(a)  No contract between an eye care provider and a healthcare entity or vision plan may require that an eye care provider provide services or materials to its beneficiaries at a fee set by the insurer or vision plan, unless the insurer or vision plan compensates the eye care provider for the provision of such services or materials to the beneficiary. Reimbursement paid by the insurer or vision plan for covered services and materials shall not provide nominal reimbursement in order to claim that services and materials are covered services.

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Terms Used In Rhode Island General Laws 27-18.8-5

  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Beneficiary: means a policy holder subscriber, enrollee, or other individual participating in a health benefit plan. See Rhode Island General Laws 27-18.8-2
  • Contract: A legal written agreement that becomes binding when signed.
  • Healthcare entity: means an insurance company licensed, or required to be licensed, by the state of Rhode Island or other entity subject to the jurisdiction of the commissioner or the jurisdiction of the department of business regulation that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including, without limitation: a for-profit or nonprofit hospital, medical or dental service corporation or plan, a health maintenance organization, a health insurance company, or any other entity providing health insurance, accident and sickness insurance, health benefits, or healthcare services. See Rhode Island General Laws 27-18.8-2
  • Provider: means a physician, hospital, professional provider, pharmacy, laboratory, dental, medical, or behavioral health provider, or other state-licensed or other state-recognized provider of health care or behavioral health services or supplies. See Rhode Island General Laws 27-18.8-2

(b)(1)  “Services” means services and materials for which reimbursement from the vision plan is provided for by a beneficiary‘s plan contract, or for which a reimbursement would be available but for the application of the beneficiary’s contractual limitations of deductibles, copayments, or coinsurance.

(2)  “Materials” means and includes, but is not limited to: lenses, devices containing lenses, prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa.

(3)  “Eye care provider” means an optometrist, optician, or ophthalmologist.

History of Section.
P.L. 2017, ch. 302, art. 5, § 4.