Section 27-41-1. – Short title.

§ 27-41-1. Short title. This chapter may be cited as the “Health Maintenance Organization Act.” History of Section.P.L. 1983, ch. 225, § 2; P.L. 2002, ch. 292, § 85.

Section 27-41-10. – Information to enrollees.

§ 27-41-10. Information to enrollees. Every health maintenance organization shall promptly provide to its enrollees notice of any material change in the operation of the organization that will affect them directly. New enrollees shall receive at least the following information: (1) The most recent annual statement of financial condition including a balance sheet and summary […]

Section 27-41-11. – Complaint system.

§ 27-41-11. Complaint system. (a) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the director after consultation with the director of health to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services. (b) The health maintenance organization shall maintain records […]

Section 27-41-12. – Investments.

§ 27-41-12. Investments. With the exception of investments made in accordance with § 27-41-5(a)(1) and (a)(2) and § 27-41-5(b), the investable funds of a health maintenance organization may be invested in the following investments and any other investments that the director authorizes by regulation: (1)(i) Governmental securities. Obligations of the United States. In bonds, notes, […]

Section 27-41-13. – Protection against insolvency.

§ 27-41-13. Protection against insolvency. (a) Unless otherwise provided, each health maintenance organization shall deposit with the general treasurer of the state of Rhode Island securities having a market value at all times of at least the amount set forth in this section, which are to be held for the benefit and protection of all […]

Section 27-41-13.1. – Initial net worth and capital requirements.

§ 27-41-13.1. Initial net worth and capital requirements. (a) Before the director issues a certificate of authority in accordance with § 27-41-4 of this act, an applicant seeking to establish or operate a health maintenance organization shall have the greater of: (1) The amount of capital required for a health organization under chapter 4.7 of […]

Section 27-41-13.2. – Ongoing net worth and capital requirements.

§ 27-41-13.2. Ongoing net worth and capital requirements. (a) A health maintenance organization shall maintain minimum net worth equal to the greater of two million five hundred thousand dollars ($2,500,000) or the amount necessary to maintain capital required pursuant to chapter 4.7 of this title. (b) The amount in subsection (a) may be adjusted annually […]

Section 27-41-13.3. – Waiver, surplus notes, and risk based capital requirements.

§ 27-41-13.3. Waiver, surplus notes, and risk based capital requirements. (a) The director may waive any of the net worth and/or total adjusted capital requirements as set forth in §§ 27-41-13.1 or 27-41-13.2 whenever satisfied that the health maintenance organization has sufficient net worth and/or total adjusted capital and an adequate history of generating net […]

Section 27-41-14. – Prohibited practices.

§ 27-41-14. Prohibited practices. (a) No health maintenance organization, or representative of a health maintenance organization, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. For the purposes of this chapter: (1) A statement […]

Section 27-41-14.1. – Prohibition against restraint on provider — Patient communications.

§ 27-41-14.1. Prohibition against restraint on provider — Patient communications. No health maintenance organization shall refuse to contract with or compensate for covered services an otherwise eligible health care provider solely because the provider has in good faith communicated with one or more of his or her current, former or prospective patients regarding the provisions, […]

Section 27-41-15. – Powers of insurers and hospital and medical service corporations.

§ 27-41-15. Powers of insurers and hospital and medical service corporations. An insurance company licensed in this state may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this chapter. Notwithstanding any other law that may be inconsistent with this section, any two (2) or […]

Section 27-41-16. – Examination.

§ 27-41-16. Examination. (a) The director of business regulation may make an examination of the affairs of any health maintenance organization and the providers with whom the organization has contracts, agreements, or other arrangements pursuant to its health care plan as often as is reasonably necessary for the protection of the interests of the people […]

Section 27-41-17. – Suspension or revocation of license.

§ 27-41-17. Suspension or revocation of license. (a) The director may suspend or revoke any license issued to a health maintenance organization under this chapter if the director finds that any of the following conditions exist: (1) The health maintenance organization is operating significantly in contravention of its basic organizational document, or in a manner […]

Section 27-41-18. – Rehabilitation, liquidation, or conservation of health maintenance organization.

§ 27-41-18. Rehabilitation, liquidation, or conservation of health maintenance organization. (a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the director of business regulation pursuant to chapters 14.1, 14.2, and 14.3 […]

Section 27-41-18.1. – Summary orders and supervision.

§ 27-41-18.1. Summary orders and supervision. (a) Whenever the director determines that the financial condition of a health maintenance organization is such that its continued operation must be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision of this act, the director may, after notice and hearing, order […]

Section 27-41-19. – Rules and regulations.

§ 27-41-19. Rules and regulations. The director of business regulation and the director of health shall, after notice and hearing, promulgate reasonable rules and regulations that are necessary or proper to carry out the provisions of this chapter. Those rules and regulations shall be subject to review in accordance with the provisions of chapter 35 […]

Section 27-41-2. – Definitions.

§ 27-41-2. Definitions. As used in this chapter: (a) “Adverse benefit determination” means any of the following: a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based […]

Section 27-41-20. – Administrative procedures.

§ 27-41-20. Administrative procedures. (a) When the director of business regulation has cause to believe that grounds for the denial of an application for a license exist, or that grounds for the suspension or revocation of a license exist, the director shall notify the health maintenance organization and the director of health, in writing, specifically […]

Section 27-41-21. – Penalties and enforcement.

§ 27-41-21. Penalties and enforcement. (a) The director of business regulation may, in lieu of the suspension or revocation of a license under § 27-41-17, levy an administrative penalty in an amount not less than five hundred dollars ($500) nor more than fifty thousand dollars ($50,000), if reasonable notice in writing is given of the […]

Section 27-41-22. – Statutory construction and relationship to other laws.

§ 27-41-22. Statutory construction and relationship to other laws. (a) Except as otherwise provided in this chapter provisions of chapters 19, 20, 20.1, and 20.2 of this title shall not be applicable to any health maintenance organization granted a license under this chapter. This provision shall not apply to an insurer or hospital or medical […]