Title 27, Title 27 Title 27

(a) In general. A carrier shall establish a special enrollment period that allows for the enrollment of a pregnant individual at any time after the commencement of the pregnancy. Coverage shall be effective as of the first of the month in which the pregnant individual applies for…

(a) The following words and phrases as used in this section have the following meanings consistent with federal law and regulations adopted thereunder, as long as they remain in effect. If such authorities are determined by the commissioner to no longer be in effect, the laws and…

The following words and phrases as used in this chapter have the following meanings unless a different meaning is required by the context: (1) “Bona fide association” means, with respect to health insurance coverage offered in this state, an association that: (i) Has been activel…

(a) Subject to subsections (b) — (i) of this section, all health insurance carriers that offer health insurance coverage in the individual market in this state shall provide for the guaranteed availability of coverage to any eligible applicant. For the purposes of this section, a…

(a) A health insurance carrier that provides individual health insurance coverage to an individual in this state shall renew or continue in force that coverage at the option of the individual. (b) A health insurance carrier may nonrenew or discontinue health insurance coverage of…

The commissioner has the power to enforce the provisions of this chapter in accordance with § 42-14-16 and all other applicable laws.

The commissioner may promulgate rules and regulations necessary to effectuate the purposes of this chapter.

If any provision of this chapter or the application of any provision to any person or circumstances is for any reason held invalid, the remainder of the chapter and the application of that provision to other persons or circumstances shall not be affected by the invalidity.

All carriers that offer health insurance in the individual market shall actively market and offer the wellness health direct benefit plan to eligible individuals. The wellness health direct benefit plan shall be determined by regulation promulgated by the office of the health ins…

(a) The commissioner shall allocate funds from the affordable health plan reinsurance fund for the affordable health reinsurance program. (b) The affordable health reinsurance program for individuals shall only be available to high-risk individuals as defined in § 27-18.5-2, and …

The purpose of this chapter is to insure compliance of all policies, contracts, certificates, and agreements of group health insurance coverage offered or delivered in this state with the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191).

If any provision of this chapter or the application of any provision to any person or circumstances is for any reason held invalid, the remainder of the chapter and the application of that provision to other persons or circumstances shall not be affected by that invalidity.

A health insurance carrier: (1) Providing proposed rate, premium, fee, or other prospective cost information in connection with an offering of health insurance coverage to a large group or large employer setting forth claims cost as an element of cost; or (2) Providing informatio…

(a) To ensure maximum competition in the purchase of group health insurance, all employers with at least one hundred (100) employees enrolled in their group health plan shall be entitled to receive their health plan loss information upon request and without charge. No contract be…

The following words and phrases as used in this chapter have the following meanings unless a different meaning is required by the context: (1) “Affiliation period” means a period that, under the terms of the health insurance coverage offered by a health maintenance organization, …

(a)(1) Notwithstanding any of the provisions of this title to the contrary, a group health plan and a health insurance carrier offering group health insurance coverage shall not deny, exclude, or limit benefits with respect to a participant or beneficiary because of a preexisting…

(a) In general. A group health plan and a carrier shall establish a special enrollment period that allows for the enrollment of a pregnant individual at any time after the commencement of the pregnancy. Coverage shall be effective as of the first of the month in which the pregnan…

(a) As used in this section, “preventive services” means those services described in 42 U.S.C. § 300gg-13 and implementing regulations and guidance. (b) If any provision of the federal Patient Protection and Affordable Care Act and implementing regulations relating to preventive …

(a)(1) Notwithstanding any of the provisions of this title to the contrary, a group health plan and a health insurance carrier offering group health insurance in connection with a group health plan may not establish rules for eligibility (including continued eligibility) of any i…

(a) Notwithstanding any of the provisions of this title to the contrary, a health insurance carrier that offers health insurance coverage in the large group market in this state in connection with a group health plan shall renew or continue in force that coverage at the option of…

(a) The requirements of this chapter do not apply to any group health plan (and health insurance coverage offered in connection with a group health plan) for any plan year if, on the first day of the plan year, the plan does not meet the definition of large employer and is subjec…

(a) Notwithstanding anything contained in this chapter to the contrary, except as provided in § 27-18.6-3(n), in the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified…

The director has the power to enforce the provisions of this chapter in accordance with § 42-14-16 and all other applicable state law.

The director may promulgate rules and regulations necessary to effectuate the purposes of this chapter.

Whenever an employee who has been employed on a full-time basis by an employer for at least three (3) months and who is an insured member of a group hospital, surgical, or medical insurance plan is placed on extended medical leave by the employer, the employee may remain on the g…

An employer may continue to contribute to the cost of the plan benefits for an employee on extended medical leave or may require an employee on extended medical leave to pay up to one hundred percent (100%) of the cost of the plan benefits.

(a) An employee shall be considered eligible for continuing coverage under the group hospital, surgical, or medical insurance plan as an employee on extended medical leave if an employer provides to the group hospital, surgical, or medical insurance plan a written statement that …

Once an employee on extended medical leave has remained on a group hospital, surgical, or medical insurance plan for eighteen (18) months and is no longer eligible to participate in that plan, the employee shall be eligible for extended medical benefits under chapter 19.1 of this…

The legislature declares that: (1) It is in the best interest of the public that those individuals and healthcare entities involved with the delivery of health plan coverage in our state meet the standards of this chapter to ensure accessibility and quality for the state’s patien…

If any section, clause, or provision of this chapter 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…

As used in this chapter: (1) “Adverse benefit determination” means a decision not to authorize a healthcare service, including a denial, reduction, or termination of, or a failure to provide or make a payment, in whole or in part, for a benefit. A decision by a utilization review…

(a) Certification and recertification process. (1) A healthcare entity operating a network plan shall not enroll consumers into its plan unless the office has certified the network plan meeting the requirements herein. (2) The commissioner shall act upon the healthcare entities’ …

No contract between a dental plan of a healthcare entity and a dentist for the provision of services to beneficiaries may require that a dentist provide services to its patients at a fee set by the healthcare entity unless said services are covered services under the applicable s…

(a) No contract between an eye care provider and a healthcare entity or vision plan may require that an eye care provider provide services or materials to its beneficiaries at a fee set by the insurer or vision plan, unless the insurer or vision plan compensates the eye care prov…

The office shall establish reporting requirements to determine if healthcare entities and/or network plans are in compliance with the provisions of this chapter and applicable regulations as well as in compliance with applicable federal law.

The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.

Adopted pursuant to this chapter; (a) The office may deny a certificate or certification upon review of the application if, upon review of the application, it finds that the applicant proposing to establish a network plan does not meet the standards required by this chapter or by…

For the purposes of this chapter, in addition to the provisions of § 27-18.8-8, a healthcare entity or any person or entity conducting any activities requiring certification under this chapter shall be subject to the penalty and enforcement provisions of this title and chapters 1…

(a) The purpose of this chapter is to: (1) Promote the delivery of quality health care in a cost-effective manner; (2) Foster greater coordination between healthcare providers, patients, healthcare entities, health benefit plans, and utilization review entities to ensure public h…

The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.

(a) The office shall waive the requirements of this chapter only when a conflict exists with those activities of a review agent that are conducted pursuant to contracts with the state or the federal government or those activities under other state or federal jurisdictions. (b) Th…

Statutory variances shall be issued for a period not to exceed one year and may be subject to such terms and conditions deemed necessary as determined by the commissioner. Prior to issuing a statutory variance, the office may provide notice and public hearing to ensure necessary …

Adopted pursuant to this chapter; (a) The office may deny a certificate or certification upon review of the application if, upon review of the application, it finds that the applicant proposing to conduct utilization review does not meet the standards required by this chapter or …

For the purposes of this chapter, in addition to the provisions of § 27-18.9-13, a healthcare entity and/or review agent or any person or entity conducting any activities requiring certification under this chapter shall be subject to the penalty and enforcement provisions of this…

If any provision of this chapter or the application of any provision to any person or circumstance shall be held invalid, that invalidity shall not affect the provisions or application of this chapter which can be given effect without the invalid provision or application, and to …

(a) The purpose of this chapter is to authorize a three-year (3) pilot program whereby, except as provided in subsection (b), an insurer shall not impose a prior authorization requirement for any admission, item, service, treatment, or procedure ordered by a primary care provider…