(a)  A health insurance carrier that provides individual health insurance coverage to an individual in this state shall renew or continue in force that coverage at the option of the individual.

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Terms Used In Rhode Island General Laws 27-18.5-4

  • 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

  • Fraud: Intentional deception resulting in injury to another.
  • 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

(b)  A health insurance carrier may non-renew or discontinue health insurance coverage of an individual in the individual market based only on one or more of the following:

(1)  The individual has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage, including terms relating to timely premium payments;

(2)  The individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage;

(3)  The carrier is ceasing to offer coverage in accordance with subsections (c) and (d) of this section;

(4)  In the case of a carrier that offers health insurance coverage in the market through a network plan, the individual no longer resides, lives, or works in the service area (or in an area for which the carrier is authorized to do business) but only if the coverage is terminated uniformly without regard to any health status-related factor of covered individuals; or

(5)  In the case of health insurance coverage that is made available in the individual market only through one or more bona fide associations, the membership of the individual in the association (on the basis of which the coverage is provided) ceases but only if the coverage is terminated uniformly and without regard to any health status-related factor of covered individuals.

(c)  In any case in which a carrier decides to discontinue offering a particular type of health insurance coverage offered in the individual market, coverage of that type may be discontinued only if:

(1)  The carrier provides notice, to each covered individual provided coverage of this type in the market, of the discontinuation at least ninety (90) days prior to the date of discontinuation of the coverage;

(2)  The carrier offers to each individual in the individual market provided coverage of this type, the opportunity to purchase any other individual health insurance coverage currently being offered by the carrier for individuals in the market; and

(3)  In exercising this option to discontinue coverage of this type and in offering the option of coverage under subdivision (2) of this subsection, the carrier acts uniformly without regard to any health status-related factor of enrolled individuals or individuals who may become eligible for the coverage.

(d)  In any case in which a carrier elects to discontinue offering all health insurance coverage in the individual market in this state, health insurance coverage may be discontinued only if:

(1)  The carrier provides notice to the commissioner and to each individual of the discontinuation at least one hundred eighty (180) days prior to the date of the expiration of the coverage; and

(2)  All health insurance issued or delivered in this state in the market is discontinued and coverage under this health insurance coverage in the market is not renewed.

(e)  In the case of a discontinuation under subsection (d) of this section, the carrier may not provide for the issuance of any health insurance coverage in the individual market in this state during the five-year (5) period beginning on the date the carrier filed its notice with the department to withdraw from the individual health insurance market in this state. This five-year (5) period may be reduced to a minimum of three (3) years at the discretion of the health insurance commissioner, based on the commissioner’s analysis of market conditions and other related factors.

(f)  The provisions of subsections (d) and (e) of this section do not apply if, at the time of coverage renewal, a health insurance carrier modifies the health insurance coverage for a policy form offered to individuals in the individual market so long as the modification is consistent with this chapter and other applicable law and effective on a uniform basis among all individuals with that policy form.

(g)  In applying this section in the case of health insurance coverage made available by a carrier in the individual market to individuals only through one or more associations, a reference to an “individual” includes a reference to the association (of which the individual is a member).

History of Section.
P.L. 2000, ch. 200, § 4; P.L. 2000, ch. 229, § 4; P.L. 2005, ch. 68, § 1; P.L. 2005, ch. 78, § 1; P.L. 2023, ch. 214, § 1, effective June 21, 2023; P.L. 2023, ch. 215, § 1, effective June 21, 2023.