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Rhode Island General Laws 27-20-6.1. Uniform explanation of benefits and coverage

     

(a)  A nonprofit medical service corporation shall provide a summary of benefits and coverage explanation and definitions to policyholders and others required by, and at the times and in the format required, by the federal regulations adopted under section 2715 of the Public Health Service Act, as amended by the federal Affordable Care Act [42 U.S.C. § 300gg-15]. The forms required by this section shall be made available to the commissioner on request. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.

Terms Used In Rhode Island General Laws 27-20-6.1

  • Affordable Care Act: means the federal Patient Protection and Affordable Care Act of 2010, as amended by the federal Health Care and Education Reconciliation Act of 2010, and federal regulations adopted thereunder;

    (3)  "Certified registered nurse practitioners" is an expanded role utilizing independent knowledge of physical assessment and management of health care and illnesses. See Rhode Island General Laws 27-20-1

  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • health insurance commissioner: means that individual appointed pursuant to §?42-14. See Rhode Island General Laws 27-20-1

(b)  The provisions of this section shall apply to grandfathered health plans. This section 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; and (9) Other limited benefit policies.

(c)  If the commissioner of the office of the health insurance commissioner determines that the corresponding provision of the federal Patient Protection and Affordable Care Act has been declared invalid by a final judgment of the federal judicial branch or has been repealed by an act of Congress, on the date of the commissioner’s determination this section shall have its effectiveness suspended indefinitely, and the commissioner shall take no action to enforce this section. Nothing in this section shall be construed to limit the authority of the commissioner under existing state law.

History of Section.
P.L. 2012, ch. 256, § 8; P.L. 2012, ch. 262, § 8.

Rhode Island General Laws 27-20.6-1. Definitions

     

As used in this chapter, the following terms shall have the following meanings:

(1)  “Insurer” means every nonprofit medical service corporation, hospital service corporation, health maintenance organization, or other insurer offering and/or insuring health services; the term shall in addition include any entity defined as an insurer under § 42-62-4; and

(2)  “Primary insurer” means the insurer primarily liable in accordance with the anti-duplication provisions established by regulations promulgated by the director of business regulation.

History of Section.
P.L. 1989, ch. 373, § 1.

Terms Used In Rhode Island General Laws 27-20.6-1

  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Insurer: means every nonprofit medical service corporation, hospital service corporation, health maintenance organization, or other insurer offering and/or insuring health services; the term shall in addition include any entity defined as an insurer under § 42-62-4; and

    (2)  "Primary insurer" means the insurer primarily liable in accordance with the anti-duplication provisions established by regulations promulgated by the director of business regulation. See Rhode Island General Laws 27-20.6-1