27 R.I. Gen. Laws § 27-20-61. Medical loss ratio reporting and rebates: Nonprofit Medical Service Corporations – Rhode Island
Status: Enacted Year Enacted: 2012
Health insurance carriers required to report medical loss ratio and rebate calculations and other medical loss ratio and rebate information to the U.S. Department of Health and Human Services shall concurrently file such information with …
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27 R.I. Gen. Laws § 27-20-62. Emergency services: Nonprofit Medical Service Corporations – Rhode Island
Status: Enacted Year Enacted: 2012
If a nonprofit medical service corporation offering health insurance coverage provides any benefits with respect to services in an emergency department of a hospital, it must cover emergency services consistent with the rules of this …
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27 R.I. Gen. Laws § 27-20-9. Examination of affairs of corporations: Nonprofit Medical Service Corporations – Rhode Island
Status: Enacted Year Enacted: 1945
It is the duty of the insurance commissioner to make an examination of the financial condition and methods of doing business of every nonprofit medical service corporation.
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27 R.I. Gen. Laws § 27-20.9-1. Health care contracts — Required provisions — Definitions: Contract with Health Care Providers – Rhode Island
Status: Enacted Year Enacted: 2007
Definitions related to Contract with Health Care Providers
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27 R.I. Gen. Laws § 27-20.9-2. Credentialing — Insurers shall notify providers of initial credentialing within ten business days of approval by the insurer credentialing committee: Contract with Health Care Providers – Rhode Island
Status: Enacted Year Enacted: 2007
The health insurer shall reimburse the health care provider for covered services rendered by the health care provider to the health insurer’s subscribers or members following the first business day after the credentialing committee’s approval, …
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27 R.I. Gen. Laws § 27-20.9-3. Pay-for-performance guidelines: Contract with Health Care Providers – Rhode Island
Status: Enacted Year Enacted: 2007
A health insurer shall not require a physician, as a condition of contracting, to participate in any financial or reimbursement incentive program, commonly referred to as pay-for-performance programs unless such program meets the principles and …
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27 R.I. Gen. Laws § 27-29-17.3. Notice of premium or coverage changes: Insurance – Unfair Competition and Practices – Rhode Island
Status: Enacted Year Enacted: 2003
An insurer shall provide to the first-named insured at the mailing address shown on the policy, and to the insurance producer of record, written notice of any premium increase in excess of ten percent (10%) …
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27 R.I. Gen. Laws § 27-41-10. Information to enrollees: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1983
Every health maintenance organization shall promptly provide to its enrollees notice of any material change in the operation of the organization that will affect them directly.
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27 R.I. Gen. Laws § 27-41-16. Examination: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1983
The director of health may make an examination concerning the quality of health care services of any health maintenance organization and the providers with whom the organization has contracts, agreements, or other arrangements as often …
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27 R.I. Gen. Laws § 27-41-2. Definitions: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1983
Provides defintions for Chapter 41 Health Maintenance Organizations.
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27 R.I. Gen. Laws § 27-41-29.1. Uniform explanation of benefits and coverage: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 2012
A health maintenance organization shall file all policy forms and rates used by it in the state with the commissioner. No such form shall be used if disapproved by the commissioner under this section
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27 R.I. Gen. Laws § 27-41-52. Restricted annual rate payments prohibited: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1998
(a) No corporation organized under this chapter shall compensate any provider of outpatient service by using the restricted annual rate method of payment. (b) The restricted annual rate method of payment is defined as any …
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27 R.I. Gen. Laws § 27-41-69. Post-payment audits: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 2006
Except as otherwise provided herein, any review, audit, or investigation by a health maintenance organization of a health-care provider’s claims that results in the recoupment or set-off of funds previously paid to the health-care provider …
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27 R.I. Gen. Laws § 27-41-78. Medical loss ratio reporting and rebates: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 2012
Health maintenance organizations required to report medical loss ratio and rebate calculations and other medical loss ratio and rebate information to the U.S. Department of Health and Human Services shall concurrently file such information with …
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27 R.I. Gen. Laws § 27-41-79. Emergency services: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 2012
If a nonprofit medical service corporation offering health insurance coverage provides any benefits with respect to services in an emergency department of a hospital, it must cover emergency services consistent with the rules of this …
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27 R.I. Gen. Laws § 27-41-8. Evidence of coverage and charges for health care services: Health Maintenance Organization Act – Rhode Island
Status: Enacted Year Enacted: 1983
Every enrollee is entitled to evidence of coverage for the payment and for the provision of health care services under a health maintenance organization. No schedule of charges, rates, or rating formulae for enrollee coverage …
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