(a) Every individual or group health insurance contract, or every individual or group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state on or after January 1, 2013, shall require that the subscriber and each dependent designate a participating primary care provider and the insurer shall collect the designation from the insured. Designation of a primary care provider shall not be a condition of enrollment and failure to designate a primary care provider shall not constitute grounds for cancellation of coverage. For purposes of this section, “primary care provider” means the physician, practice or other medical provider considered by the insured to be his or her usual source of medical care.
Terms Used In Rhode Island General Laws 27-18-78
- insured: as used in this chapter , shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under the policy to any indemnities, benefits, and rights provided in the policy. See Rhode Island General Laws 27-18-7.
- provider: means a health care professional or a health care facility. See Rhode Island General Laws 27-18-1.1.
(b) Requirements for designating a primary care provider enumerated in subsection (a) shall not apply to insurance coverage providing benefits for:
(1) Hospital confinement indemnity;
(2) Disability income;
(3) Accident only;
(4) Long-term care;
(5) Medicare supplement;
(6) Limited benefit health;
(7) Specified disease indemnity;
(8) Sickness or bodily injury or death by accident or both; or
(9) Other limited benefit policies.
(P.L. 2012, ch. 189, § 3; P.L. 2012, ch. 202, § 3.)