§ 5-8-1 Registration required for practice of engineering
§ 5-8-2 Definitions
§ 5-8-3 Board — Creation — Duties — Composition — Appointments — Terms
§ 5-8-4 Board — Member qualifications
§ 5-8-5 Board — Compensation and expenses of members
§ 5-8-6 Board — Removal of members — Vacancies
§ 5-8-7 Board — Organization — Meetings — Quorum
§ 5-8-8 Board — Powers
§ 5-8-9 Records and reports
§ 5-8-10 Roster of registered engineers
§ 5-8-11 General requirements for registration or certification
§ 5-8-12 Form of application for registration or certification — Registration, certification, and enrollment fees
§ 5-8-13 Examinations
§ 5-8-14 Certificates of registration — Enrollment cards — Seals
§ 5-8-15 Expiration and renewal of certificates of registration
§ 5-8-17 Public works
§ 5-8-18 Suspension and revocation of certificates — Complaints — Hearings
§ 5-8-19 Appeals
§ 5-8-20 Violations and penalties — Enforcement — Injunctions
§ 5-8-21 Exemptions
§ 5-8-22 Severability
§ 5-8-23 Deposit of fees
§ 5-8-24 Sole proprietorship, partnership, limited liability partnership, corporate and limited liability company
§ 5-8-25 Engineers rendering assistance during disaster emergency — Immunity from civil liability

Terms Used In Rhode Island General Laws > Chapter 5-8

  • Administrator: means a person who directly or indirectly solicits or effects coverage of, underwrites, collects charges or premiums from, or adjusts or settles claims on residents of this state, or residents of another state from offices in this state, in connection with life or health insurance coverage or annuities, except any of the following:

    (i) An employer on behalf of its employees or the employees of one or more subsidiaries or affiliated corporations of the employer;

    (ii) A union on behalf of its members;

    (iii) An insurer which is authorized to transact insurance in this state with respect to a policy lawfully issued and delivered in and pursuant to the laws of this state or another state;

    (iv) A producer licensed to sell life or health insurance in this state, whose activities are limited exclusively to the sale of insurance;

    (v) A creditor on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtors;

    (vi) A trust and its trustees, agents and employees acting pursuant to the trust established in conformity with 29 U. See Rhode Island General Laws 27-20.7-2.

  • Adverse benefit determination: means a decision not to authorize a health care service, including a denial, reduction, or termination of, or a failure to provide or make a payment, in whole or in part, for a benefit. See Rhode Island General Laws 27-18.9-2.
  • affiliated: means an entity or person who directly or indirectly through one or more intermediaries controls or is controlled by, or is under common control with, a specified entity or person. See Rhode Island General Laws 27-20.7-2.
  • Affiliation period: means a period which, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective. See Rhode Island General Laws 27-18.6-2.
  • 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. See Rhode Island General Laws 27-18-1.1.
  • 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;

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

  • Authorization: means a review by a review agent, performed according to this chapter, concluding that the allocation of health care services ordered by a provider, given or proposed to be given to a beneficiary, was approved or authorized. See Rhode Island General Laws 27-18.9-2.
  • Authorized representative: means an individual acting on behalf of the beneficiary and shall include: the ordering provider; any individual to whom the beneficiary has given express written consent to act on his or her behalf; a person authorized by law to provide substituted consent for the beneficiary; and, when the beneficiary is unable to provide consent, a family member of the beneficiary. See Rhode Island General Laws 27-18.9-2.
  • Beneficiary: has the meaning given that term under section 3(8) of the Employee Retirement Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2.
  • Beneficiary: means a policy holder subscriber, enrollee, or other individual participating in a health benefit plan. See Rhode Island General Laws 27-18.8-2.
  • Beneficiary: means a policy-holder subscriber, enrollee, or other individual participating in a health benefit plan. See Rhode Island General Laws 27-18.9-2.
  • Benefit determination: means a decision to approve or deny a request to provide or make payment for a health care service or treatment. See Rhode Island General Laws 27-18.9-2.
  • 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 or health benefits by which health care services are paid or financed for an eligible individual or his or her dependents by such entity on the basis of a periodic premium, paid directly or through an association, trust, or other intermediary, and issued, renewed, or delivered within or without Rhode Island to cover a natural person who is a resident of this state, including a certificate issued to a natural person which evidences coverage under a policy or contract issued to a trust or association;

    (8)(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 27-18.5-2.

  • 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.

  • Certificate: means a certificate granted by the commissioner to a health care entity meeting the requirements of this chapter. See Rhode Island General Laws 27-18.8-2.
  • Certificate: means a certificate granted by the commissioner to a review agent meeting the requirements of this chapter. See Rhode Island General Laws 27-18.9-2.
  • Church plan: has the meaning given that term under section 3(33) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2.
  • Claim: means a request for plan benefit(s) made by a claimant in accordance with the health care entity's reasonable procedures for filing benefit claims. See Rhode Island General Laws 27-18.9-2.
  • Claimant: means a health care entity participant, beneficiary, and/or authorized representative who makes a request for plan benefit(s). See Rhode Island General Laws 27-18.9-2.
  • Commissioner: means the health insurance commissioner. See Rhode Island General Laws 27-18.5-2.
  • Commissioner: means the commissioner of the office of the health insurance commissioner. See Rhode Island General Laws 27-18.8-2.
  • Commissioner: means the health insurance commissioner. See Rhode Island General Laws 27-18.9-2.
  • Commissioner: means the commissioner of insurance. See Rhode Island General Laws 27-20.7-2.
  • Complaint: means an oral or written expression of dissatisfaction by a beneficiary, authorized representative, or provider. See Rhode Island General Laws 27-18.8-2.
  • Complaint: means an oral or written expression of dissatisfaction by a beneficiary, authorized representative, or a provider. See Rhode Island General Laws 27-18.9-2.
  • 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.

  • 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 R. See Rhode Island General Laws 27-18-1.1.
  • 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 R. See Rhode Island General Laws 27-19-1.
  • Delegate: means a person or entity authorized pursuant to a delegation of authority or directly or re-delegation of authority, by a health care entity or network plan to perform one or more of the functions and responsibilities of a health care entity and/or network plan set forth in this chapter or regulations or guidance promulgated thereunder. See Rhode Island General Laws 27-18.8-2.
  • Dental service: means the professional services rendered by persons duly licensed under the laws of this state to practice dentistry, and prosthetic dentures, bridges, appliances, or other structures to be used and worn as substitutes for natural teeth, prosthetic appliances, orthodontic appliances, precious metal, and ceramic restorations, necessary in connection with the services and supplied by licensed persons, and drugs, medicines, supplies, and nursing care necessary in connection with the services, or expense indemnity for the services, prosthetic dentures, bridges, appliances, or other structures to be used and worn as substitutes for natural teeth, prosthetic appliances, orthodontic appliances, precious metal and ceramic restorations, drugs, medicines, supplies, and care, as may be specified in any nonprofit dental service plan. See Rhode Island General Laws 27-20.1-1.
  • Director: means the director of the department of business regulation;

    (5) "Eligible individual" means an individual:

    (i) For whom, as of the date on which the individual seeks coverage under this chapter, the aggregate of the periods of creditable coverage is eighteen (18) or more months and whose most recent prior creditable coverage was under a group health plan, a governmental plan established or maintained for its employees by the government of the United States or by any of its agencies or instrumentalities, or church plan (as defined by the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.5-2.

  • 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.

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

    (2) "Individual contract" means any health benefit contract that is not a group contract;

    (3) "Insurer" means every medical service corporation, hospital service corporation, health maintenance organization licensed under chapter 41 of this title or as defined in § 42-62-4, or insurance company offering and/or insuring health services;

    (4) "Late enrollee" means a person who requests enrollment in a group plan following the initial enrollment period provided under the terms of the plan, except that a person is not a late enrollee if:

    (i) The request for enrollment is made within thirty (30) days after the termination of coverage under a prior contract or policy and the individual did not request coverage initially under the succeeding contract because that individual was covered under a prior contract and coverage under that contract ceased due to termination of employment, death of a spouse, or divorce; or

    (ii) A court has ordered that coverage be provided for a spouse or minor child under a covered employee's plan and the request for coverage is made within thirty (30) days after issuance of the court order;

    (5) "Prior contract" means the group or individual health benefit contract or health benefit plan that previously covered the person;

    (6) "Replacement contract" means a total group health benefit contract which replaces another total group health benefit contract;

    (7) "Succeeding contract" means the group health benefit contract under which the person is seeking coverage or a different health benefit plan under the same group health benefit contract; and

    (8) "Total group contract" means a health benefit contract for the coverage of all eligible members of the employer health plan. See Rhode Island General Laws 27-20.4-3.

  • 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.
  • Enrollment date: means , with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for the enrollment;

    (11) "Governmental plan" has the meaning given that term under section 3(32) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2.

  • External review: means a review of a non-administrative adverse benefit determination (including final internal adverse benefit determination) conducted pursuant to an applicable external review process performed by an independent review organization. See Rhode Island General Laws 27-18.9-2.
  • External review decision: means a determination by an independent review organization at the conclusion of the external review. See Rhode Island General Laws 27-18.9-2.
  • Governmental plan: has the meaning given that term under section 3(32) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.6-2.
  • Grandfathered health plan: means any group health plan or health insurance coverage subject to 42 U. See Rhode Island General Laws 27-18-1.1.
  • 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. See Rhode Island General Laws 27-18-1.1.
  • 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.

  • 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.

  • Group health plan: means an employee welfare benefit plan, as defined in 29 U. See Rhode Island General Laws 27-18-1.1.
  • Group health plan: means an employee welfare benefit plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, 29 U. See Rhode Island General Laws 27-18.5-2.
  • 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.
  • 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.
  • Health care contract: means a contract entered into or renewed between a health insurer and a health care provider for the delivery of health care services to others. See Rhode Island General Laws 27-20.9-1.
  • Health care entity: means an insurance company licensed, or required to be licensed, by the state of Rhode Island or other entity subject to the jurisdiction of the commissioner or the jurisdiction of the department of business regulation that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including, without limitation: a for-profit or nonprofit hospital, medical or dental service corporation or plan, a health maintenance organization, a health insurance company, or any other entity providing health insurance, accident and sickness insurance, health benefits, or health care services. See Rhode Island General Laws 27-18.8-2.
  • Health care entity: means an insurance company licensed, or required to be licensed, by the state of Rhode Island or other entity subject to the jurisdiction of the commissioner or the jurisdiction of the department of business regulation pursuant to chapter 62 of title 42, that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including, without limitation: a for-profit or nonprofit hospital, medical or dental service corporation or plan, a health maintenance organization, a health insurance company, or any other entity providing a plan of health insurance, accident and sickness insurance, health benefits, or health care services. See Rhode Island General Laws 27-18.9-2.
  • Health care facility: means an institution providing health care services or a health care 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. See Rhode Island General Laws 27-18-1.1.
  • Health care professional: means a physician or other health care practitioner licensed, accredited or certified to perform specified health care services consistent with state law. See Rhode Island General Laws 27-18-1.1.
  • Health care provider: means a person licensed or certified in this state to practice medicine, pharmacy, chiropractic, nursing, physical therapy, podiatry, dentistry, optometry, occupational therapy, or other healing arts. See Rhode Island General Laws 27-20.9-1.
  • Health care services: means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease. See Rhode Island General Laws 27-18-1.1.
  • Health care services: means and includes, but is not limited to: an admission, diagnostic procedure, therapeutic procedure, treatment, extension of stay, the ordering and/or filling of formulary or non-formulary medications, and any other medical, behavioral, dental, vision care services, activities, or supplies that are covered by the beneficiary's health benefit plan. See Rhode Island General Laws 27-18.8-2.
  • Health care services: means and includes, but is not limited to: an admission, diagnostic procedure, therapeutic procedure, treatment, extension of stay, the ordering and/or filling of formulary or non-formulary medications, and any other medical, behavioral, dental, vision care services, activities, or supplies that are covered by the beneficiary's health benefit plan. See Rhode Island General Laws 27-18.9-2.
  • Health insurance carrier: means a person, firm, corporation or other entity subject to the jurisdiction of the commissioner under this chapter. See Rhode Island General Laws 27-18-1.1.
  • health insurance commissioner: means that individual appointed pursuant to § 42-14. See Rhode Island General Laws 27-18-1.1.
  • Health 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 any third-party administrator when interacting with health care providers and enrollees on behalf of such an insurer. See Rhode Island General Laws 27-20.9-1.
  • health plan: means a policy, contract, certificate, or agreement entered into, offered, or issued by a health care entity to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Rhode Island General Laws 27-18.8-2.
  • 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 conditions arising out of acts of domestic violence; and

    (viii) Disability;

    (10) "Individual market" means the market for health insurance coverage offered to individuals other than in connection with a group health plan;

    (11) "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;

    (12) "Preexisting condition" means, with respect to health insurance coverage, a condition (whether physical or mental), regardless of the cause of the condition, that was present before the date of enrollment for the coverage, for which medical advice, diagnosis, care, or treatment was recommended or received within the six (6) month period ending on the enrollment date. See Rhode Island General Laws 27-18.5-2.

  • 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.

  • Health-care facility: means an institution providing health-care services or a health-care 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) "Health-care professional" means a physician or other health-care practitioner licensed, accredited or certified to perform specified health-care services consistent with state law;

    (13) "Health-care provider" or "provider" means a health-care professional or a health-care facility;

    (14) "Health-care 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.

  • High-risk individuals: means those individuals who do not pass medical underwriting standards, due to high health care needs or risks;

    (14) "Wellness health benefit plan" means that health benefit plan offered in the individual market pursuant to § 27-18. See Rhode Island General Laws 27-18.5-2.

  • 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.
  • 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.
  • 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.

  • Insurer: includes all persons, firms or corporations offering and/or insuring health services on a prepaid basis, including, but not limited to, policies of accident and sickness insurance as defined by chapter 18 of this title, nonprofit hospital or medical service plans as defined by chapters 19 and 20 of this title, or any other entity whose primary function is to provide diagnostic, therapeutic or preventive services to a defined population on the basis of a periodic premium. See Rhode Island General Laws 27-20.7-2.
  • internal appeal: means a subsequent review of an adverse benefit determination upon request by a claimant to include the beneficiary or provider to reconsider all or part of the original adverse benefit determination. See Rhode Island General Laws 27-18.9-2.
  • IRO: means an entity that conducts independent external reviews of adverse benefit determinations or final internal adverse benefit determinations. See Rhode Island General Laws 27-18.9-2.
  • 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.

  • Legal service: means the professional services rendered by persons duly licensed under the laws of this state to engage in the practice of law who have agreed to perform services as may be specified under any nonprofit prepaid legal service plan, and to accept payment for the services on the basis provided in the plan. See Rhode Island General Laws 27-20.3-1.
  • 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.
  • Most-favored-rate clause: means a provision in a provider contract whereby the rates or fees to be paid by a health care entity are fixed, established, or adjusted to be equal to or lower than the rates or fees paid to the provider by any other health care entity. See Rhode Island General Laws 27-18.8-2.
  • Network: means the group or groups of participating providers providing health care services under a network plan. See Rhode Island General Laws 27-18.8-2.
  • Network: means the group or groups of participating providers providing health care services under a network plan. See Rhode Island General Laws 27-18.9-2.
  • Network plan: means a health benefit plan or health plan that either requires a beneficiary to use, or creates incentives, including financial incentives, for a beneficiary to use the providers managed, owned, under contract with, or employed by the health care entity. See Rhode Island General Laws 27-18.8-2.
  • Network plan: means a health benefit plan or health plan that either requires a beneficiary to use, or creates incentives, including financial incentives, for a beneficiary to use the providers managed, owned, under contract with, or employed by the health care entity. See Rhode Island General Laws 27-18.9-2.
  • Nonprofit dental service corporation: means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit dental service plan;

    (3) "Nonprofit dental service plan" means a plan by which specified dental service is provided to subscribers to the plan by a nonprofit dental service corporation; and

    (4) "Subscribers" means those persons or groups of persons who contract with a nonprofit dental service corporation for dental service pursuant to a nonprofit dental service plan. See Rhode Island General Laws 27-20.1-1.

  • 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.

  • Nonprofit optometric service corporation: means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit optometric service plan;

    (2) "Nonprofit optometric service plan" means a plan by which specified optometric service is provided to subscribers to the plan by a nonprofit optometric service corporation;

    (3) "Optometric service" means the professional services rendered by persons duly licensed under the laws of this state to practice optometry or the expense indemnity for the services, appliances, supplies, and care as may be specified in any nonprofit optometric service plan. See Rhode Island General Laws 27-20.2-1.

  • Nonprofit prepaid legal service corporation: means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit prepaid legal services plan;

    (3) "Nonprofit prepaid legal services plan" means any plan by which reimbursement for specified legal services is provided to participating attorneys or subscribers to the plan by a nonprofit prepaid legal service corporation, and the plan shall be open for participation to all qualified, practicing members of the Rhode Island Bar Association; and

    (4) "Subscribers" means those persons or groups of persons who shall contract with a nonprofit legal service corporation for reimbursement for specified legal services pursuant to a nonprofit legal services plan. See Rhode Island General Laws 27-20.3-1.

  • oath: includes affirmation; the word "sworn" includes affirmed; and the word "engaged" includes either sworn or affirmed. See Rhode Island General Laws 43-3-11.
  • Office: means the office of the health insurance commissioner. See Rhode Island General Laws 27-18.8-2.
  • Office: means the office of the health insurance commissioner. See Rhode Island General Laws 27-18.9-2.
  • Office of the health insurance commissioner: means the agency established under § 42-14. See Rhode Island General Laws 27-18-1.1.
  • 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.
  • person: extends to and includes co-partnerships and bodies corporate and politic. See Rhode Island General Laws 43-3-6.
  • Placed for adoption: means , in connection with any placement for adoption of a child with any person, the assumption and retention by that person of a legal obligation for total or partial support of the child in anticipation of adoption of the child. 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.
  • Policy of accident and sickness insurance: as used in this chapter , includes any policy or contract covering against loss resulting from sickness or from bodily injury or death by accident, or both. See Rhode Island General Laws 27-18-1.
  • Pre-service claim: means the request for a plan benefit(s) by a claimant prior to a service being rendered and is not considered a concurrent claim. See Rhode Island General Laws 27-18.9-2.
  • Preexisting condition exclusion: means , with respect to health insurance coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for the coverage, whether or not any medical advice, diagnosis, care or treatment was recommended or received before the date; and

    (27) "Waiting period" means, with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. See Rhode Island General Laws 27-18.6-2.

  • Professional provider: means an individual provider or health care professional licensed, accredited, or certified to perform specified health care services consistent with state law and who provides these health care services and is not part of a separate facility or institutional contract. See Rhode Island General Laws 27-18.8-2.
  • Professional provider: means an individual provider or health care professional licensed, accredited, or certified to perform specified health care services consistent with state law and who provides health care services and is not part of a separate facility or institutional contract. See Rhode Island General Laws 27-18.9-2.
  • provider: means a health care professional or a health care facility. See Rhode Island General Laws 27-18-1.1.
  • Provider: means a physician, hospital, professional provider, pharmacy, laboratory, dental, medical, or behavioral health provider, or other state-licensed or other state-recognized provider of health care or behavioral health services or supplies. See Rhode Island General Laws 27-18.8-2.
  • Provider: means a physician, hospital, professional provider, pharmacy, laboratory, dental, medical, or behavioral health provider or other state-licensed or other state-recognized provider of health care or behavioral health services or supplies. See Rhode Island General Laws 27-18.9-2.
  • 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.
  • 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.

  • Review agent: means a person or health care entity performing benefit determination reviews that is either employed by, affiliated with, under contract with, or acting on behalf of a health care entity. See Rhode Island General Laws 27-18.9-2.
  • Same or similar specialty: means a practitioner who has the appropriate training and experience that is the same or similar as the attending provider in addition to experience in treating the same problems to include any potential complications as those under review. See Rhode Island General Laws 27-18.9-2.
  • seal: shall be construed to include an impression of the seal made with or without the use of wax or wafer on the paper. See Rhode Island General Laws 43-3-15.
  • 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.
  • Subscribers: means those persons or groups of persons who contract with a nonprofit optometric service corporation for optometric service pursuant to a nonprofit optometric service plan. See Rhode Island General Laws 27-20.2-1.
  • 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.
  • underwriting: means , but is not limited to, the acceptance of employer or individual applications for coverage of individuals in accordance with the written rules of the insurer; the overall planning and coordinating of an insurance program; and the ability to procure bonds and excess insurance. See Rhode Island General Laws 27-20.7-2.
  • United States: include the several states and the territories of the United States. See Rhode Island General Laws 43-3-8.
  • Utilization review: means the prospective, concurrent, or retrospective assessment of the medical necessity and/or appropriateness of the allocation of health care services of a provider, given or proposed to be given, to a beneficiary. See Rhode Island General Laws 27-18.9-2.