§ 27-20-1 Definitions
§ 27-20-1.1 Applicability
§ 27-20-2 Organization as charitable corporation – Insurance laws inapplicable
§ 27-20-3 Qualifications of directors
§ 27-20-4 Approval of articles of association
§ 27-20-5 Contracts with subscribers
§ 27-20-5.1 Cancellation of coverage by employers
§ 27-20-5.3 Patient responsibility – Administrative requirements
§ 27-20-6 Rates charged subscribers – Hearing by commissioner
§ 27-20-6.1 Uniform explanation of benefits and coverage
§ 27-20-6.2 Filing of policy forms
§ 27-20-7 Relationship of physician and patient – Actions against corporation
§ 27-20-8 Annual and quarterly statements
§ 27-20-9 Examination of affairs of corporation
§ 27-20-10 Commission plans for solicitors or insurance producers
§ 27-20-11 Investment standards
§ 27-20-12 Corporation deemed public charitable institution
§ 27-20-13 Adoption of chapter by hospital service corporation
§ 27-20-14 Coverage for adoptive children
§ 27-20-15 Itemized bills for services rendered
§ 27-20-16 Changing coverage
§ 27-20-17 Mammograms and pap smears – Coverage mandated
§ 27-20-17.1 Insurance coverage for postpartum hospital stays
§ 27-20-18 Mammograms – Quality assurance standards
§ 27-20-19 Pap smears – Quality assurance standards
§ 27-20-20 Coverage for infertility
§ 27-20-21 Nonprofit medical service corporation assessment
§ 27-20-22 Discontinuance of coverage – Chronic disabilities
§ 27-20-23 Drug coverage
§ 27-20-23.1 Medication synchronization
§ 27-20-23.2 Pharmacy benefit manager requirements with respect to multi-source generic pricing updates to pharmacies
§ 27-20-24 Rehabilitation, liquidation, or conservation
§ 27-20-25 Holding company systems
§ 27-20-25.1 No derogation of attorney general
§ 27-20-25.2 Health insurance rates
§ 27-20-26 Regulations
§ 27-20-27 New cancer therapies – Under investigation
§ 27-20-27.1 “Reliable evidence” defined
§ 27-20-27.2 Conditions of coverage
§ 27-20-27.3 Managed care
§ 27-20-29 Mastectomy treatment
§ 27-20-29.1 Insurance coverage for mastectomy hospital stays
§ 27-20-30 Diabetes treatment
§ 27-20-31 Primary and preventive obstetric and gynecological care
§ 27-20-31.1 Hysterectomy or myomectomy treatment
§ 27-20-32 Whistleblowers protection
§ 27-20-33 Penalties and remedies
§ 27-20-34 Additional relief and damages – Reinstatement
§ 27-20-35 Third-party reimbursement for services of certain healthcare workers
§ 27-20-35.1 Third-party reimbursement for services of registered nurse first assistants
§ 27-20-36 Human leukocyte antigen testing
§ 27-20-37 Drug coverage
§ 27-20-37.1 Specialty drugs
§ 27-20-38 Restricted annual rate payments prohibited
§ 27-20-39 Genetic testing
§ 27-20-39.1 Genetic information
§ 27-20-41 Magnetic resonance imaging – Quality assurance standards
§ 27-20-42 Acupuncture services
§ 27-20-43 FDA approved prescription contraceptive drugs and devices
§ 27-20-44 Prostate and colorectal examinations – Coverage mandated – The Maryellen Goodwin Colorectal Cancer Screening Act
§ 27-20-45 Eligibility for children’s benefits
§ 27-20-46 Hearing aids
§ 27-20-47 Prompt processing of claims
§ 27-20-48 Mandatory coverage for certain lyme disease treatments
§ 27-20-49 Dental insurance assignment of benefits
§ 27-20-50 Coverage for early intervention services
§ 27-20-51 Post-payment audits
§ 27-20-52 Reimbursement for orthotics and prosthetic services
§ 27-20-53 Tobacco cessation programs
§ 27-20-54 Mandatory coverage for scalp hair prosthesis
§ 27-20-55 Licensed ambulance service
§ 27-20-56 Enteral nutrition products
§ 27-20-57 Prohibition on preexisting condition exclusions
§ 27-20-58 Prohibition on rescission of coverage
§ 27-20-59 Annual and lifetime limits
§ 27-20-60 Coverage for individuals participating in approved clinical trials
§ 27-20-61 Medical loss ratio reporting and rebates
§ 27-20-62 Emergency services
§ 27-20-63 Internal and external appeal of adverse benefit determinations
§ 27-20-65 Primary care provider designation requirement
§ 27-20-66 Discretionary clauses
§ 27-20-67 Orally administered anticancer medication – Cost-sharing requirement
§ 27-20-68 Consumer notification
§ 27-20-69 Opioid antagonists
§ 27-20-70 Healthcare provider credentialing
§ 27-20-71 Unfair discrimination prohibited
§ 27-20-72 Health insurance contracts – Full year coverage for contraception
§ 27-20-73 Prohibition on discrimination in organ transplants
§ 27-20-74 Health insurance contracts – Copayments exemption for COVID-19 vaccinations
§ 27-20-75 Perinatal doulas
§ 27-20-76 Gender rating
§ 27-20-77 Coverage for biomarker testing
§ 27-20-78 Mandatory coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome
§ 27-20-79 Coverage for treatment of pre-exposure prophylaxis (PrEP) for the prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection
§ 27-20-80 Expedited prior authorization
§ 27-20-81 Dispensing and administration of HIV PrEP or PEP drugs
§ 27-20-82 Epinephrine injectors
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Terms Used In Rhode Island General Laws > Chapter 27-20 - Nonprofit Medical Service Corporations

  • Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
  • Affordable Care Act: means the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, and federal regulations adopted thereunder. See Rhode Island General Laws 27-20-1
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • 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
  • Certified registered nurse practitioners: is a n expanded role utilizing independent knowledge of physical assessment and management of health care and illnesses. See Rhode Island General Laws 27-20-1
  • Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
  • Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • 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.
  • Counselor in mental health: means a person who has been licensed pursuant to §?5-63. See Rhode Island General Laws 27-20-1
  • covered benefits: means coverage or benefits for the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body including coverage or benefits for transportation primarily for and essential thereto, and including medical services as defined in §?27-19-17. See Rhode Island General Laws 27-20-1
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Dependent: A person dependent for support upon another.
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Donor: The person who makes a gift.
  • 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.
  • Grandfathered health plan: means any group health plan or health insurance coverage subject to Rhode Island General Laws 27-20-1
  • Group health insurance coverage: means , in connection with a group health plan, health insurance coverage offered in connection with such plan. See Rhode Island General Laws 27-20-1
  • Group health plan: means an employee welfare benefit plan as defined in Rhode Island General Laws 27-20-1
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • health benefit plan: means health insurance coverage and a group health plan, including coverage provided through an association plan if it covers Rhode Island residents. See Rhode Island General Laws 27-20-1
  • Health insurance carrier: means a person, firm, corporation, or other entity subject to the jurisdiction of the commissioner under this chapter, and includes a nonprofit medical service corporation. See Rhode Island General Laws 27-20-1
  • health insurance commissioner: means that individual appointed pursuant to §?42-14. See Rhode Island General Laws 27-20-1
  • Healthcare facility: means an institution providing healthcare services or a healthcare setting, including but not limited to: hospitals and other licensed inpatient centers; ambulatory surgical or treatment centers; skilled nursing centers; residential treatment centers; diagnostic, laboratory, and imaging centers; and rehabilitation and other therapeutic health settings. See Rhode Island General Laws 27-20-1
  • Healthcare professional: means a physician or other healthcare practitioner licensed, accredited, or certified to perform specified healthcare services consistent with state law. See Rhode Island General Laws 27-20-1
  • Healthcare services: means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Rhode Island General Laws 27-20-1
  • in writing: include printing, engraving, lithographing, and photo-lithographing, and all other representations of words in letters of the usual form. See Rhode Island General Laws 43-3-16
  • 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.
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Licensed midwife: means any midwife licensed under §?23-13-9. See Rhode Island General Laws 27-20-1
  • Medical services: means those professional services rendered by persons duly licensed under the laws of this state to practice medicine, surgery, chiropractic, podiatry, and other professional services rendered by a licensed midwife, certified registered nurse practitioners, and psychiatric and mental health nurse clinical specialists, and appliances, drugs, medicines, supplies, and nursing care necessary in connection with the services, or the expense indemnity for the services, appliances, drugs, medicines, supplies, and care, as may be specified in any nonprofit medical service plan. See Rhode Island General Laws 27-20-1
  • Nonprofit medical service corporation: means any corporation organized pursuant hereto for the purpose of establishing, maintaining, and operating a nonprofit medical service plan. See Rhode Island General Laws 27-20-1
  • Nonprofit medical service plan: means a plan by which specified medical service is provided to subscribers to the plan by a nonprofit medical service corporation. See Rhode Island General Laws 27-20-1
  • 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.
  • Office of the health insurance commissioner: means the agency established under §?42-14. See Rhode Island General Laws 27-20-1
  • 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
  • provider: means a healthcare professional or a healthcare facility. See Rhode Island General Laws 27-20-1
  • Psychiatric and mental health nurse clinical specialist: is a n expanded role utilizing independent knowledge and management of mental health and illnesses. See Rhode Island General Laws 27-20-1
  • Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
  • Rescission: means a cancellation or discontinuance of coverage that has retroactive effect for reasons unrelated to timely payment of required premiums or contribution to costs of coverage. See Rhode Island General Laws 27-20-1
  • Subpoena: A command to a witness to appear and give testimony.
  • Subscribers: means those persons or groups of persons who contract with a nonprofit medical service corporation for medical service pursuant to a nonprofit medical service plan. See Rhode Island General Laws 27-20-1
  • Therapist in marriage and family practice: means a person who has been licensed pursuant to §?5-63. See Rhode Island General Laws 27-20-1
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • United States: include the several states and the territories of the United States. See Rhode Island General Laws 43-3-8