R.I. Gen. Laws tit. 27, ch. 41 – Health Maintenance Organizations | Midpage

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Rhode Island General Laws

Chapter 27-41

R.I. Gen. Laws tit. 27, ch. 41

Health Maintenance Organizations

27-41-1Short title 27-41-2Definitions 27-41-3Establishment of health maintenance organizations 27-41-4Issuance of license 27-41-5Powers of health maintenance organizations 27-41-6Governing body 27-41-7Fiduciary responsibilities 27-41-8Evidence of coverage and charges for healthcare services 27-41-9Required reports 27-41-10Information to enrollees 27-41-11Complaint system 27-41-12Investments 27-41-13Protection against insolvency 27-41-13.1Initial net worth and capital requirements 27-41-13.2Ongoing net worth and capital requirements 27-41-13.3Waiver, surplus notes, and risk-based capital requirements 27-41-14Prohibited practices 27-41-14.1Prohibition against restraint on provider — Patient communications 27-41-15Powers of insurers and hospital and medical service corporations 27-41-16Examination 27-41-17Suspension or revocation of license 27-41-18Rehabilitation, liquidation, or conservation of health maintenance organization 27-41-18.1Summary orders and supervision 27-41-19Rules and regulations 27-41-20Administrative procedures 27-41-21Penalties and enforcement 27-41-22Statutory construction and relationship to other laws 27-41-23Filings and reports as public documents 27-41-24Director of health’s authority to contract 27-41-25Holding company systems 27-41-26Enrollee liability 27-41-26.1Patient responsibility — Administrative requirements 27-41-27Offer of health maintenance organization alternative to employees 27-41-27.1No derogation of attorney general 27-41-27.2Health insurance rates 27-41-28Applicability 27-41-29Severability 27-41-29.1Uniform explanation of benefits and coverage 27-41-29.2Filing of policy forms 27-41-30Mammograms and pap smears — Coverage mandated 27-41-30.1Postpartum hospital stays 27-41-31Mammograms — Quality assurance standards 27-41-32Pap smears — Quality assurance standards 27-41-33Coverage for infertility 27-41-34Health maintenance organizations’ assessment 27-41-35Enrollment period in the event of insolvency 27-41-36Services of midwives 27-41-37Discontinuance of coverage — Chronic disabilities 27-41-38Drug coverage 27-41-38.1Medication synchronization 27-41-38.2Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies 27-41-38.3Specialty drugs 27-41-38.4Patient choice in dispensing of clinician-administered drugs 27-41-39Certified registered nurse practitioners and psychiatric and mental health nurse clinical specialists 27-41-40Certified counselors in mental health and therapists in marriage and family practice 27-41-43Mastectomy treatment 27-41-43.1Insurance coverage for mastectomy hospital stays 27-41-44Diabetes treatment 27-41-45Primary and preventive obstetric and gynecological care 27-41-45.1Hysterectomy or myomectomy treatment 27-41-46Whistleblowers protection 27-41-47Penalties and remedies 27-41-48Additional relief and damages — Reinstatement 27-41-49Third-party reimbursement for services of certain healthcare workers 27-41-49.1Third-party reimbursement for services of registered nurse first assistants 27-41-50Human leukocyte antigen testing 27-41-51Drug coverage 27-41-52Restricted annual rate payments prohibited 27-41-53Genetic testing 27-41-53.1Genetic information 27-41-54Disassociation prohibited 27-41-56Magnetic resonance imaging — Quality assurance standards 27-41-57Acupuncture services 27-41-58Prohibition against requiring indemnification from dentists 27-41-59FDA approved prescription contraceptive drugs and devices 27-41-60Prostate and colorectal examinations — Coverage mandated — The Maryellen Goodwin Colorectal Cancer Screening Act 27-41-61Eligibility for children’s benefits 27-41-62Temporary credentials 27-41-63Hearing aids 27-41-64Prompt processing of claims 27-41-65Mandatory coverage for certain lyme disease treatments 27-41-66Dental insurance assignment of benefits 27-41-67Determination of maximum coverage limitation for prescription drug benefits 27-41-68Coverage for early intervention services 27-41-69Post-payment audits 27-41-70Tobacco cessation programs 27-41-71Mandatory coverage for scalp hair prosthesis 27-41-72Reimbursement for orthotic and prosthetic services 27-41-73Licensed ambulance service 27-41-74Enteral nutrition products 27-41-75Prohibition on rescission of coverage 27-41-76Prohibition on annual and lifetime limits 27-41-77Coverage for individual participating in approved clinical trials 27-41-78Medical loss ratio reporting and rebates 27-41-79Emergency services 27-41-80Internal and external appeal of adverse benefit determinations 27-41-81Prohibition on preexisting condition exclusions 27-41-82Primary care provider designation requirement 27-41-83Discretionary clauses 27-41-84Orally administered anticancer medication — Cost-sharing requirement 27-41-85Consumer notification 27-41-86Opioid antagonists 27-41-87Healthcare provider credentialing 27-41-88Unfair discrimination prohibited 27-41-89Health insurance contracts — Full year coverage for contraception 27-41-90Prohibition on discrimination in organ transplants 27-41-91Health insurance contracts — Copayments exemption for COVID-19 vaccinations 27-41-92Perinatal doulas 27-41-93Gender rating 27-41-94Coverage for biomarker testing 27-41-95Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome 27-41-96Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection 27-41-98Dispensing and administration of HIV PrEP or PEP drugs 27-41-99Epinephrine injectors 27-41-100Acute mental health crisis mobile response and stabilization services. [Effective January 1, 2026.]