Terms Used In Rhode Island General Laws > Chapter 27-18.5 - Individual Health Insurance Coverage

• 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 healthcare 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 healthcare 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 that evidences coverage under a policy or contract issued to a trust or association;

  (9)(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 healthcare services. See Rhode Island General Laws 27-18.5-2

• Commissioner: means the health insurance commissioner;

  (4)  "Creditable coverage" has the same meaning as defined in the United States Public Health Service Act, Section 2701(c), Rhode Island General Laws 27-18.5-2

• Contract: A legal written agreement that becomes binding when signed.
• 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.
• Dependent: A person dependent for support upon another.
• Director: means the director of the department of business regulation;

  (6)  "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, Rhode Island General Laws 27-18.5-2

• 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.
• Group health plan: means an employee welfare benefit plan as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, 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 conditions arising out of acts of domestic violence; and

  (viii)  Disability;

  (11)  "High-risk individuals" means those individuals who do not pass medical underwriting standards due to high healthcare needs or risks;

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

  (13)  "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;

  (14)  "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-month (6) period ending on the enrollment date. See Rhode Island General Laws 27-18.5-2

• 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.
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• 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
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• United States: include the several states and the territories of the United States. See Rhode Island General Laws 43-3-8
• Wellness health benefit plan: means that health benefit plan offered in the individual market pursuant to Rhode Island General Laws 27-18.5-2