(a)  Subscribers to any health maintenance organization plan shall be afforded coverage under that plan for prostate and colorectal examinations and laboratory tests for cancer for any nonsymptomatic person covered under the policy or plan. The coverage required by this section shall include preventive colorectal cancer screening coverage for all colorectal cancer examinations and laboratory tests in accordance with American Cancer Society guidelines, including for colorectal cancer screening of average risk individuals, including an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial medical test or procedure are abnormal.

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Terms Used In Rhode Island General Laws 27-41-60

  • Health maintenance organization: means a single public or private organization that:

    (i)  Provides or makes available to enrolled participants healthcare services, including at least the following basic healthcare services: usual physician services, hospitalization, laboratory, x-ray, emergency, and preventive services, and out-of-area coverage, and the services of licensed midwives;

    (ii)  Is compensated, except for copayments, for the provision of the basic healthcare services listed in subsection (20)(i) of this section to enrolled participants on a predetermined periodic rate basis;

    (iii)(A)  Provides physicians' services primarily:

    (I)  Directly through physicians who are either employees or partners of the organization; or

    (II)  Through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis;

    (B)  "Health maintenance organization" does not include prepaid plans offered by entities regulated under chapter 1, 2, 19, or 20 of this title that do not meet the criteria above and do not purport to be health maintenance organizations; and

    (iv)  Provides the services of licensed midwives primarily:

    (A)  Directly through licensed midwives who are either employees or partners of the organization; or

    (B)  Through arrangements with individual licensed midwives or one or more groups of licensed midwives organized on a group practice or individual practice basis. See Rhode Island General Laws 27-41-2

  • person: may be construed to extend to and include co-partnerships and bodies corporate and politic. See Rhode Island General Laws 43-3-6
  • provider: means a healthcare professional or a healthcare facility. See Rhode Island General Laws 27-41-2

(b)  An insurer or the organization may not impose cost sharing on the coverage required by subsection (a) when the services are delivered within the health insurer’s provider network.

History of Section.
P.L. 2000, ch. 125, § 4; P.L. 2000, ch. 345, § 4; P.L. 2021, ch. 7, § 5, effective April 29, 2021; P.L. 2021, ch. 8, § 5, effective April 29, 2021.