(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 the plan sponsor of the plan.

Terms Used In Rhode Island General Laws 27-18.6-5

  • 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

  • Director: means the director of the department of business regulation;

    (8)  "Employee" has the meaning given that term under section 3(6) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2

  • 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
  • Fraud: Intentional deception resulting in injury to another.
  • 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

  • Large group market: means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer;

    (20)  "Late enrollee" means, with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during:

    (i)  The first period in which the individual is eligible to enroll under the plan; or

    (ii)  A special enrollment period;

    (21)  "Medical care" means amounts paid for:

    (i)  The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body;

    (ii)  Amounts paid for transportation primarily for and essential to medical care referred to in paragraph (i) of this subdivision; and

    (iii)  Amounts paid for insurance covering medical care referred to in paragraphs (i) and (ii) of this subdivision;

    (22)  "Network plan" means health insurance coverage offered by a health insurance carrier under which the financing and delivery of medical care including items and services paid for as medical care are provided, in whole or in part, through a defined set of providers under contract with the carrier;

    (23)  "Participant" has the meaning given such term under section 3(7) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2

  • Plan sponsor: has the meaning given that term under section 3(16)(B) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2

(b)  A health insurance carrier may nonrenew or discontinue health insurance coverage offered in connection with a group health plan in the large group market based only on one or more of the following:

(1)  The plan sponsor has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the carrier has not received timely premium payments;

(2)  The plan sponsor has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage;

(3)  The plan sponsor has failed to comply with a material plan provision relating to employer contribution or group participation rules, as permitted by the director pursuant to rule or regulation;

(4)  The carrier is ceasing to offer coverage in accordance with subsections (c) and (d) of this section;

(5)  The director finds that the continuation of the coverage would:

(i)  Not be in the best interests of the policyholders or certificate holders; or

(ii)  Impair the carrier’s ability to meet its contractual obligations;

(6)  In the case of a health insurance carrier that offers health insurance coverage in the large group market through a network plan, there is no longer any enrollee in connection with that plan who resides, lives, or works in the service area of the carrier (or in an area for which the carrier is authorized to do business); and

(7)  In the case of health insurance coverage that is made available in the large group market only through one or more bona fide associations, the membership of an employer in the association (on the basis of which the coverage is provided) ceases, but only if the coverage is terminated under this section uniformly without regard to any health status-related factor relating to any covered individual.

(c)  In any case in which a carrier decides to discontinue offering a particular type of group health insurance coverage offered in the large group market, coverage of that type may be discontinued by the carrier only if:

(1)  The carrier provides notice of the decision to all affected plan sponsors, participants, and beneficiaries at least ninety (90) days prior to the date of discontinuation of coverage;

(2)  The carrier offers to each plan sponsor provided coverage of this type in the large group market the option to purchase any other health insurance coverage currently being offered by the carrier to a group health plan in the market; and

(3)  In exercising this option to discontinue coverage of this type and in offering the option of coverage under subdivision (3) of this subsection, the carrier acts uniformly without regard to the claims experience of those plan sponsors or any health status-related factor relating to any participants or beneficiaries covered or new participants or beneficiaries who may become eligible for coverage.

(d)  In any case in which a carrier elects to discontinue offering and to nonrenew all of its health insurance coverage in the large group market in this state, the carrier shall:

(1)  Provide advance notice to the director, to the insurance commissioner in each state in which the carrier is licensed, and to each plan sponsor (and participants and beneficiaries covered under that coverage and to the insurance commissioner in each state in which an affected insured individual is known to reside) of the decision at least one hundred eighty (180) days prior to the date of the discontinuation of coverage. Notice to the insurance commissioner shall be provided at least three (3) working days prior to the notice to the affected plan sponsors, participants, and beneficiaries; and

(2)  Discontinue all health insurance issued or delivered for issuance in this state’s large group market and not renew coverage under any health insurance coverage issued to a large employer.

(e)  In the case of a discontinuation under subsection (d) of this section, the carrier shall be prohibited from the issuance of any health insurance coverage in the large group market in this state for a period of five (5) years from the date of notice to the director.

(f)  At the time of coverage renewal, a health insurance carrier may modify the health insurance coverage for a product offered to a group health plan in the large group market.

(g)  In applying this section in the case of health insurance coverage that is made available by a carrier in the large group market to employers only through one or more associations, a reference to a “plan sponsor” is deemed, with respect to coverage provided to an employer member of the association, to include a reference to that employer.

History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4; P.L. 2003, ch. 120, § 2; P.L. 2003, ch. 286, § 2.