§ 27-19-1 Definitions
§ 27-19-2 Organization as charitable corporation – Insurance laws inapplicable
§ 27-19-2.1 Investments and holdings in certain corporations authorized
§ 27-19-3 Repealed
§ 27-19-4 Certificate of public convenience and advantage
§ 27-19-5 Contracts with subscribers, hospitals, and other eligible entities
§ 27-19-5.1 Cancellation of coverage by employers
§ 27-19-5.2 Patient responsibility – Administrative requirements
§ 27-19-5.3 Additional powers
§ 27-19-6 Rates charged subscribers – Reserves
§ 27-19-7 Rates charged by hospitals
§ 27-19-7.1 Uniform explanation of benefits and coverage
§ 27-19-7.2 Filing of policy forms
§ 27-19-8 Annual and quarterly statements
§ 27-19-9 Examination of affairs of corporations
§ 27-19-10 Commission plans for solicitors or insurance producers
§ 27-19-11 Investment standards
§ 27-19-12 Corporations deemed public charitable institutions
§ 27-19-13 Services rendered in certain institutions
§ 27-19-14 Repealed
§ 27-19-15 Repealed
§ 27-19-16 Repealed
§ 27-19-17 Additional benefits
§ 27-19-18 Coverage for adoptive children
§ 27-19-19 Changing coverage
§ 27-19-20 Mammograms and pap smears – Coverage mandated
§ 27-19-21 Mammograms – Quality assurance standards
§ 27-19-22 Pap smears – Quality assurance standards
§ 27-19-23 Coverage for infertility
§ 27-19-23.1 Insurance coverage for post-partum hospital stays
§ 27-19-24 Nonprofit hospital service corporations assessment
§ 27-19-25 Discontinuance of coverage – Chronic disabilities
§ 27-19-26 Drug coverage
§ 27-19-26.1 Medication synchronization
§ 27-19-26.2 Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies
§ 27-19-27 Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists
§ 27-19-28 Rehabilitation, liquidation, or conservation
§ 27-19-29 Holding company systems
§ 27-19-29.1 No derogation of attorney general
§ 27-19-30 Regulations
§ 27-19-30.1 Health insurance rates
§ 27-19-31 Certified counselors in mental health and therapists in marriage and family practice
§ 27-19-32 Repealed
§ 27-19-32.1 Repealed
§ 27-19-32.2 Repealed
§ 27-19-32.3 Repealed
§ 27-19-33 Repealed
§ 27-19-34 Mastectomy treatment
§ 27-19-34.1 Insurance coverage for mastectomy hospital stays
§ 27-19-35 Diabetes treatment
§ 27-19-36 Primary and preventive obstetric and gynecological care
§ 27-19-36.1 Hysterectomy or myomectomy treatment
§ 27-19-37 Whistleblowers protection
§ 27-19-38 Penalties and remedies
§ 27-19-39 Additional relief and damages – Reinstatement
§ 27-19-40 Third-party reimbursement for services of certain healthcare workers
§ 27-19-40.1 Third party reimbursement for services of registered nurse first assistants
§ 27-19-41 Human leukocyte antigen testing
§ 27-19-42 Drug coverage
§ 27-19-43 Restricted annual rate payments prohibited
§ 27-19-44 Genetic testing
§ 27-19-44.1 Genetic information
§ 27-19-45 Repealed
§ 27-19-46 Magnetic resonance imaging – Quality assurance standards
§ 27-19-47 Acupuncture services
§ 27-19-48 F.D.A. approved prescription contraceptive drugs and devices
§ 27-19-49 Prostate and colorectal examinations – Coverage mandated – The Maryellen Goodwin Colorectal Cancer Screening Act
§ 27-19-50 Eligibility for children’s benefits
§ 27-19-51 Hearing aids
§ 27-19-52 Prompt processing of claims
§ 27-19-53 Mandatory coverage for certain lyme disease treatments
§ 27-19-54 Dental insurance assignment of benefits
§ 27-19-55 Coverage for early intervention services
§ 27-19-56 Post-payment audits
§ 27-19-57 Tobacco cessation programs
§ 27-19-58 Reimbursement for orthotics and prosthetic services
§ 27-19-59 Mandatory coverage for scalp hair prosthesis
§ 27-19-60 Licensed ambulance service
§ 27-19-61 Enteral nutrition products
§ 27-19-62 Prohibition on rescission of coverage
§ 27-19-63 Prohibition on annual and lifetime limits
§ 27-19-64 Coverage for individuals participating in approved clinical trials
§ 27-19-65 Medical loss ratio reporting and rebates
§ 27-19-66 Emergency services
§ 27-19-67 Internal and external appeal of adverse benefit determinations
§ 27-19-68 Prohibition on preexisting condition exclusions
§ 27-19-69 Primary care provider designation requirement
§ 27-19-70 Discretionary clauses
§ 27-19-71 Orally administered anticancer medication – Cost-sharing requirement
§ 27-19-72 Consumer notification
§ 27-19-73 Opioid antagonists
§ 27-19-74 Healthcare provider credentialing
§ 27-19-75 Unfair discrimination prohibited
§ 27-19-76 Health insurance contracts – Full year coverage for contraception
§ 27-19-77 Prohibition on discrimination in organ transplants
§ 27-19-78 Health insurance contracts – Copayments exemption for COVID-19 vaccinations
§ 27-19-79 Perinatal doulas
§ 27-19-80 Gender rating
§ 27-19-81 Coverage for biomarker testing
§ 27-19-82 Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome

Terms Used In Rhode Island General Laws > Chapter 27-19 - Nonprofit Hospital Service Corporations

  • 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;

    (4)  "Commissioner" or "health insurance commissioner" means that individual appointed pursuant to § 42-14. See Rhode Island General Laws 27-19-1

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
  • Contract: A legal written agreement that becomes binding when signed.
  • Contracting hospital: means an eligible hospital which has contracted with a nonprofit hospital service corporation to render hospital care to subscribers to the nonprofit hospital service plan operated by the corporation;

    (2)  "Adverse benefit determination" means any of the following: a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of an individual's eligibility to participate in a plan or to receive coverage under a plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit resulting from the application of any utilization review, as well as a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate. See Rhode Island General Laws 27-19-1

  • Conviction: A judgement of guilt against a criminal defendant.
  • 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.
  • covered benefits: means coverage or benefits for the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body including coverage or benefits for transportation primarily for and essential thereto, and including medical services as defined in § 27-19-17;

    (11)  "Healthcare facility" means an institution providing healthcare services or a healthcare setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings;

    (12)  "Healthcare professional" means a physician or other healthcare practitioner licensed, accredited or certified to perform specified healthcare services consistent with state law;

    (13)  "Healthcare provider" or "provider" means a healthcare professional or a healthcare facility;

    (14)  "Healthcare services" means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease;

    (15)  "Health insurance carrier" means a person, firm, corporation or other entity subject to the jurisdiction of the commissioner under this chapter, and includes nonprofit hospital service corporations. See Rhode Island General Laws 27-19-1

  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Dependent: A person dependent for support upon another.
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Donor: The person who makes a gift.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fraud: Intentional deception resulting in injury to another.
  • Grandfathered health plan: means any group health plan or health insurance coverage subject to 42 U. See Rhode Island General Laws 27-19-1
  • Group health insurance coverage: means , in connection with a group health plan, health insurance coverage offered in connection with such plan;

    (9)  "Group health plan" means an employee welfare benefit plan as defined 29 U. See Rhode Island General Laws 27-19-1

  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • 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 27-19-1
  • in writing: include printing, engraving, lithographing, and photo-lithographing, and all other representations of words in letters of the usual form. See Rhode Island General Laws 43-3-16
  • 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.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Medical services: as used in this chapter means professional services rendered by physicians, dentists, podiatrists, or other providers of health services for any medical, dental, surgical, and other health services as may lawfully be rendered by them to subscribers; the term includes appliances, drugs, medicines, supplies, and nursing care necessary in connection with those services, or the expense indemnity for those services, appliances, drugs, medicines, supplies, and care, as may be specified in any nonprofit medical service plan. See Rhode Island General Laws 27-19-17
  • Nonprofit hospital service corporation: means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit hospital service plan;

    (18)  "Nonprofit hospital service plan" means a plan by which specified hospital care is to be provided to subscribers to the plan by a contracting hospital;

    (19)  "Office of the health insurance commissioner" means the agency established under § 42-14. See Rhode Island General Laws 27-19-1

  • Oversight: Committee review of the activities of a Federal agency or program.
  • person: may be construed to extend to and include co-partnerships and bodies corporate and politic. See Rhode Island General Laws 43-3-6
  • Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
  • 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; and

    (21)  "Subscribers" mean those persons, whether or not residents of this state, who have contracted with a nonprofit hospital service corporation for hospital care pursuant to a nonprofit hospital service plan operated by the corporation. See Rhode Island General Laws 27-19-1

  • Subpoena: A command to a witness to appear and give testimony.
  • Subscribers: as used in this chapter includes, in addition to those set forth in § 27-19-1, persons contracting with the corporation for coverage or benefits for medical services. See Rhode Island General Laws 27-19-17
  • town: may be construed to include city; the words "town council" include city council; the words "town clerk" include city clerk; the words "ward clerk" include clerk of election district; the words "town treasurer" include city treasurer; and the words "town sergeant" include city sergeant. See Rhode Island General Laws 43-3-9
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • United States: include the several states and the territories of the United States. See Rhode Island General Laws 43-3-8