Title 27, Title 27 Title 27

(a) Any accident and sickness insurer that utilizes a formulary of medications for which coverage is provided under an individual or group plan master contract shall require any physician or other person authorized by the department of health to prescribe medication to prescribe …

(a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2017, providing prescription drug coverage in the state, must permit and apply a prorated, daily cost-sharing rate to covered prescriptions f…

(a) The general assembly makes the following findings: (1) In 2015, an estimated six hundred thirty-five thousand (635,000) Rhode Island residents had at least one chronic disease, and an estimated two hundred forty-nine thousand (249,000) residents had two (2) or more chronic di…

(a) No policy delivered or issued in this state shall contain a provision for compensating any provider of outpatient mental health and/or substance abuse treatment service by using the restricted annual rate method of payment. (b) The restricted annual rate method of payment is …

(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and i…

(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and providers shall be prohibited from releasing genetic information without prior written authorization of the individual. Written authorization shall be required for each disclosure and i…

(a) Except as otherwise provided in subsection (b) of this section, a magnetic resonance imaging examination eligible for reimbursement under the provisions of any individual or group health insurance contract, plan, or policy delivered in this state shall be reimbursed only if t…

No insurance company organized as a stock or mutual corporation that merges or consolidates with, acquires ownership or control or possession of twenty percent (20%) or greater of the operating assets of, or otherwise acquires control of a nonprofit hospital service corporation o…

(a) Every group health insurance contract, plan, or group policy delivered, issued for delivery, or renewed in this state that provides medical coverage, and every group policy that provides for treatment of persons for the prevention, cure, or correction of any illness or physic…

No accident and sickness insurance provider may contract to require that a dentist indemnify or hold harmless the accident and sickness insurance provider for any expenses and liabilities, including, without limitation, judgments, settlements, attorneys’ fees, court costs, and an…

(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage and is delivered, issued for delivery, or renewed in this state shall provide coverage for FDA approved contraceptive drugs and devices requiring a prescription. Provided,…

(a) Every accident and sickness insurance policy, medical expense insurance policy, or medical services plan contract delivered, issued for delivery, or renewed in this state shall provide coverage for prostate and colorectal preventive screening examinations and laboratory tests…

(a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state and every group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state that provides health benefits coverage for dependents, except for suppleme…

The provisions that are the subject of §§ 27-18-3 and 27-18-4, or any corresponding provisions used in lieu of them in accordance with those sections, shall be printed in the consecutive order of the provisions in the section or, at the option of the insurer, the provision may ap…

(a)(1) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2026, shall provide coverage for one thousa…

(a) A healthcare entity or health plan operating in the state shall pay all complete claims for covered healthcare services submitted to the healthcare entity or health plan by a healthcare provider or by a policyholder within forty (40) calendar days following the date of receip…

Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2004, shall provide coverage for diagnostic testing and long-te…

Every entity providing a policy of accident and sickness insurance as defined in this chapter shall allow, as a provision in a group or individual policy, contract, or health benefit plan for coverage of dental services, any person insured by such entity to direct, in writing, th…

(a) Every individual or group hospital or medical expense insurance policy or contract providing coverage for dependent children, delivered or renewed in this state on or after July 1, 2004, shall include coverage of early intervention services which coverage shall take effect no…

(a) Except as otherwise provided herein, any review, audit, or investigation by a health insurer or health plan of a healthcare provider’s claims that results in the recoupment or set-off of funds previously paid to the healthcare provider in respect to such claims shall be compl…

(a) Every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2010, that provides medical coverage that includes coverage for physician services in a physician’s office, and every policy wh…

(a) As used in this section: (1) “Federal reimbursement rates” means the current listed fee schedule from the Centers for Medicare & Medicaid Services, listing the current Healthcare Common Procedure Coding system (HCPCS) and the corresponding reimbursement rates. (2) “Orthosis” …

(a) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state on or after January 1, 2007, that provides coverage for any other prosthesis, shal…

(a) No individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide for a copayment for ground ambulance services in excess of fifty dollars ($50.00). (b) As used in this section…

The word “insured”, as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under the policy to any indemnities, bene…

(a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2009, shall provide coverage for nonprescripti…

(a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant to this title and/or chapter: (1) Shall not limit or exclude coverage for an indivi…

(a)(1) Coverage under a health benefit plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be rescinded after the…

(a) Annual limits. (1) For plan or policy years beginning prior to January 1, 2014, for any individual, a health insurance carrier and a health benefit plan subject to the jurisdiction of the commissioner under this chapter may establish an annual limit on the dollar amount of be…

(a) As used in this section, (1) “Approved clinical trial” means a phase I, phase II, phase III, or phase IV clinical trial that is conducted in relation to the prevention, detection, or treatment of cancer or a life-threatening disease or condition and is described in any of the…

(a) A health insurance carrier offering group or individual health insurance coverage of a health benefit plan, including a grandfathered health plan, shall comply with the provisions of Section 2718 of the Public Health Service Act as amended by the federal Patient Protection an…

(a) As used in this section: (1) “Emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) so that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably ex…

(a) The commissioner shall adopt regulations to implement standards and procedures with respect to internal claims and appeals of adverse benefit determinations, and with respect to external appeals of adverse benefit determinations. (b) The regulations adopted by the commissione…

(a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2013, shall require that the subscriber and ea…

(a) No new or existing policy or certificate issued by an insurer or healthcare entity may contain any provision: (1) Purporting to reserve sole discretion to the insurer or healthcare entity to determine eligibility for benefits or interpret the terms of a policy or certificate;…

(a) Any insurance company authorized to do an accident and sickness business within this state in accordance with the provisions of this title shall file all accident and sickness insurance policy forms and rates used by it in the state with the insurance commissioner, including …

Each filing shall be on file for a waiting period of sixty (60) days before it becomes effective. The commissioner may authorize a filing that the commissioner has reviewed to become effective before the expiration of the waiting period or any extension of the waiting period. A f…

If within the waiting period the commissioner finds that a filing does not meet the requirements of this chapter, the commissioner shall send to the insurer that made the filing written notice of disapproval of the filing, specifying in the notice in what respects the commissione…

After proper notice and a hearing in accordance with chapter 35 of title 42, the commissioner may withdraw the commissioner’s approval of any form approved under § 27-18-8.1 if the commissioner finds that the form does not meet the requirements of this chapter. If approval is wit…

The commissioner may make any reasonable rules and regulations concerning the procedure for the filing or submission of policies subject to this chapter as are necessary, proper, or advisable to the administration of this chapter. This provision shall not abridge any other author…

(a) Every individual or group hospital or medical expense insurance policy or individual or group hospital or medical services plan contract, plan, or certificate of insurance delivered, issued for delivery, or renewed in this state, on or after January 1, 2014, that offers both …

Every health insurer or health plan providing dental benefits to subscribers shall include on the identification card provided to its subscribers on the front of the cards the following language when the underlying plan contains a nonduplication of benefits clause: “NO DUPLICATIO…

(a) Every individual or group health insurance contract, plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended, or renewed in this state on or after January 1, 2017, shall provide coverage for at least one generic opioid antagonist an…

(a) For applications received on or after January 1, 2018, a healthcare entity or health plan operating in the state shall be required to issue a decision regarding the credentialing of a healthcare provider as soon as practicable, but no later than forty-five (45) calendar days …

Beginning on the first day of each plan year after April 1, 2019, every health insurance issuer offering group or individual health insurance coverage that covers prescription contraception shall not restrict reimbursement for dispensing a covered prescription contraceptive up to…

Pursuant to chapter 95 of title 23, any health insurer that provides coverage for anatomical gifts, organ transplants, or related treatment and services shall not: (1) Deny coverage to a covered person solely on the basis of the person’s disability; (2) Deny to a patient eligibil…