Title 27, Title 27 Title 27

For the purposes of this chapter, the following terms shall mean: (1) “Director” shall mean the director of the department of business regulation. (2) “Health plan” shall mean an insurance carrier as defined in chapters 18, 19, 20, and 41 of this title. (3) “Insured” shall mean a…

Any health plan that offers pharmacy benefits shall comply with the following: (a) When a health plan’s pharmacy benefit has a dollar limit, the insured’s use of such benefit shall be determined based on the health plan’s contracted rate to purchase the drug minus the enrollee’s …

(a) As used in this section, unless the context otherwise requires, “prescription insulin drug” means a prescription drug, as defined in § 21-31-2, that contains insulin and is used to treat diabetes. (b) A health plan that provides coverage for prescription insulin drugs pursuan…

A plan sponsor, health insurance carrier, or pharmacy benefits manager shall not prohibit a pharmacist from providing an insured information regarding the amount of the insured’s cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharm…

(a) On and after January 1, 2008, a health insurer that contracts with a healthcare provider shall comply with the provisions of this chapter and shall include the provisions required by this chapter in the healthcare contract. A contract in existence prior to January 1, 2008, th…

The health insurer shall reimburse the healthcare provider for covered services rendered by the healthcare provider to the health insurer’s subscribers or members following the first business day after the credentialing committee’s approval, provided that the healthcare provider …

A health insurer shall not require a physician, as a condition of contracting, to participate in any financial or reimbursement incentive program, commonly referred to as pay-for-performance programs, unless such program meets the principles and guidelines for pay-for-performance…

For purposes of this chapter, the following terms shall mean: (1) “Director” shall mean the director of the department of business regulation. (2) “Eligible bidder” shall mean a retail pharmacy, community pharmacy, or pharmacy department registered pursuant to chapter 19.1 of tit…

The total cost of the enforcement of §§ 27-29.1-3 and 27-29.1-8 shall be borne by the pharmacy benefits manager(s) and/or the insurer(s) against whom the complaint is made on an equal basis and shall include the following expenses: (1) One hundred fifty percent (150%) of the tota…

The health insurance commissioner, pursuant to § 42-14.5-1, shall evaluate the impact of nonrestricted pharmacy networks on health insurance costs in Rhode Island and shall submit a report of findings to the joint legislative committee on health care oversight on or before May 1,…

In accordance with § 23-17.13-3 [repealed], an insurer must demonstrate to the director of health the willingness and potential ability to ensure that pharmacy services will be provided in a manner to ensure both availability and accessibility of adequate personnel and facilities…

(a) An insurer that offers insureds a restricted pharmacy network shall, in soliciting, arranging, competitively bidding, contracting for, and operating that network, comply with the following requirements for the purpose of promoting fair and competitive bidding, regardless of w…

Every healthcare insurer that delivers or issues for delivery or renews in this state a contract, plan, or policy that provides coverage for pharmaceuticals delivered on an outpatient basis through a restricted pharmacy network shall: (1) Also offer insurance purchasers an option…

(a) Any pharmacies licensed in the state of Rhode Island that are not owned or controlled, directly or indirectly, by an entity that owns pharmacies licensed in two (2) or more jurisdictions other than Rhode Island, which are not participating in an insurer’s restricted pharmacy …

(a) Nothing in this chapter shall preclude an insurer from entering into an agreement to allow non-network providers, other than independent community pharmacies, the ability to participate with the insurer’s plans under terms and conditions set forth by the insurer. (b) The prov…

Pharmacy benefits managers shall be included within the definition of third-party administrator under chapter 20.7 of this title and shall be regulated as such. The annual report filed by third-party administrators with the department of business regulation shall include: contrac…

The department of business regulation shall have authority to enforce the provisions of §§ 27-29.1-3 — 27-29.1-7, subject to the provisions of chapter 35 of title 42.

If any provision of §§ 27-29.1-1 — 27-29.1-8, or the application of those sections to any person or circumstances is held invalid, the invalidity shall not affect other provisions or applications of §§ 27-29.1-1 — 27-29.1-8 which can be given effect without the invalid provision …

The general assembly hereby finds that all patients who are in need of an orthosis or prosthesis in the state of Rhode Island shall have the freedom of choice to select any orthotist or prosthetist licensed by the state to practice orthotics or prosthetics.

As used in this chapter: (1) “Orthosis” means a custom fabricated brace or support that is designed based on medical necessity. “Orthosis” does not include prefabricated or direct-formed orthotic devices, or any of the following assistive technology devices: Commercially availabl…

This chapter shall not apply to the policies and procedures of the Veterans’ Affairs Medical Center of Rhode Island or Veterans’ Affairs Medical Center Prosthetics and Orthotics Clinics.

This chapter shall apply to every individual or group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in this state on or after July 1, 2007, that provides medical coverage that includes coverage for physician services in a physician’s office…

The purpose of this chapter is to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollment practices, to establish standards for long…

(a)(1) If the director for any reason has cause to believe that any violation of this chapter has occurred or is threatened, the director may give notice to any persons who appear to be involved in the suspected violation to arrange a conference with the alleged violators or thei…

(a) Each insurer offering long-term care insurance shall, as a protection against unintentional lapse comply with the following: (1)(i) No individual long-term care policy or certificate shall be issued until the insurer has received from the applicant either: a written designati…

(a) No insurer may offer a long-term care insurance policy unless the insurer also offers to the policyholder in addition to any other inflation protection the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations t…

(a) Every insurer, healthcare services plan, or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall: (1) Establish marketing procedures to ensure that any comparison of policies by its agents or other insurance producer…

(a) A long-term care insurance shopper’s guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the director, shall be provided to all prospective applicants of a long-term care insurance policy or certificate. (b…

The director shall issue reasonable regulations to promote premium adequacy and to protect the policymaker in the event of substantial rate increases, and to establish minimum standards for producer education, marketing practices, producer compensation, producer testing, penaltie…

The department of business regulation shall pre-certify long-term care insurance policies that meet all other applicable requirements imposed by this chapter and that: (1) Offer the option of home and community based services in addition to nursing home care; (2) In all home care…

(a) Except as provided in subsection (b), a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit.…

Long-term care insurance is deemed to be accident and health insurance and is classified as such for the purposes of chapter 34.3 of this title, the Rhode Island Life and Health Insurance Guaranty Association Act. The requirements of this chapter apply to policies delivered or is…

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

(a) On or after January 1, 2008, an individual may not sell, solicit, or negotiate long-term care insurance unless the individual is licensed as an insurance producer for accident and health or sickness or life and has completed a one-time training course. The training shall meet…

(a) No new or existing policy or certificate may contain any provision: (1) Purporting to reserve sole discretion to the insurance company to determine eligibility for benefits or interpret the terms of a policy or certificate; or (2) Specifying or affecting a standard of review …

This chapter may be known and cited as the “Long-term Care Insurance Act.”

Unless the context requires otherwise, the following definitions apply throughout the chapter: (1) “Applicant” means: (i) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (ii) In the case of a group long-term care in…

No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in § 27-34.2-4(4)(v), unless this state or another state having statutory and regulatory long-term care insurance requirements s…

(a) The director may adopt regulations that establish: (1) Standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility…

(a) For a policy or certificate that has been in force for less than six (6) months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the accep…

The director may upon written request issue an order to modify or suspend a specific provision or provisions of regulations adopted pursuant to this chapter, and may upon written request permit the use of waivers or riders, with respect to a specific long-term care insurance poli…

Regulations adopted pursuant to this chapter shall be in accordance with the provisions of chapter 35 of title 42.

This chapter shall be known and may be cited as the “Rhode Island Life and Health Insurance Guaranty Association Act.”

(a)(1) The plan of operation as previously established and approved under this section shall continue to be effective. The association may amend the plan of operation when necessary or suitable to assure the fair, reasonable, and equitable administration of the association. Amend…

In addition to the duties and powers enumerated in this chapter, (a) The commissioner shall: (1) Upon request of the board of directors, provide the association with a statement of the premiums in this and any other appropriate states for each member insurer; (2) When an impairme…

To aid in the detection and prevention of insurer insolvencies or impairments: (a) It shall be the duty of the commissioner: (1) To notify the commissioners of all the other states, territories of the United States, and the District of Columbia within thirty (30) days following t…