§ 27-41-1. Short title.
This chapter may be cited as the “Health Maintenance Organization Act.”
History of Section.P.L. 1983, ch. 225, § 2; P.L. 2002, ch. 292, § 85.
Structure Rhode Island General Laws
Chapter 27-41 - Health Maintenance Organizations
Section 27-41-1. - Short title.
Section 27-41-2. - Definitions.
Section 27-41-3. - Establishment of health maintenance organizations.
Section 27-41-4. - Issuance of license.
Section 27-41-5. - Powers of health maintenance organizations.
Section 27-41-6. - Governing body.
Section 27-41-7. - Fiduciary responsibilities.
Section 27-41-8. - Evidence of coverage and charges for health care services.
Section 27-41-9. - Required reports.
Section 27-41-10. - Information to enrollees.
Section 27-41-11. - Complaint system.
Section 27-41-12. - Investments.
Section 27-41-13. - Protection against insolvency.
Section 27-41-13.1. - Initial net worth and capital requirements.
Section 27-41-13.2. - Ongoing net worth and capital requirements.
Section 27-41-13.3. - Waiver, surplus notes, and risk based capital requirements.
Section 27-41-14. - Prohibited practices.
Section 27-41-14.1. - Prohibition against restraint on provider — Patient communications.
Section 27-41-15. - Powers of insurers and hospital and medical service corporations.
Section 27-41-16. - Examination.
Section 27-41-17. - Suspension or revocation of license.
Section 27-41-18. - Rehabilitation, liquidation, or conservation of health maintenance organization.
Section 27-41-18.1. - Summary orders and supervision.
Section 27-41-19. - Rules and regulations.
Section 27-41-20. - Administrative procedures.
Section 27-41-21. - Penalties and enforcement.
Section 27-41-22. - Statutory construction and relationship to other laws.
Section 27-41-23. - Filings and reports as public documents.
Section 27-41-24. - Director of health’s authority to contract.
Section 27-41-25. - Holding company systems.
Section 27-41-26. - Enrollee liability.
Section 27-41-26.1. - Patient responsibility — Administrative requirements.
Section 27-41-27. - Offer of health maintenance organization alternative to employees.
Section 27-41-27.1. - No derogation of attorney general.
Section 27-41-27.2. - Health insurance rates.
Section 27-41-28. - Applicability.
Section 27-41-29. - Severability.
Section 27-41-29.1. - Uniform explanation of benefits and coverage.
Section 27-41-29.2. - Filing of policy forms.
Section 27-41-30. - Mammograms and pap smears — Coverage mandated.
Section 27-41-30.1. - Post-partum hospital stays.
Section 27-41-31. - Mammograms — Quality assurance standards.
Section 27-41-32. - Pap smears — Quality assurance standards.
Section 27-41-33. - Coverage for infertility.
Section 27-41-34. - Health maintenance organizations’ assessment.
Section 27-41-35. - Enrollment period in the event of insolvency.
Section 27-41-36. - Services of midwives.
Section 27-41-37. - Discontinuance of coverage — Chronic disabilities.
Section 27-41-38. - Drug coverage.
Section 27-41-38.1. - Medication synchronization.
Section 27-41-41.1. - Repealed.
Section 27-41-41.2. - Repealed.
Section 27-41-41.3. - Repealed.
Section 27-41-43. - Mastectomy treatment.
Section 27-41-43.1. - Insurance coverage for mastectomy hospital stays.
Section 27-41-44. - Diabetes treatment.
Section 27-41-45. - Primary and preventive obstetric and gynecological care.
Section 27-41-45.1. - Hysterectomy or myomectomy treatment.
Section 27-41-46. - Whistleblowers protection.
Section 27-41-47. - Penalties and remedies.
Section 27-41-48. - Additional relief and damages — Reinstatement.
Section 27-41-49. - Third-party reimbursement for services of certain healthcare workers.
Section 27-41-49.1. - Third party reimbursement for services of registered nurse first assistants.
Section 27-41-50. - Human leukocyte antigen testing.
Section 27-41-51. - Drug coverage.
Section 27-41-52. - Restricted annual rate payments prohibited.
Section 27-41-53. - Genetic testing.
Section 27-41-53.1. - Genetic information.
Section 27-41-54. - Disassociation prohibited.
Section 27-41-56. - Magnetic resonance imaging — Quality assurance standards.
Section 27-41-57. - Acupuncture services.
Section 27-41-58. - Prohibition against requiring indemnification from dentists.
Section 27-41-59. - F.D.A. approved prescription contraceptive drugs and devices.
Section 27-41-61. - Eligibility for children’s benefits.
Section 27-41-62. - Temporary credentials.
Section 27-41-63. - Hearing aids.
Section 27-41-64. - Prompt processing of claims.
Section 27-41-65. - Mandatory coverage for certain lyme disease treatments.
Section 27-41-66. - Dental insurance assignment of benefits.
Section 27-41-67. - Determination of maximum coverage limitation for prescription drug benefits.
Section 27-41-68. - Coverage for early intervention services.
Section 27-41-69. - Post-payment audits.
Section 27-41-70. - Tobacco cessation programs.
Section 27-41-71. - Mandatory coverage for scalp hair prosthesis.
Section 27-41-72. - Reimbursement for orthotic and prosthetic services.
Section 27-41-73. - Licensed ambulance service.
Section 27-41-74. - Enteral nutrition products.
Section 27-41-75. - Prohibition on rescission of coverage.
Section 27-41-76. - Prohibition on annual and lifetime limits.
Section 27-41-77. - Coverage for individual participating in approved clinical trials.
Section 27-41-78. - Medical loss ratio reporting and rebates.
Section 27-41-79. - Emergency services.
Section 27-41-80. - Internal and external appeal of adverse benefit determinations.
Section 27-41-81. - Prohibition on preexisting condition exclusions.
Section 27-41-82. - Primary care provider designation requirement.
Section 27-41-83. - Discretionary clauses.
Section 27-41-84. - Orally administered anticancer medication — Cost-sharing requirement.
Section 27-41-85. - Consumer notification.
Section 27-41-86. - Opioid antagonists.
Section 27-41-87. - Healthcare provider credentialing.
Section 27-41-88. - Unfair discrimination prohibited.
Section 27-41-89. - Health insurance contracts — Full year coverage for contraception.
Section 27-41-90. - Prohibition on discrimination in organ transplants.
Section 27-41-91. - Health insurance contracts — Copayments exemption for COVID-19 vaccinations.
Section 27-41-92. - Perinatal doulas.
Section 27-41-93. - Gender rating. [Effective January 1, 2023.]