(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 individual to enroll under the terms of the plan based on health status-related factors in relation to the individual or dependent of the individual.

(2)  Rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for enrollment.

Terms Used In Rhode Island General Laws 27-18.6-4

  • carrier: means any entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the director, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including, without limitation, an insurance company offering accident and sickness insurance, a health maintenance organization, a nonprofit hospital, medical or dental service corporation, or any other entity providing a plan of health insurance, health benefits, or health services;

    (15)(i)  "Health insurance coverage" means a policy, contract, certificate, or agreement offered by a health insurance carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Rhode Island General Laws 27-18.6-2

  • Dependent: A person dependent for support upon another.
  • Employer: has the meaning given that term under section 3(5) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2
  • Group health insurance coverage: means , in connection with a group health plan, health insurance coverage offered in connection with that plan;

    (13)  "Group health plan" means an employee welfare benefits plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2

  • Health status-related factor: means any of the following factors:

    (i)  Health status;

    (ii)  Medical condition, including both physical and mental illnesses;

    (iii)  Claims experience;

    (iv)  Receipt of health care;

    (v)  Medical history;

    (vi)  Genetic information;

    (vii)  Evidence of insurability, including contributions arising out of acts of domestic violence; and

    (viii)  Disability;

    (18)  "Large employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least fifty-one (51) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year. See Rhode Island General Laws 27-18.6-2

(b)  Subsection (a) of this section shall not be construed:

(1)  To require a group health plan or group health insurance coverage to provide particular benefits other than those provided under the terms of the plan or coverage; or

(2)  To prevent a plan or coverage from establishing limitations on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the coverage.

(c)(1)  A group health plan and a health insurance carrier offering health insurance coverage in connection with a group health plan may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as dependent of the individual.

(2)  Nothing contained within this subsection shall be construed to:

(i)  Restrict the amount that an employer may be charged for coverage under a group health plan; or

(ii)  Prevent a group health plan and a health insurance carrier offering group health insurance coverage from establishing premium discounts or rebates or modifying applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4.