(a)(1) Coverage under a health benefit plan subject to the jurisdiction of the commissioner under this chapter with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, shall not be rescinded after the individual is covered under the plan, unless:
Terms Used In Rhode Island General Laws 27-18-72
- 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 such plan. See Rhode Island General Laws 27-18-1.1.
- health benefit plan: means health insurance coverage and a group health plan, including coverage provided through an association plan if it covers Rhode Island residents. See Rhode Island General Laws 27-18-1.1.
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- person: extends to and includes co-partnerships and bodies corporate and politic. See Rhode Island General Laws 43-3-6.
- Rescission: means a cancellation or discontinuance of coverage that has retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage. See Rhode Island General Laws 27-18-1.1.
(A) The individual or a person seeking coverage on behalf of the individual, performs an act, practice or omission that constitutes fraud; or
(B) The individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage.
(2) For purposes of paragraph (a)(1)(A), a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health carrier.
(b) At least thirty (30) days advance written notice shall be provided to each health benefit plan enrollee or, for individual health insurance coverage, primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of, in the case of group health insurance coverage, whether the rescission applies to the entire group or only to an individual within the group.
(c) For purposes of this section, “to rescind” means to cancel or to discontinue coverage with retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage.
(d) This section applies to grandfathered health plans.
(P.L. 2012, ch. 256, § 2; P.L. 2012, ch. 262, § 2.)