(a)  This section applies to all health benefit group contracts issued by an insurer when a member of the group changes from one group to another group due to a change in employment, or when due to the action of the employer or insurer is: (1) Forced to change from one benefit plan to another; or (2) Forced to change from one insurer to another.

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Terms Used In Rhode Island General Laws 27-20.4-5

  • Contract: A legal written agreement that becomes binding when signed.
  • 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. See Rhode Island General Laws 27-20.4-3
  • 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. See Rhode Island General Laws 27-20.4-3

  • person: may be construed to extend to and include co-partnerships and bodies corporate and politic. See Rhode Island General Laws 43-3-6
  • Prior contract: means the group or individual health benefit contract or health benefit plan that previously covered the person. See Rhode Island General Laws 27-20.4-3
  • 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. See Rhode Island General Laws 27-20.4-3

(b)  Except as provided in subsection (c) of this section, this section provides continuity of coverage for a person who seeks coverage under a succeeding contract if coverage under the prior contract is terminated within three (3) months before the date the person enrolls or is eligible to enroll in the succeeding contract. No period of ineligibility for any health plan imposed by terms of employment may be considered in determining whether the coverage ended within three (3) months of the date the person enrolls or would be eligible to enroll, and if:

(1)  That person was covered under an individual or group contract or policy issued by any insurer and that person’s health benefit plan was eliminated by the employer or the insurer; or

(2)  That person was covered under an individual or group contract or policy issued by any insurer and that person has terminated employment and at, or following, termination of employment that person is not eligible or is no longer eligible for COBRA continuation coverage under group health plans as provided for in 42 U.S.C. § 300bb-1 et seq., or for extended medical benefits as provided in chapter 19.1 of this title.

(c)  Notwithstanding subsection (b) of this section, this section does not provide continuity of coverage for a late enrollee.

(d)  Except as otherwise provided in this section, in a group health benefit contract subject to this section, any insurer covering employees of the employer must, for any person described in subsection (b) of this section, waive any medical underwriting, but only to the extent that the underwriting is used to exclude a specific condition or the person, or waive preexisting conditions exclusion or limitations to the extent that benefits would have been payable under the prior contract if that contract were still in effect. The issuer of the succeeding contract is not required to duplicate any benefits covered by the issuer of the prior contract.

History of Section.
P.L. 1991, ch. 321, § 1; P.L. 1992, ch. 387, § 1.