a certificate that reflects the period of coverage under the policy,
				  after the individual's coverage under the group health plan ceases.
(1) The provision of the information pursuant
				  to §
													10.8(A)(1)(e)   of this Part to the carrier shall satisfy the entity's
				  obligation to provide an automatic certificate pursuant to §
													10.8(A) and
				  (B)   of this Part
(2) The entity
				  providing the information pursuant to §
													10.8(A)(1)(e)   of this Part shall
				  cooperate with the carrier in responding to any request made under
				  §
													10.8(F)   of this Part.
(3) If
				  the individual's coverage under the group health plan ceases at the time the
				  individual's coverage under the policy ceases, the entity that issued the
				  policy shall provide an automatic certificate pursuant to §
													10.8(A)(2) or
				  (3)   of this Part.
(4) An entity
				  that issued the policy may presume that an individual whose coverage ceases at
				  a time other than the effective date for changing enrollment options has ceased
				  to be covered under the group health plan.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.9 - Restrictive Riders

Current through June 14, 2024
A restrictive rider, endorsement or other provision that
					 would violate the provisions of R.I. Gen. Laws §
										27-50-7(d)(10)(iii)
					 is prohibited. Furthermore, except as permitted in R.I. Gen. Laws §
										27-50-7(d)(2), a
					 small employer carrier shall not modify or restrict any health benefit plan
					 with respect to any eligible employee or dependent of an eligible employee,
					 through riders, endorsements or otherwise, for the purpose of restricting or
					 excluding the coverage or benefits provided to such employee or dependent for
					 specific diseases, medical conditions or services otherwise covered by the
					 plan.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.10 - Rules Related to Fair Marketing

Current through June 14, 2024
A. Marketing of
				  health plans. A small employer carrier shall actively market each of its health
				  benefit plans to small employers in this state, unless otherwise permitted or
				  required by Rhode Island or federal law.
B. Offering health plans. A small employer
				  carrier shall actively offer all health benefit plans it actively markets in
				  this state to any small employer that applies for or makes an inquiry regarding
				  health insurance coverage from the small employer carrier, unless otherwise
				  permitted or required by Rhode Island or federal law. The offer may be provided
				  directly to the small employer or delivered through a producer. The offer shall
				  be in writing and shall include at least the following information:
1. a general description of the benefits
				  contained in any health benefit plans being offered to the small employer;
				  and
2. information describing how
				  the small employer may enroll in the plans.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.11 - Status of Carriers as Small Employer Carriers

Current through June 14, 2024
A.
				  Filing required. Each carrier providing health benefit plans in this state
				  shall make a filing with the health insurance commissioner indicating whether
				  the carrier intends to operate as a small employer carrier in this state under
				  the terms of this regulation. There is no application form nor requirement for
				  approval. A letter stating the carrier's intention to operate in Rhode Island
				  as a small employer carrier is sufficient. If a carrier has already made such a
				  filing with either the commissioner or the predecessor to the OHIC, the
				  Department of Business Regulation, the carrier need not make a new
				  filing.
B. Prohibition on providing
				  coverage. Subject to §
										10.11(C)   of this Part, a carrier shall not offer
				  health benefit plans to small employers, or continue to provide coverage under
				  health benefit plans previously issued to small employers in this state, unless
				  the filing provided pursuant to §
										10.11(A)   of this Part indicates that the
				  carrier intends to operate as a small employer carrier in this state.
C. Exceptions. If the filing made pursuant
				  §
										10.11(A)   of this Part indicates that a carrier does not intend to operate
				  as a small employer carrier in this state, the carrier may continue to provide
				  coverage under health benefit plans previously issued to small employers in
				  this state only if the carrier complies with the following provisions:
1. the carrier complies with the requirements
				  of the Act with respect to each of the health benefit plans previously issued
				  to a small employer by the carrier;
2. the carrier provides coverage to each new
				  entrant to a health benefit plan previously issued to a small employer by the
				  carrier; and
3. the carrier
				  complies with the requirements of R.I. Gen. Laws §
											27-50-15 and §§
											10.9  and
				   10.12   of the Part as they apply to small employers whose coverage has been
				  terminated by the carrier and to individuals and small employers whose coverage
				  has been limited or restricted by the carrier.
4. For the purpose of §
											10.11(C)(2)   of
				  this Part, the provisions of the Act and this regulation shall apply to the
				  coverage issued to new entrants.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.12 - Annual Filings

Current through June 14, 2024
A. Annual filing
				  required.
1. A small employer carrier shall
				  make three annual filings with the health insurance commissioner:
a. a rate/trend filing,
b. an actuarial certification, and
c. an informational filing.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.13 - Wellness Health Benefit Plan-The HEALTHpact Plan

Current through June 14, 2024
A. Requirement to offer. Carriers that
				  actively market health benefit plans to small employers in Rhode Island shall
				  offer to those employers a wellness health benefit plan that meets the
				  requirements of §
										10.13   of this Part and complies with all other
				  requirements of the Act and this regulation. Nothing in the Act or this
				  regulation prohibits the sale of health benefit plans that differ from the
				  wellness health benefit plans provided for in §
										10.13   of this
				  Part.
B. Effective date. Unless a
				  carrier has received a waiver from the health insurance commissioner, all
				  carriers that actively market health benefit plans to small employers in Rhode
				  Island shall offer a wellness health benefit plan to small employers.
C. HEALTHpact. The wellness health benefit
				  plan shall be referred to as the "HEALTHpact" plan.
D. Requirements of the HEALTHpact plan.
1. In general.
a. The HEALTHpact plan shall have two levels
				  of benefits: Advantage and Basic.
b. Requirements for Advantage-level benefits
				  are dependent on the member's age.
(1)
				  Members (including dependents) who are eighteen years of age or over at the
				  time of enrollment or renewal are classified as "adult members" and are subject
				  to the requirements for adult members.
(2) Members who are between the ages of
				  twelve and seventeen years of age at the time of enrollment or renewal are
				  considered "adolescent members" and are subject to the requirements for
				  adolescent members.
(3) Members who
				  a under the age of twelve at the time of enrollment or renewal are considered
				  "child members" and are subject to the requirements for child
				  members.
c. The premium
				  rates for the Advantage-level and Basic-level plans shall be the same, with
				  Advantage-level members paying less for medical care, including but not limited
				  to:
(1) lower copays for physician
				  visits;
(2) lower coinsurance for
				  specific procedures;
(3) lower
				  annual deductibles; and
(4) lower
				  out-of-pocket maximums.
d. Members who do not complete the
				  requirements for Advantage-level benefits will receive Basic-level benefits.
				  All members of a family must complete the Advantage-level requirements
				  specified in §
												10.13(D)(2)   of this Part in order for the family to be
				  eligible to receive Advantage-level benefits.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 10 - Small Employer Health Insurance Availability › Section 230-RICR-20-30-10.14 - Severability

Current through June 14, 2024
If any provision of this regulation or the application
					 thereof to any person or circumstances are for any reason held to be invalid,
					 the remainder of the regulation and the application of its provisions to other
					 persons or circumstances shall not be affected thereby.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 11 - Multiple Employer Welfare Arrangements (230-RICR-20-30-11) › Section 230-RICR-20-30-11.1 - Purpose

Current through June 14, 2024
The Health Insurance Commissioner has determined that
					 certain multiple employer welfare arrangements may be transacting the business
					 of insurance in the State of Rhode Island; that certain multiple employer
					 welfare arrangements and their actions are hazardous to the public; that in
					 order to protect the interests of the public concerning multiple employer
					 welfare arrangements that provide employee benefits, it is necessary to
					 regulate such activities.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 11 - Multiple Employer Welfare Arrangements (230-RICR-20-30-11) › Section 230-RICR-20-30-11.2 - Definitions

Current through June 14, 2024
A. Multiple Employer Welfare Arrangements
				  ("MEWA") shall have the meaning as defined in Section  3   of Title I of the
				  Employee Retirement Income Security Act of 1974,
				  29 U.S.C. §
											1002(40) as amended, which
				  states that a MEWA:
1. Means an employee
				  welfare benefit plan, or any other arrangement (other than an employee welfare
				  benefit plan), which is established or maintained for the purpose of offering
				  or providing any benefit as described in
				  29 U.S.C. §
												1002(1) to the employees of
				  two (2) or more employers (including one or more self-employed individuals), or
				  to their beneficiaries, except that such term does not include any such plan or
				  other arrangement which is established or maintained --
a. Under or pursuant to one or more
				  agreements which the United States Secretary of Labor ("Secretary") finds to be
				  collective bargaining agreements,
b. By a rural electric cooperative,
				  or
c. By a rural telephone
				  cooperative association.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 11 - Multiple Employer Welfare Arrangements (230-RICR-20-30-11) › Section 230-RICR-20-30-11.3 - Certificate of Compliance Required

Current through June 14, 2024
A. A MEWA which
				  meets either or both of the following criteria:
1. One or more of the employer members in the
				  MEWA is either domiciled in the State of Rhode Island or has its principal
				  headquarters or principal administrative office in this State;
2. The MEWA solicits an employer that is
				  domiciled in the State of Rhode Island or has its principal headquarters or
				  principal administrative office in this State;
3. shall not do business as, hold itself out
				  as, establish, or maintain a MEWA which is an employee welfare benefit plan or
				  any other arrangement other than an employee benefit plan, (as those terms are
				  defined in Section  3   of Title I of the Employee Retirement Income Security Act
				  of 1974, 29 U.S.C. §
												1002) in this State unless the MEWA obtains
				  and maintains a certificate of compliance or license to provide insurance in
				  Rhode Island pursuant to R.I. Gen. Laws Title 27.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 11 - Multiple Employer Welfare Arrangements (230-RICR-20-30-11) › Section 230-RICR-20-30-11.4 - Certificate of Compliance Not Required

Current through June 14, 2024
A MEWA or employee welfare benefit plan which offers or
					 provides benefits which are fully insured by a carrier authorized to transact
					 insurance in the State of Rhode Island or are insured by an entity otherwise
					 specifically exempt from insurance regulation by State law or a MEWA which is
					 exempt under the Federal Employee Retirement Income Security Act of 1974,
					 29 U.S.C. §
											1144(b)(6)(B), shall not be
					 required to obtain a certificate of compliance or license and shall not be
					 subject to this regulation.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 11 - Multiple Employer Welfare Arrangements (230-RICR-20-30-11) › Section 230-RICR-20-30-11.5 - Fully Insured Requirement

Current through June 14, 2024
A MEWA shall not be deemed fully insured if the insurance
					 benefits are payable to the MEWA or MEWA administrator or would not be directly
					 payable to the full extent of contract benefits to beneficiaries of the MEWA in
					 the event of the insolvency of the MEWA.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 12 - Tobacco Cessation Treatment Coverage (230-RICR-20-30-12) › Section 230-RICR-20-30-12.1 - Preamble

Current through June 14, 2024
A. According to the Centers for Disease
				  Control, smoking accounts for an estimated 438,000 deaths, or nearly 1 of every
				  5 deaths, each year in the United States. More deaths are caused each year by
				  tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal
				  drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.
				  (Centers for Disease Control and Prevention, "Smoking and Tobacco Use, Fact
				  Sheet," available at
				  www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/health_effects.htm
				  (last viewed April 21, 2009). In addition, the economic costs of smoking in the
				  United States are estimated at $167 billion annually ($92 billion in
				  productivity losses from premature death and $75.5 billion in health care
				  expenditures). (Centers for Disease Control and Prevention, "Cigarette Smoking
				  Among Adults - United States, 2006," Morbidity and Mortality Weekly Report,
				  November 9, 2007 / 56(44); 1157-1161, available at
www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm
(last viewed Jan. 16, 2009).) State government can reduce tobacco use, save
				  lives and reduce overall health care expenditures by improving accessibility to
				  smoking cessation programs. This regulation sets out to
1. improve access to smoking cessation by
				  establishing uniform standards for cessation treatment coverage,
2. redefine tobacco cessation treatments
				  consistent with the most recent clinical practice guideline sponsored by United
				  States Department of Health and Human Services and
3. improve transparency of tobacco cessation
				  coverage for Rhode Island's insured population.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 12 - Tobacco Cessation Treatment Coverage (230-RICR-20-30-12) › Section 230-RICR-20-30-12.2 - Authority

Current through June 14, 2024
This Part is promulgated in accordance with R.I. Gen. Laws
					 §§
										27-18-66,
					 27-19-57, 27-20 - 53, 27-41-70,
					 42-14-5, 42-14-17, and 42-14.5-1 et seq.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 12 - Tobacco Cessation Treatment Coverage (230-RICR-20-30-12) › Section 230-RICR-20-30-12.3 - Purpose

Current through June 14, 2024
This Part establishes consistent cessation treatment
					 coverage across health insurance carriers, further defines tobacco cessation
					 treatments to include treatments included in the most recent clinical practice
					 guideline issued by the federal government, and promotes transparency of
					 coverage to enhance access by insureds.