2023 -- H 5832 | |
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LC002082 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2023 | |
____________ | |
A N A C T | |
RELATING TO INSURANCE -- PRODUCER LICENSING ACT | |
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Introduced By: Representatives Kennedy, Azzinaro, Diaz, Ackerman, Casimiro, and | |
Date Introduced: March 01, 2023 | |
Referred To: House Corporations | |
(Dept. of Business Regulation) | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Sections 27-2.4-2 and 27-2.4-16 of the General Laws in Chapter 27-2.4 |
2 | entitled "Producer Licensing Act" are hereby amended to read as follows: |
3 | 27-2.4-2. Definitions. |
4 | The following definitions apply to this chapter: |
5 | (1) "Business entity” means a corporation, association, partnership, limited liability |
6 | company, limited liability partnership, or other legal entity; |
7 | (2) "Contracted producer report” means the annual report that all insurers contracting with |
8 | insurance producers must provide to the department on or by March 1 listing each insurance |
9 | producer to whom the insurer paid one hundred dollars ($100) or more in commissions for the |
10 | preceding calendar year of January 1 to December 31. The department shall prescribe the form and |
11 | manner of reporting. |
12 | (3) "Department” means the department of business regulation; |
13 | (4) "Home state” means any state or territory of the United States, or the District of |
14 | Columbia, in which an insurance producer maintains his or her principal place of residence or |
15 | principal place of business and is licensed to act as an insurance producer; |
16 | (5) "Insurance” means any of the lines of authority set forth in this title; |
17 | (6) "Insurance commissioner” means the director of the department of business regulation |
18 | or his or her designee; |
19 | (7) "Insurance producer” means a person required to be licensed under the laws of this state |
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1 | to sell, solicit or negotiate insurance; |
2 | (8) "Insurer” means: (i) any person, reciprocal exchange, interinsurer, Lloyds insurer, |
3 | fraternal benefit society, and any other legal entity engaged in the business of insurance, including |
4 | insurance producers; (ii) notwithstanding §§ 27-19-2, 27-20-2, 27-20.1-2, 27-20.2-2, 27-20.3-2, |
5 | and 27-41-22, all of whom shall be engaged in the business of insurance for the purpose of this |
6 | chapter, nonprofit hospital and/or medical service corporation, a nonprofit dental service |
7 | corporation, a nonprofit optometric service corporation, a nonprofit legal service corporation, a |
8 | health maintenance organization as defined in chapter 41 of this title or as defined in chapter 62 of |
9 | title 42, or any other entity providing a plan of health benefits subject to state insurance regulation; |
10 | and (iii) an organization that for consideration assumes certain risks for an insured. Insurer |
11 | organizations may include corporations, stock companies, mutual companies, risk retention groups, |
12 | reciprocals, captives, Lloyds associations, and government residual plans. |
13 | (9) "License” means a document issued by this state's insurance commissioner authorizing |
14 | a person to act as an insurance producer for the lines of authority specified in the document. The |
15 | license itself does not create any authority, actual, apparent or inherent, in the holder to represent |
16 | or commit an insurance carrier; |
17 | (10) "Limited line credit insurance” includes credit life, credit disability, credit property, |
18 | credit unemployment, involuntary unemployment, mortgage life, mortgage guaranty, mortgage |
19 | disability, guaranteed automobile protection (gap) insurance, and any other form of insurance |
20 | offered in connection with an extension of credit that is limited to partially or wholly extinguishing |
21 | that credit obligation that the insurance commissioner determines should be designated a form of |
22 | limited line credit insurance; |
23 | (11) "Limited line credit insurance producer” means a person who sells, solicits or |
24 | negotiates one or more forms of limited line credit insurance coverage to individuals through a |
25 | master, corporate, group or individual policy; |
26 | (12) "Limited lines insurance” means those lines of insurance that the insurance |
27 | commissioner deems necessary to recognize for purposes of complying with subsection 27-2.4- |
28 | 10(e); |
29 | (13) "Limited lines producer” means a person authorized by the insurance commissioner |
30 | to sell, solicit or negotiate limited lines insurance; |
31 | (14) "NAIC” means National Association of Insurance Commissioners; |
32 | (15) "Negotiate” means the act of conferring directly with or offering advice directly to a |
33 | purchaser or prospective purchaser of a particular contract of insurance concerning any of the |
34 | substantive benefits, terms or conditions of the contract, provided that the person engaged in that |
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1 | act either sells insurance or obtains insurance from insurers for purchasers; |
2 | (16) "Person” means an individual; |
3 | (17) "Resident” means a person who either resides in Rhode Island or maintains an office |
4 | in Rhode Island where the business of producing insurance is transacted and designates Rhode |
5 | Island as the residence for purposes of licensure; |
6 | (18) "Sell” means to exchange a contract of insurance by any means, for money or its |
7 | equivalent, on behalf of an insurance company; |
8 | (19) "Solicit” means attempting to sell insurance or asking or urging a person to apply for |
9 | a particular kind of insurance from a particular company; |
10 | (20) "Terminate” means the cancellation of the relationship between an insurance producer |
11 | and the insurer or the termination of an insurance producer's authority to transact insurance; |
12 | (21) "Uniform application” means the current version of the NAIC uniform application for |
13 | resident and nonresident insurance producer licensing. |
14 | 27-2.4-16. Notification to insurance commissioner of termination. |
15 | (a) Termination for cause. An insurer or authorized representative of the insurer that |
16 | terminates the appointment, employment contract or other insurance business relationship with an |
17 | insurance producer shall notify the insurance commissioner within thirty (30) days following the |
18 | effective date of the termination, using a format prescribed by the insurance commissioner, if the |
19 | reason for termination is one of the reasons set forth in § 27-2.4-14 or the insurer has knowledge |
20 | the insurance producer was found by a court, government body, or self-regulatory organization |
21 | authorized by law to have engaged in any of the activities in § 27-2.4-14. Upon the written request |
22 | of the insurance commissioner, the insurer shall provide additional information, documents, records |
23 | or other data pertaining to the termination or activity of the insurance producer. |
24 | (b) Termination without cause. An insurer or authorized representative of the insurer that |
25 | terminates the appointment, employment, or contract with a producer for any reason not set forth |
26 | in § 27-2.4-14, shall notify the insurance commissioner within thirty (30) days following the |
27 | effective date of the termination, using a format prescribed by the insurance commissioner. Upon |
28 | written request of the insurance commissioner, the insurer shall provide additional information, |
29 | documents, records or other data pertaining to the termination. |
30 | (b)(c) Ongoing notification requirement. The insurer or the authorized representative of |
31 | the insurer shall promptly notify the insurance commissioner in a format acceptable to the insurance |
32 | commissioner if, upon further review or investigation, the insurer discovers additional information |
33 | that would have been reportable to the insurance commissioner in accordance with subsection (a) |
34 | of this section had the insurer then known of its existence. |
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1 | (c)(d) Copy of notification to be provided to the insurance producer. |
2 | (1) Within fifteen (15) days after making the notification required by subsections (a) and |
3 | (b)(c) of this section, the insurer shall mail a copy of the notification to the insurance producer at |
4 | his or her last known address. If the insurance producer is terminated for cause for any of the |
5 | reasons listed in § 27-2.4-14, the insurer shall provide a copy of the notification to the insurance |
6 | producer at his or her last known address by certified mail, return receipt requested, postage prepaid |
7 | or by overnight delivery using a nationally recognized carrier. |
8 | (2) Within thirty (30) days after the insurance producer has received the original or |
9 | additional notification, the insurance producer may file written comments concerning the substance |
10 | of the notification with the insurance commissioner. The insurance producer shall, by the same |
11 | means, simultaneously send a copy of the comments to the reporting insurer, and the comments |
12 | shall become a part of the insurance commissioner's file and accompany every copy of a report |
13 | distributed or disclosed for any reason about the insurance producer as permitted under subsection |
14 | (e)(f) of this section. |
15 | (d)(e) Immunities. |
16 | (1) In the absence of actual malice, an insurer, the authorized representative of the insurer, |
17 | an insurance producer, the insurance commissioner, or an organization of which the insurance |
18 | commissioner is a member and that compiles the information and makes it available to other |
19 | insurance commissioners or regulatory or law enforcement agencies shall not be subject to civil |
20 | liability, except as provided in this section, and a civil cause of action of any nature shall not arise |
21 | against these entities or their respective agents or employees, except as provided in this section, as |
22 | a result of any statement or information required by or provided pursuant to this section or any |
23 | information relating to any statement that may be requested in writing by the insurance |
24 | commissioner, from an insurer or insurance producer; or a statement by a terminating insurer or |
25 | insurance producer to an insurer or insurance producer limited solely and exclusively to whether a |
26 | termination for cause under subsection (a) of this section was reported to the insurance |
27 | commissioner, provided that the propriety of any termination for cause under subsection (a) of this |
28 | section is certified in writing by an officer or authorized representative of the insurer or insurance |
29 | producer terminating the relationship. |
30 | (2) In any action brought against a person that may have immunity under this chapter for |
31 | making any statement required by this section or providing any information relating to any |
32 | statement that may be requested by the insurance commissioner, the party bringing the action shall |
33 | plead specifically in any allegation that subdivision (d)(e)(1) of this section does not apply because |
34 | the person making the statement or providing the information did so with actual malice. |
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1 | (3) This chapter shall not abrogate or modify any existing statutory or common law |
2 | privileges or immunities. |
3 | (e)(f) Confidentiality. |
4 | (1) Any documents, materials or other information in the control or possession of the |
5 | department that is furnished by an insurer, insurance producer or an employee or agent of the |
6 | insurer or insurance producer acting on behalf of the insurer or insurance producer, or obtained by |
7 | the insurance commissioner in an investigation pursuant to this section, shall be confidential by law |
8 | and privileged, shall not be subject to chapter 2 of title 38, shall not be subject to subpoena, and |
9 | shall not be subject to discovery or admissible in evidence in any private civil action. The insurance |
10 | commissioner is authorized to use the documents, materials or other information in the furtherance |
11 | of any regulatory or legal action brought as a part of the insurance commissioner's duties. |
12 | (2) Neither the insurance commissioner nor any person who received documents, materials |
13 | or other information while acting under the authority of the insurance commissioner shall be |
14 | permitted or required to testify in any private civil action concerning any confidential documents, |
15 | materials, or information subject to this chapter. |
16 | (3) In order to assist in the performance of the insurance commissioner's duties under this |
17 | chapter, the insurance commissioner: |
18 | (i) May share documents, materials or other information, including the confidential and |
19 | privileged documents, materials or information subject to this chapter, with other state, federal, and |
20 | international regulatory agencies, with the NAIC, its affiliates or subsidiaries, and with state, |
21 | federal, and international law enforcement authorities, provided that the recipient agrees to |
22 | maintain the confidentiality and privileged status of the document, material or other information; |
23 | (ii) May receive documents, materials or information, including confidential and privileged |
24 | documents, materials or information, from the NAIC, its affiliates or subsidiaries and from |
25 | regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall |
26 | maintain as confidential or privileged any document, material or information received with notice |
27 | or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the |
28 | source of the document, material or information; |
29 | (iii) May enter into agreements governing sharing and use of information consistent with |
30 | this subsection; |
31 | (iv) No waiver of any applicable privilege or claim of confidentiality in the documents, |
32 | materials, or information shall occur as a result of disclosure to the commissioner under this section |
33 | or as a result of sharing as authorized in this chapter; |
34 | (v) Nothing in this chapter shall prohibit the insurance commissioner from releasing final, |
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1 | adjudicated actions including for cause terminations that are open to public inspection pursuant to |
2 | chapter 2 of title 38 to a database or other clearinghouse service maintained by the NAIC, its |
3 | affiliates or subsidiaries; and |
4 | (vi) If the department releases to an unauthorized third party any documents, materials or |
5 | other information provided to the department pursuant to this section, then the department shall be |
6 | subject to a fine not to exceed one thousand dollars ($1,000) after a hearing on this violation brought |
7 | in the Superior Court. |
8 | (f)(g) Penalties for failing to report. An insurer, the authorized representative of the |
9 | insurer, or insurance producer that fails to report as required under the provisions of this section or |
10 | that is found to have reported with actual malice by a court of competent jurisdiction may, after |
11 | notice and hearing, have its license or certificate of authority suspended or revoked and may be |
12 | fined in accordance with § 42-14-16. |
13 | SECTION 2. Section 27-10-1.1 of the General Laws in Chapter 27-10 entitled "Claim |
14 | Adjusters" is hereby amended to read as follows: |
15 | 27-10-1.1. Definitions. |
16 | (a) "Adjuster” means an individual licensed as either a public company or independent |
17 | adjuster. |
18 | (b) "Catastrophic disaster” according to the Federal Response Plan, means an event that |
19 | results in large numbers of deaths and injuries; causes extensive damage or destruction of facilities |
20 | that provide and sustain human needs; produces an overwhelming demand on state and local |
21 | response resources and mechanisms; causes a severe long-term effect on general economic activity; |
22 | and severely affects state, local, and private sector capabilities to begin and sustain response |
23 | activities. A catastrophic disaster shall be declared by the President of the United States, the |
24 | governor of the state, or the insurance commissioner. |
25 | (c) "Company adjuster” means a person who: |
26 | (1) Is an individual who contracts for compensation with insurers or self-insurers as an |
27 | employee; and |
28 | (2) Investigates, negotiates, or settles property, casualty, or workers' compensation claims |
29 | for insurers or for self-insurers as an employee. |
30 | (d) "Department” means the insurance division of the department of business regulation. |
31 | (e) "Home state” means the District of Columbia and any state or territory of the United |
32 | States in which the adjuster's principal place of residence or principal place of business is located. |
33 | If neither the state in which the public independent or company adjuster maintains the principal |
34 | place of residence, nor the state in which the adjuster maintains the principal place of business, has |
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1 | a substantially similar law governing adjusters, the adjuster may declare another state in which it |
2 | becomes licensed and acts as a public an independent or company adjuster to be the "home state.” |
3 | Designated home state is not available for public adjusters. |
4 | (f) "Independent adjuster” means a person who: |
5 | (1) Is an individual who contracts for compensation with insurers or self-insurers as an |
6 | independent contractor; or |
7 | (2) Investigates, negotiates, or settles property, casualty, or workers' compensation claims |
8 | for insurers or for self-insurers as an independent contractor. |
9 | (g) "Insurance commissioner” means the director of the department of business regulation |
10 | or his or her designee. |
11 | (h) "NAIC” means the National Association of Insurance Commissioners. |
12 | (i) "Public adjuster” means any person who, for compensation or any other thing of value |
13 | on behalf of the insured: |
14 | (1) Acts or aids, solely in relation to first-party claims arising under insurance contracts |
15 | that insure the real or personal property of the insured, other than automobile, on behalf of an |
16 | insured in negotiating for, or effecting the settlement of, a claim for loss or damage covered by an |
17 | insurance contract; |
18 | (2) Advertises for employment as a public adjuster of insurance claims or solicits business |
19 | or represents himself themself or herself to the public as a public adjuster of first-party insurance |
20 | claims for losses or damages arising out of policies of insurance that insure real or personal |
21 | property; or |
22 | (3) Directly or indirectly solicits business, investigates or adjusts losses, or advises an |
23 | insured about first-party claims for losses or damages arising out of policies of insurance that insure |
24 | real or personal property for another person engaged in the business of adjusting losses or damages |
25 | covered by an insurance policy, for the insured. |
26 | (j) "Uniform individual application” means the current version of the National Association |
27 | of Insurance Commissioners (NAIC) Uniform Individual Application for resident and nonresident |
28 | individuals. |
29 | SECTION 3. Section 27-13.1-7 of the General Laws in Chapter 27-13.1 entitled |
30 | "Examinations" is hereby amended to read as follows: |
31 | 27-13.1-7. Cost of examinations. |
32 | (a) The total cost of the examinations shall be borne by the examined companies and shall |
33 | include the following expenses: |
34 | (1) One hundred fifty percent (150%) of the total salaries and benefits paid to the examining |
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1 | personnel of the banking and insurance division engaged in those examinations less any salary |
2 | reimbursements; |
3 | (2) All reasonable technology costs related to the examination process. Technology costs |
4 | shall include the actual cost of software and hardware utilized in the examination process and the |
5 | cost of training examination insurance personnel in the proper use of the software or hardware; |
6 | (3) All necessary and reasonable education and training costs incurred by the state to |
7 | maintain the proficiency and competence of the examining insurance personnel. All these costs |
8 | shall be incurred in accordance with appropriate state of Rhode Island regulations, guidelines and |
9 | procedures. |
10 | (b) Expenses incurred pursuant to subsections (a)(2) and (a)(3) of this section shall be |
11 | allocated equally to each company domiciled in Rhode Island no more frequently than annually |
12 | and shall not exceed an annual average assessment of three thousand five hundred dollars ($3,500) |
13 | five thousand dollars ($5,000) per company for any given three (3) calendar year period. All |
14 | revenues collected pursuant to this section shall be deposited as general revenues. That assessment |
15 | shall be in addition to any taxes and fees payable to the state. |
16 | SECTION 4. Sections 27-34.3-2, 27-34.3-3, 27-34.3-5, 27-34.3-6, 27-34.3-7, 27-34.3-8, |
17 | 27-34.3-9, 27-34.3-11, 27-34.3-12, 27-34.3-13, 27-34.3-14, 27-34.3-19 and 27-34.3-20 of the |
18 | General Laws in Chapter 27-34.3 entitled "Rhode Island Life and Health Insurance Guaranty |
19 | Association Act" are hereby amended to read as follows: |
20 | 27-34.3-2. Purpose. |
21 | (a) The purpose of this chapter is to protect, subject to certain limitations, the persons |
22 | specified in § 27-34.3-3(a) against failure in the performance of contractual obligations, under life, |
23 | and health insurance policies and annuity policies, plans or contracts specified in § 27-34.3-3(b), |
24 | because of the impairment or insolvency of the member insurer that issued the policies, plans, or |
25 | contracts. |
26 | (b) To provide this protection, an association of member insurers is created to pay benefits |
27 | and to continue coverages as limited in this chapter, and members of the association are subject to |
28 | assessment to provide funds to carry out the purpose of this chapter. |
29 | (c) In accordance with this purpose, in determining the coverage limits to be applied in § |
30 | 27-34.3-3 in cases in which there were different statutory limits at the time the insurer was declared |
31 | impaired and the time the insurer was declared insolvent, the statute with the higher limits shall be |
32 | applied to the claim. |
33 | 27-34.3-3. Coverage and limitations. |
34 | (a) This chapter shall provide coverage for the policies and contracts specified in subsection |
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1 | (b) of this section: |
2 | (1) To persons who, regardless of where they reside (except for nonresident certificate |
3 | holders under group policies or contracts), are the beneficiaries, assignees or payees, including |
4 | health care providers rendering services covered under health insurance policies or certificates, of |
5 | the persons covered under subsection (2); and |
6 | (2) To persons who are owners of or certificate holders or enrollees under the policies or |
7 | contracts (other than unallocated annuity contracts, and structured settlement annuities) and in each |
8 | case who: |
9 | (i) Are residents; or |
10 | (ii) Are not residents, but only under all of the following conditions: |
11 | (A) The member insurer that issued the policies or contracts is domiciled in this state; |
12 | (B) The states in which the persons reside have associations similar to the association |
13 | created by this chapter; and |
14 | (C) The persons are not eligible for coverage by an association in any other state due to the |
15 | fact that the insurer or the health maintenance organization was not licensed in the state at the time |
16 | specified in the state's guaranty association law. |
17 | (3) For unallocated annuity contracts set forth in subsection (b) of this section, paragraphs |
18 | (1) and (2) of this subsection shall not apply, and this chapter shall (except as provided in |
19 | paragraphs (5) and (a)(6) of this subsection) provide coverage to: |
20 | (i) Persons who are owners of the unallocated annuity contracts if the contracts are issued |
21 | to or in connection with a specific benefit plan whose plan sponsor has its principal place of |
22 | business in this state; and |
23 | (ii) Persons who are owners of unallocated annuity contracts issued to or in connection |
24 | with government lotteries if the owners are residents. |
25 | (4) For structured settlement annuities specified in subsection (b)(1), paragraphs (1) and |
26 | (2) of this subsection shall not apply, and this chapter shall (except as provided in paragraphs (5) |
27 | and (6) of this subsection) provide coverage to a person who is a payee under a structured settlement |
28 | annuity (or beneficiary of a payee if the payee is deceased), if the payee: |
29 | (i) Is a resident, regardless of where the contract owner resides; or |
30 | (ii) Is not a resident, but only under both of the following conditions: |
31 | (A)(I) The contract owner of the structured settlement annuity is a resident; or |
32 | (II) The contract owner of the structured settlement annuity is not a resident but the insurer |
33 | that issued the structured settlement annuity is domiciled in this state; and |
34 | The state in which the contract owner resides has an association similar to the association |
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1 | created by this chapter; and |
2 | (B) Neither the payee or beneficiary, nor the contract owner is eligible for coverage by the |
3 | association of the state in which the payee or contract owner resides. |
4 | (5) This chapter shall not provide coverage to: |
5 | (i) A person who is a payee or beneficiary of a contract owner resident of this state, if the |
6 | payee or beneficiary is afforded any coverage by the association of another state; or |
7 | (ii) A person covered under paragraph (3) of this subsection, if any coverage is provided |
8 | by the association of another state to the person.; or |
9 | (iii) A person who acquires rights to receive payments through a structured settlement |
10 | factoring transaction as defined in 26 U.S.C. 5891(c)(3)(A), regardless of whether the transaction |
11 | occurred before or after such section became effective. |
12 | (6) This chapter is intended to provide coverage to a person who is a resident of this state |
13 | and, in special circumstances, to a nonresident. In order to avoid duplicate coverage, if a person |
14 | who would otherwise receive coverage under this chapter is provided coverage under the laws of |
15 | any other state, the person shall not be provided coverage under this chapter. In determining the |
16 | application of the provisions of this paragraph in situations where a person could be covered by the |
17 | association of more than one state, whether as an owner, payee, enrollee, beneficiary, or assignee, |
18 | this chapter shall be construed in conjunction with other state laws to result in coverage by only |
19 | one association. |
20 | (b)(1) This chapter shall provide coverage to the persons specified in subsection (a) of this |
21 | section for policies or contracts for direct, non-group life insurance, health, or annuity policies or |
22 | contracts including health maintenance organization subscriber contracts and certificates, or |
23 | annuities and supplemental policies or contracts to any of these, for certificates under direct group |
24 | policies and contracts, and for unallocated annuity contracts issued by member insurers, except as |
25 | limited by this chapter. Annuity contracts and certificates under group annuity contracts include, |
26 | but are not limited to, guaranteed investment contracts, deposit administration contracts, |
27 | unallocated funding agreements, allocated funding agreements, structured settlement annuities, |
28 | annuities issued to or in connection with government lotteries and any immediate or deferred |
29 | annuity contracts. |
30 | (2) This Except as otherwise provided in subsection (b)(3) of this section, this chapter shall |
31 | not provide coverage for: |
32 | (i) A portion of a policy or contract not guaranteed by the member insurer, or under which |
33 | the risk is borne by the policy or contract owner; |
34 | (ii) A policy or contract of reinsurance, unless assumption certificates have been issued |
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1 | pursuant to the reinsurance policy or contract; |
2 | (iii) A portion of a policy or contract to the extent that the rate of interest on which it is |
3 | based, or the interest rate, crediting rate or similar factor determined by use of an index or other |
4 | external reference stated in the policy or contract employed in calculating returns or changes in |
5 | value: |
6 | (A) Averaged over the period of four (4) years prior to the date on which the member |
7 | insurer becomes an impaired or insolvent insurer under this chapter, whichever is earlier, exceeds |
8 | the rate of interest determined by subtracting two (2) percentage points from Moody's corporate |
9 | bond yield average averaged for that same four-year (4) period or for such lesser period if the policy |
10 | or contract was issued less than four (4) years before the member insurer becomes an impaired or |
11 | insolvent insurer under this chapter, whichever is earlier; and |
12 | (B) On and after the date on which the member insurer becomes an impaired or insolvent |
13 | insurer under this chapter, whichever is earlier, exceeds the rate of interest determined by |
14 | subtracting three (3) percentage points from Moody's corporate bond yield average as most recently |
15 | available; |
16 | (iv) A portion of a policy or contract issued to a plan or program of an employer, association |
17 | or other person to provide life, health or annuity benefits to its employees, members or others to |
18 | the extent that the plan or program is self-funded or uninsured, including but not limited to benefits |
19 | payable by an employer, association or other person under: |
20 | (A) A multiple employer welfare arrangement as defined in 29 U.S.C. § 1144; |
21 | (B) A minimum premium group insurance plan; |
22 | (C) A stop-loss group insurance plan; or |
23 | (D) An administrative services only contract; |
24 | (v) A portion of a policy or contract to the extent that it provides for: |
25 | (A) Dividends or experience rating credits; |
26 | (B) Voting rights; or |
27 | (C) Payment of any fees or allowances to any person, including the policy or contract |
28 | owner, in connection with the service to or administration of the policy or contract. |
29 | (vi) A policy or contract issued in this state by a member insurer at a time when it was not |
30 | licensed or did not have a certificate of authority to issue the policy or contract in this state; |
31 | (vii) An unallocated annuity contract issued to or in connection with a benefit plan |
32 | protected under the federal pension benefit guaranty corporation, regardless of whether the federal |
33 | pension benefit guaranty corporation has yet become liable to make any payments with respect to |
34 | the benefit plan; |
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1 | (viii) A portion of unallocated annuity contract that is not issued to or in connection with a |
2 | specific employee, union or association of natural persons benefit plan or a government lottery; |
3 | (ix) A portion of a policy or contract to the extent that the assessments required by § 27- |
4 | 34.3-9 with respect to the policy or contract are preempted by federal or state law; and |
5 | (x) An obligation that does not arise under the express written terms of the policy or |
6 | contract issued by the member insurer to the enrollee, certificate holder, contract owner or policy |
7 | owner, including, without limitation: |
8 | (A) Claims based on marketing materials; |
9 | (B) Claims based on side letters, riders or other documents that were issued by the member |
10 | insurer without meeting applicable policy or contract form filing or approval requirements; |
11 | (C) Misrepresentations of or regarding policy or contract benefits; |
12 | (D) Extracontractual claims; or |
13 | (E) A claim for penalties or consequential or incidental damages; |
14 | (xi) A contractual agreement that establishes the member insurer's obligations to provide a |
15 | book value accounting guaranty for defined contribution benefit plan participants by reference to a |
16 | portfolio of assets that is owned by the benefit plan or its trustee, which in each case is not an |
17 | affiliate of the member insurer; |
18 | (xii) A portion of a policy or contract to the extent it provides for interest or other changes |
19 | in value to be determined by the use of an index or other external reference stated in the policy or |
20 | contract, but which have not been credited to the policy or contract, or as to which the policy or |
21 | contract owner's rights are subject to forfeiture, as of the date the member insurer becomes an |
22 | impaired or insolvent insurer under this chapter, whichever is earlier. If a policy's or contract's |
23 | interest or changes in value are credited less frequently than annually, then, for purposes of |
24 | determining the values that have been credited and are not subject to forfeiture under this paragraph, |
25 | the interest or change in value determined by using the procedures defined in the policy or contract |
26 | will be credited as if the contractual date of crediting interest or changing values was the date of |
27 | impairment or insolvency, whichever is earlier, and will not be subject to forfeiture; |
28 | (xiii) Any transaction or combination of transactions between a protected cell and the |
29 | general account or another protected cell of a protected cell company organized under chapter 64 |
30 | of this title; or |
31 | (xiv) A policy or contract providing any hospital, medical, prescription drug or other |
32 | healthcare benefits pursuant to Part C or Part D of subchapter XVIII, chapter 7 of title 42 of the |
33 | United States Code (commonly known as Medicare part C & D), or subchapter XIX, chapter 7 of |
34 | title 42 of the United States Code (commonly known as Medicaid), or any regulations issued |
| LC002082 - Page 12 of 61 |
1 | pursuant thereto.; or |
2 | (xvii) Structured settlement annuity benefits to which a payee (or beneficiary) has |
3 | transferred their rights in a structured settlement factoring transaction as defined in 26 U.S.C. |
4 | 5891(c)(3)(A), regardless of whether the transaction occurred before or after such section became |
5 | effective. |
6 | (3) The exclusion from coverage referenced in subsection (b)(2)(iii) of this section shall |
7 | not apply to any portion of a policy or contract, including a rider, that provides long-term care or |
8 | any other health insurance benefits. |
9 | (c) The benefits that the association may become obligated to cover shall in no event exceed |
10 | the lesser of: |
11 | (1) The contractual obligations for which the member insurer is liable or would have been |
12 | liable if it were not an impaired or insolvent insurer; or |
13 | (2)(i) With respect to any one life, regardless of the number of policies or contracts: |
14 | (A) Three hundred thousand dollars ($300,000) in life insurance death benefits, but not |
15 | more than one hundred thousand dollars ($100,000) in net cash surrender and net cash withdrawal |
16 | values for life insurance; |
17 | (B) In For health insurance benefits: |
18 | (I) One hundred thousand dollars ($100,000) for coverages not considered as disability |
19 | income insurance or basic hospital, medical and surgical insurance health benefit plans or major |
20 | medical insurance or long-term care insurance, including any net cash surrender and net cash |
21 | withdrawal values; |
22 | (II) Three hundred thousand dollars ($300,000) for disability income insurance and three |
23 | hundred thousand dollars ($300,000) for long-term care insurance; |
24 | (III) Five hundred thousand dollars ($500,000) for basic hospital, medical and surgical |
25 | insurance health benefit plans; or |
26 | (C) Two hundred fifty thousand dollars ($250,000) in the present value of annuity benefits, |
27 | including net cash surrender and net cash withdrawal values; |
28 | (ii) With respect to each individual participating in a governmental retirement plan |
29 | established under § 401, 403(b) or 457 of the U.S. Internal Revenue Code, 26 U.S.C. § 401, 403(b) |
30 | or 457, covered by an unallocated annuity contract or the beneficiaries of each such individual if |
31 | deceased, in the aggregate, two hundred fifty thousand dollars ($250,000) in present value annuity |
32 | benefits, including net cash surrender and net cash withdrawal values; |
33 | (iii) With respect to each payee of a structured settlement annuity or beneficiary or |
34 | beneficiaries, of the payee if deceased, two hundred fifty thousand dollars ($250,000) in present |
| LC002082 - Page 13 of 61 |
1 | value annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal |
2 | values if any; |
3 | (iv) However in no event shall the association be obligated to cover more than: (A) an |
4 | aggregate of three hundred thousand dollars ($300,000) in benefits with respect to any one life |
5 | under this paragraph and paragraphs (i), (ii) and (iii) of this subdivision except with respect to |
6 | benefits for basic hospital, medical and surgical insurance and major medical insurance health |
7 | benefit plans under subparagraph 2(i)(B) of this subsection, in which case the aggregate liability of |
8 | the association shall not exceed five hundred thousand dollars ($500,000) with respect to any one |
9 | individual; or (B) with respect to one owner of multiple non-group policies of life insurance, |
10 | whether the policy or contract owner is an individual, firm, corporation or other person, and whether |
11 | the persons insured are officers, managers, employees or other persons, more than five million |
12 | dollars ($5,000,000) in benefits, regardless of the number of policies and contracts held by the |
13 | owner; |
14 | (v) With respect to either: (A) one contract owner provided coverage under subsection |
15 | (a)(3)(i); or (B) one plan sponsor whose plans own directly or in trust any one or more unallocated |
16 | annuity contracts not included in paragraph (ii) of this subdivision, five million dollars ($5,000,000) |
17 | in benefits, irrespective of the number of contracts with respect to the contract owner or plan |
18 | sponsor. Provided, however, in the case where one or more unallocated annuity contracts that are |
19 | covered contracts under this chapter and are owned by a trust or other entity for the benefit of two |
20 | (2) or more plan sponsors, coverage shall be afforded by the association if the largest interest in the |
21 | trust or entity owning the contract or contracts is held by a plan sponsor whose principal place of |
22 | business is in this state and in no event shall the association be obligated to cover more than five |
23 | million dollars ($5,000,000) in benefits with respect to all such unallocated contracts; |
24 | (vi) The limitations set forth in this subsection are limitations on the benefits for which the |
25 | association is obligated before taking into account either its subrogation and assignment rights or |
26 | the extent to which those benefits could be provided out of the assets of the impaired or insolvent |
27 | insurer attributable to covered policies. The costs of the association's obligations under this chapter |
28 | may be met by the use of assets attributable to covered policies or reimbursed to the association |
29 | pursuant to its subrogation and assignment rights. |
30 | (vii) For purposes of this chapter, benefits provided by a long-term care rider to a life |
31 | insurance policy or annuity contract shall be considered the same type of benefits as the base life |
32 | insurance policy or annuity contract to which it relates. |
33 | (d) In performing its obligations to provide coverage under § 27-34.3-8, the association |
34 | shall not be required to guarantee, assume, reinsure, reissue or perform, or cause to be guaranteed, |
| LC002082 - Page 14 of 61 |
1 | assumed, reinsured, reissued or performed, contractual obligations of the insolvent or impaired |
2 | insurer under a covered policy or contract that do not materially affect the economic values or |
3 | economic benefits of the covered policy or contract. |
4 | 27-34.3-5. Definitions. |
5 | As used in this chapter: |
6 | (1) "Account” means either of the two accounts created under § 27-34.3-6. |
7 | (2) "Association” means the Rhode Island life and health insurance guaranty association |
8 | created under § 27-34.3-6. |
9 | (3) "Authorized assessment” or the term "authorized” when used in the context of |
10 | assessments means a resolution by the board of directors has been passed whereby an assessment |
11 | will be called immediately or in the future from member insurers for a specified amount. An |
12 | assessment is authorized when the resolution is passed. |
13 | (4) "Benefit plan” means a specific employee, union or association of natural persons |
14 | benefit plan. |
15 | (5) "Called assessment” or the term "called” when used in the context of assessments means |
16 | that a notice has been issued by the association to member insurers requiring that an authorized |
17 | assessment be paid within the time frame set forth within the notice. An authorized assessment |
18 | becomes a called assessment when notice is mailed by the association to member insurers. |
19 | (6) "Commissioner” means the commissioner of insurance within the department of |
20 | business regulation of this state definition prescribed by § 42-14-5. |
21 | (7) "Contractual obligation” means any obligation under a policy or contract or certificate |
22 | under a group policy or contract, or portion of a group policy or contract for which coverage is |
23 | provided under § 27-34.3-3. |
24 | (8) "Covered contract or covered policy” means any policy or contract or portion of a policy |
25 | or contract for which coverage is provided under § 27-34.3-3. |
26 | (9) "Extra-contractual claims” means claims not arising directly out of contract provisions, |
27 | including, for example, claims relating to bad faith in the payment of claims, punitive or exemplary |
28 | damages or attorneys' fees and costs. |
29 | (10) "Health benefit plan" means any hospital or medical expense policy or certificate, or |
30 | health maintenance organization subscriber contract or any other similar health contract. "Health |
31 | benefit plan" does not include: |
32 | (i) Accident only insurance: |
33 | (ii) Credit insurance; |
34 | (iii) Dental only insurance; |
| LC002082 - Page 15 of 61 |
1 | (iv) Vision only insurance; |
2 | (v) Medicare Supplement insurance; |
3 | (vi) Benefits for long-term care, home health care, community-based care, or any |
4 | combination thereof; |
5 | (vii) Disability income insurance; |
6 | (viii) Coverage for on-site medical clinics; or |
7 | (ix) Specified disease, hospital confinement indemnity, or limited benefit health insurance |
8 | if the types of coverage do not provide coordination of benefits and are provided under separate |
9 | policies or certificates. |
10 | (10)(11) "Impaired insurer” means a member insurer which is not an insolvent insurer, and |
11 | (i) Is placed under an order of rehabilitation or conservation by a court of competent |
12 | jurisdiction. |
13 | (11)(12) "Insolvent insurer” means a member insurer which after January 1, 1996, is placed |
14 | under an order of liquidation by a court of competent jurisdiction with a finding of insolvency. |
15 | (12)(13) "Member insurer” means any insurer or health maintenance organization licensed |
16 | or which holds a certificate of authority to transact in this state any kind of insurance or health |
17 | maintenance organization business for which coverage is provided under § 27-34.3-3, and includes |
18 | any insurer or health maintenance organization whose license or certificate of authority in this state |
19 | may have been suspended, revoked, not renewed or voluntarily withdrawn, but does not include: |
20 | (i) A hospital or medical service organization, whether profit or nonprofit; or |
21 | (ii) A health maintenance organization; or |
22 | (iii) A fraternal benefit society; or |
23 | (iv) A mandatory state pooling plan; or |
24 | (v) A mutual assessment company or other person that operates on an assessment basis; or |
25 | (vi) An insurance exchange; or |
26 | (vii) An organization that has a certificate or license limited to the issuance of charitable |
27 | gift annuities; or |
28 | (viii) An entity similar to any of the above. |
29 | (13)(14) "Moody's corporate bond yield average” means the monthly average corporates |
30 | as published by Moody's investors service, inc. Investors Service, Inc., or any successor to it. |
31 | (14)(15) "Owner” of a policy or contract and "policyholder," "policy owner” and or |
32 | "contract owner” means the person who is identified as the legal owner under the terms of the |
33 | policy or contract or who is otherwise vested with legal title to the policy or contract through a |
34 | valid assignment completed in accordance with the terms of the policy or contract and properly |
| LC002082 - Page 16 of 61 |
1 | recorded as the owner on the books of the member insurer. The terms owner, contract owner, |
2 | policyholder and policy owner do not include persons with a mere beneficial interest in a policy or |
3 | contract. |
4 | (15)(16) "Person” means any individual, corporation, limited liability company, |
5 | partnership, association, governmental body or entity or voluntary organization. |
6 | (16)(17) "Plan sponsor” means: |
7 | (i) The employer in case of a benefit plan established or maintained by a single employer; |
8 | (ii) The employee organization in the case of a benefit plan established or maintained by |
9 | an employee organization; or |
10 | (iii) In the case of a benefit plan established or maintained by two (2) or more employers |
11 | or jointly by one or more employers and one or more employee organizations, the association, |
12 | committee, joint board of trustees, or other similar group of representatives of the parties who |
13 | establish or maintain the benefit plan. |
14 | (17)(18) "Premiums” means amounts or considerations (by whatever name called) received |
15 | on covered policies or contracts less returned premiums, considerations and deposits, and less |
16 | dividends and experience credits. "Premiums” does not include any amounts or consideration |
17 | received for any policies or contracts or for the portions of policies or contracts for which coverage |
18 | is not provided under § 27-34.3-3(b) except that assessable premium shall not be reduced on |
19 | account of § 27-34.3-3(b)(2)(iii) relating to interest limitations and § 27-34.3-3(c)(2) relating to |
20 | limitations with respect to one individual, one participant and one owner. "Premiums” shall not |
21 | include: |
22 | (i) Premiums in excess of five million dollars ($5,000,000) on an unallocated annuity |
23 | contract not issued under a governmental retirement benefit plan (or its trustee) established under |
24 | § 401, 403(b) or 457 of the United States Internal Revenue Code, 26 U.S.C. § 401, 403(b) or 457. |
25 | (ii) With respect to multiple nongroup policies of life insurance owned by one owner, |
26 | whether the policy or contract owner is an individual, firm, corporation or other person, and whether |
27 | the persons insured are officers, managers, employees or other persons, premiums in excess of five |
28 | million dollars ($5,000,000) with respect to these policies or contracts, regardless of the number of |
29 | policies or contracts held by the owner. |
30 | (18)(19)(i) "Principal place of business” of a plan sponsor or a person other than a natural |
31 | person means the single state in which the natural persons who establish policy for the direction, |
32 | control and coordination of the operations of the entity as a whole primarily exercise that function, |
33 | determined by the association in its reasonable judgment by considering the following factors: |
34 | (A) The state in which the primary executive and administrative headquarters of the entity |
| LC002082 - Page 17 of 61 |
1 | is located; |
2 | (B) The state in which the principal office of the chief executive officer of the entity is |
3 | located; |
4 | (C) The state in which the board of directors (or similar governing person or persons) of |
5 | the entity conducts the majority of its meetings; |
6 | (D) The state in which the executive or management committee of the board of directors |
7 | (or a similar governing person or persons) of the entity, conducts the majority of its meetings; |
8 | (E) The state from which the management of the overall operations of the entity is directed; |
9 | and |
10 | (F) In the case of a benefit plan sponsored by affiliated companies comprising a |
11 | consolidated corporation, the state in which the holding company or controlling affiliate has its |
12 | principal place of business as determined using the above factors. However, in the case of a plan |
13 | sponsor, if more than fifty percent (50%) of the participants in the benefit plan are employed in a |
14 | single state, that state shall be deemed to be the principal place of business of the plan sponsor. |
15 | (ii) The principal place of business of a plan sponsor of a benefit plan described in |
16 | subsection (16)(17)(iii) of this section shall be deemed to be the principal place of business of the |
17 | association, committee, joint board of trustees or other similar group of representatives of the |
18 | parties who establish or maintain the benefit plan that, in lieu of a specific or clear designation of |
19 | a principal place of business, shall be deemed to be the principal place of business of the employer |
20 | or employee organization that has the largest investment in the benefit plan in question. |
21 | (19)(20) "Receivership court” means the court in the insolvent or impaired insurer's state |
22 | having jurisdiction over the conservation, rehabilitation or liquidation of the member insurer. |
23 | (20)(21) "Resident” means a person to whom a contractual obligation is owed and who |
24 | resides in this state on the date of entry of court order that determines a member insurer to be an |
25 | impaired insurer or a court order that determines a member insured to be an insolvent insurer, |
26 | whichever occurs first. A person may be a resident of only one state, which in the case of a person |
27 | other than a natural person shall be its principal place of business. Citizens of the United States that |
28 | are either: (i) residents of foreign countries; or (ii) residents of United States possessions, territories |
29 | or protectorates that do not have an association similar to the association created by this chapter, |
30 | shall be deemed residents of the state of domicile of the member insurer that issued the polices or |
31 | contracts. |
32 | (21)(22) "Structured settlement annuity” means an annuity purchased in order to fund |
33 | periodic payments for a claimant in payment for or with respect to personal injuries suffered by the |
34 | claimant. |
| LC002082 - Page 18 of 61 |
1 | (22)(23) "State” means a state, the District of Columbia, Puerto Rico, or a United States |
2 | possession, territory or protectorate. |
3 | (23)(24) "Supplemental contract” means a written agreement entered into for the |
4 | distribution of proceeds under a life, health or annuity policy or contract. |
5 | (24)(25) "Unallocated annuity contract” means any annuity contract or group annuity |
6 | certificate which is not issued to and owned by an individual, except to the extent of any annuity |
7 | benefits guaranteed to an individual by an insurer under the contract or certificate. |
8 | 27-34.3-6. Creation of the association. |
9 | (a) There is created a nonprofit legal entity to be known as the Rhode Island life and health |
10 | insurance guaranty association. All member insurers shall be and remain members of the |
11 | association as a condition of their authority to transact insurance or health maintenance organization |
12 | business in this state. The association shall perform its functions under the plan of operation |
13 | established and approved under § 27-34.3-10, or as previously established and approved under § |
14 | 27-34.1-11 [Repealed] and shall exercise its powers through a board of directors established under |
15 | § 27-34.3-7 or as previously established under § 27-34.1-8 [Repealed]. For purposes of |
16 | administration and assessment, the association shall maintain two (2) accounts: |
17 | (1) The life insurance and annuity account which includes the following subaccounts: |
18 | (i) Life insurance account; |
19 | (ii) Annuity account; which shall include annuity contracts owned by a governmental |
20 | retirement plan (or its trustee) established under section 401, 403(b) or 457 of the United States |
21 | Internal Revenue Code, 26 U.S.C. § 401, 403(b) or 457, but shall otherwise exclude unallocated |
22 | annuities; and |
23 | (iii) Unallocated annuity account which shall exclude contracts owned by a governmental |
24 | retirement benefit plan (or its trustee) established under § 401, 403(b) or 457 of the United States |
25 | Internal Revenue Code, 26 U.S.C. § 401, 403(b) or 457. |
26 | (2) The health insurance account. |
27 | (b) The association shall come under the immediate supervision of the commissioner and |
28 | shall be subject to the applicable provisions of the insurance laws of this state. Meetings or records |
29 | of the association may be open to the public upon majority vote of the board of directors. The |
30 | commissioner or his or her designee shall have full and complete access to all documents received |
31 | by, created by or otherwise obtained by the association and shall be invited to be present at all |
32 | association meetings. The disclosure of confidential or privileged association information, |
33 | documents, or records to the commissioner shall not change the confidential or privileged status of |
34 | the information, documents or records. |
| LC002082 - Page 19 of 61 |
1 | 27-34.3-7. Board of directors. |
2 | (a) The board of directors of the association shall consist of: |
3 | (1) Not less than five (5) seven (7) nor more than nine (9) eleven (11) member insurers |
4 | serving terms as established in the plan of operation; and |
5 | (2) The commissioner or the commissioner's designee. Only member insurers or a health |
6 | maintenance organization shall be eligible to vote. The members of the board shall be selected by |
7 | member insurers subject to the approval of the commissioner. The board of directors, previously |
8 | established under § 27-34.1-8 [Repealed], shall continue to operate in accordance with the |
9 | provision of this section. Vacancies on the board shall be filled for the remaining period of the term |
10 | by a majority vote of the remaining board members, subject to the approval of the commissioner. |
11 | (b) In approving selections to the board, the commissioner shall consider, among other |
12 | things, whether all member insurers are fairly represented. |
13 | (c) Members of the board may be reimbursed from the assets of the association for expenses |
14 | incurred by them as members of the board of directors but members of the board shall not be |
15 | compensated by the association for their services. |
16 | 27-34.3-8. Powers and duties of the association. |
17 | (a) If a member insurer is an impaired insurer, the association may, in its discretion, and |
18 | subject to any conditions imposed by the association that do not impair the contractual obligations |
19 | of the impaired insurer, and that are approved by the commissioner: |
20 | (1) Guarantee, assume, reissue or reinsure, or cause to be guaranteed, assumed, reissued or |
21 | reinsured, any or all of the policies or contracts of the impaired insurer; |
22 | (2) Provide the monies, pledges, loans, notes, guarantees or other means that are proper to |
23 | effectuate subdivision (1) of this subsection and assure payment of the contractual obligations of |
24 | the impaired insurer pending action under subdivision (1) of this subsection. |
25 | (b) If a member insurer is an insolvent insurer, the association shall, in its discretion, either: |
26 | (1)(i)(A) Guaranty, assume, reissue or reinsure, or cause to be guaranteed, assumed, |
27 | reissued or reinsured, the policies or contracts of the insolvent insurer; or |
28 | (B) Assure payment of the contractual obligations of the insolvent insurer; and |
29 | (ii) Provide monies, pledges, loans, notes, guarantees, or other means that are reasonably |
30 | necessary to discharge the association's duties; or |
31 | (2) Provide benefits and coverages in accordance with the following provisions: |
32 | (i) With respect to life and health insurance policies and annuities policies and contracts, |
33 | assure payment of benefits for premiums identical to the premiums and benefits (except for terms |
34 | of conversion and renewability) that would have been payable under the policies or contracts of the |
| LC002082 - Page 20 of 61 |
1 | insolvent insurer, for claims incurred: |
2 | (A) With respect to group policies and contracts, not later than the earlier of the next |
3 | renewal date under such policies or contracts or forty-five (45) days, but in no event less than thirty |
4 | (30) days after the date on which the association becomes obligated with respect to the policies or |
5 | contracts; |
6 | (B) With respect to nongroup policies, contracts and annuities not later than the earlier of |
7 | the next renewal date (if any) under the policies or contracts or one year, but in no event less than |
8 | thirty (30) days from the date on which the association becomes obligated with respect to the |
9 | policies and contracts; |
10 | (ii) Make diligent efforts to provide all known insured insureds, enrollees or annuitants (for |
11 | non-group policies and contracts) or group policy or contract owners with respect to group policies |
12 | or contracts thirty (30) days' notice of the termination (pursuant to subparagraph (i) of this |
13 | paragraph) of the benefits provided; |
14 | (iii) With respect to nongroup life and health insurance policies and annuities policies and |
15 | contracts covered by the association, make available to each known insured, enrollee or annuitant, |
16 | or owner if other than the insured, enrollee, or annuitant and with respect to an individual formerly |
17 | an insured, enrollee or formerly an annuitant under a group policy or contract who is not eligible |
18 | for replacement group coverage, make available substitute coverage on an individual basis in |
19 | accordance with the provisions of subdivision (iv) of this subsection, if the insureds, enrollees or |
20 | annuitants had a right under law or the terminated policy, contract or annuity to convert coverage |
21 | to individual coverage or to continue an individual policy, contract or annuity in force until a |
22 | specified age or for a specified time, during which the insurer or health maintenance organization |
23 | had no right unilaterally to make changes in any provision of the policy, contract or annuity or had |
24 | a right only to make changes in premium by class; |
25 | (iv)(A) In providing the substitute coverage required under subdivision (iii) of this |
26 | subsection, the association may offer either to reissue the terminated coverage or to issue an |
27 | alternative policy or contract at actuarially justified rates subject to the prior approval of the |
28 | commissioner. |
29 | (B) Alternative or reissued policies or contracts shall be offered without requiring evidence |
30 | of insurability, and shall not provide for any waiting period or exclusion that would not have applied |
31 | under the terminated policy or contracts. |
32 | (C) The association may reinsure any alternative or reissued policy or contract. |
33 | (v)(A) Alternative policies or contracts adopted by the association shall be subject to the |
34 | approval of the domiciliary insurance commissioner and the receivership court. The association |
| LC002082 - Page 21 of 61 |
1 | may adopt alternative policies or contracts of various types for future issuance without regard to |
2 | any particular impairment or insolvency. |
3 | (B) Alternative policies or contracts shall contain at least the minimum statutory provisions |
4 | required in this state and provide benefits that shall not be unreasonable in relation to the premium |
5 | charged. The association shall set the premium in accordance with a table of rates which it shall |
6 | adopt. The premium shall reflect the amount of insurance to be provided and the age and class of |
7 | risk of each insured, but shall not reflect any changes in the health of the insured after the original |
8 | policy or contract was last underwritten. |
9 | (C) Any alternative policy or contract issued by the association shall provide coverage of |
10 | a type similar to that of the policy or contract issued by the impaired or insolvent insurer, as |
11 | determined by the association. |
12 | (vi) If the association elects to reissue terminated coverage at a premium rate different from |
13 | that charged under the terminated policy or contract, the premium shall be actuarially justified and |
14 | be set by the association in accordance with the amount of insurance or coverage provided and the |
15 | age and class of risk, subject to approval of the domiciliary insurance commissioner and the |
16 | receivership court. |
17 | (vii) The association's obligations with respect to coverage under any policy or contract of |
18 | the impaired or insolvent insurer or under any reissued or alternative policy or contract shall cease |
19 | on the date such coverage or policy or contract is replaced by another similar policy or contract by |
20 | the policy or contract owner, the insured, the enrollee, or the association. |
21 | (viii) When proceeding under paragraph (b)(2) of this section with respect to any policy or |
22 | contract carrying guaranteed minimum interest rates, the association shall assure the payment or |
23 | crediting of a rate of interest consistent with § 27-34.3-3(b)(2)(iii). |
24 | (c) Nonpayment of premiums within thirty-one (31) days after the date required under the |
25 | terms of any guaranteed, assumed, alternative or reissued policy or contract or substitute coverage |
26 | shall terminate the association's obligations under the policy, contract or coverage under this |
27 | chapter with respect to the policy, contract or coverage, except with respect to any claims incurred |
28 | or any net cash surrender value which may be due in accordance with the provisions of this chapter. |
29 | (d) Premiums due for coverage after entry of an order of liquidation of an insolvent insurer |
30 | shall belong to and be payable at the direction of the association. If the liquidator of an insolvent |
31 | insurer requests, the association shall provide a report to the liquidator regarding such premium |
32 | collected by the association. The association shall be liable for unearned premiums due to policy |
33 | or contract owners arising after the entry of the order. |
34 | (e) The protection provided by this chapter shall not apply where any guaranty protection |
| LC002082 - Page 22 of 61 |
1 | is provided to residents of this state by laws of the domiciliary state or jurisdiction of the impaired |
2 | or insolvent insurer other than this state. |
3 | (f) In carrying out its duties under subsection (b), the association may: |
4 | (1) Subject to approval by a court of competent jurisdiction in this state, impose permanent |
5 | policy or contract liens in connection with any guarantee, assumption or reinsurance agreement, if |
6 | the association finds that the amounts which can be assessed under this chapter are less than the |
7 | amounts needed to assure full and prompt performance of the association's duties under this chapter, |
8 | or that the economic or financial conditions as they affect member insurers are sufficiently adverse |
9 | to render the imposition of such permanent policy or contract liens, to be in the public interest; |
10 | (2) Subject to approval by a court of competent jurisdiction in this state, impose temporary |
11 | moratoriums or liens on payments of cash values and policy loans, or any other right to withdraw |
12 | funds held in conjunction with policies or contracts, in addition to any contractual provisions for |
13 | deferral of cash or policy loan value. In addition, in the event of a temporary moratorium or |
14 | moratorium charge imposed by the receivership court on payment of cash values or policy loans, |
15 | or on any other right to withdraw funds held in conjunction with policies or contracts, out of the |
16 | assets of the impaired or insolvent insurer, the association may defer the payment of such cash |
17 | values, policy loans or other rights by the association for the period of the moratorium or |
18 | moratorium charge imposed by the receivership court, except for claims covered by the association |
19 | to be paid in accordance with a hardship procedure established by the liquidator or rehabilitator and |
20 | approved by the receivership court. |
21 | (g) A deposit in this state, held pursuant to law or required by the commissioner for the |
22 | benefit of creditors, including policy or contract owners, not turned over to the domiciliary |
23 | liquidator upon the entry of a final order of liquidation or order approving a rehabilitation plan of |
24 | an a member insurer domiciled in this state or in a reciprocal state, pursuant to § 27-14.3-56, shall |
25 | be promptly paid to the association. The association shall be entitled to retain a portion of any |
26 | amounts so paid to it equal to the percentage determined by dividing the aggregate amount of policy |
27 | or contract owners' claims related to that insolvency for which the association has provided |
28 | statutory benefits by the aggregate amount of all policy or contract owners' claims in this state |
29 | related to that insolvency and shall remit to the domiciliary receiver the amount so paid to the |
30 | association less the amount retained pursuant to this subsection. Any amount so paid to the |
31 | association and retained by it shall be treated as a distribution of estate assets pursuant to applicable |
32 | state insurance law dealing with early access disbursements. |
33 | (h) If the association fails to act within a reasonable period of time with respect to an |
34 | insolvent insurer, as provided in subsection (b) of this section, the commissioner shall have the |
| LC002082 - Page 23 of 61 |
1 | powers and duties of the association under this chapter with respect to the insolvent insurers. |
2 | (i) The association may render assistance and advice to the commissioner, upon the |
3 | commissioner's request, concerning rehabilitation, payment of claims, continuance of coverage, or |
4 | the performance of other contractual obligations of any impaired or insolvent insurer. |
5 | (j) The association shall have standing to appear or intervene before any court or agency in |
6 | this state with jurisdiction over an impaired or insolvent insurer concerning which the association |
7 | is or may become obligated under this chapter or with jurisdiction over any person or property |
8 | against whom the association may have rights through subrogation or otherwise. Standing shall |
9 | extend to all matters germane to the powers and duties of the association, including, but not limited |
10 | to, proposals for reinsuring, reissuing, modifying or guaranteeing the policies or contracts of the |
11 | impaired or insolvent insurer and the determination of the polices or contracts and contractual |
12 | obligations. The association shall also have the right to appear or intervene before a court or agency |
13 | in another state with jurisdiction over an impaired or insolvent insurer for which the association is |
14 | or may become obligated or with jurisdiction over any person or property against whom the |
15 | association may have rights through subrogation or otherwise. |
16 | (k)(1) A person receiving benefits under this chapter shall be deemed to have assigned the |
17 | rights under, and any causes of action against any person for losses arising under, resulting from or |
18 | otherwise relating to, the covered policy or contract to the association to the extent of the benefits |
19 | received because of this chapter, whether the benefits are payments of or on account of contractual |
20 | obligations, continuation of coverage or provision of substitute or alternative policies, contracts or |
21 | coverage. The association may require an assignment to it of these rights and causes of action by |
22 | any enrollee, payee, policy or contract owner, beneficiary, insured or annuitant as a condition |
23 | precedent to the receipt of any right or benefits conferred by this chapter upon the person. |
24 | (2) The subrogation rights of the association under this subsection shall have the same |
25 | priority against the assets of the impaired or insolvent insurer as that possessed by the person |
26 | entitled to receive benefits under this chapter. |
27 | (3) In addition to subdivisions (1) and (2) of this subsection, the association shall have all |
28 | common law rights of subrogation and any other equitable or legal remedy that would have been |
29 | available to the impaired or insolvent insurer or owner, beneficiary, enrollee or payee, of a policy |
30 | or contract with respect to the policy or contracts including without limitation, in the case of a |
31 | structured settlement annuity, any rights of the owner, beneficiary or payee of the annuity, to the |
32 | extent of benefits received pursuant to this chapter, against a person originally or by succession |
33 | responsible for the losses arising from the personal injury relating to the annuity or payment |
34 | therefore, excepting any such person responsible solely by reason of serving as an assignee in |
| LC002082 - Page 24 of 61 |
1 | respect of a qualified assignment under § 130 of the United States Internal Revenue Code, 26 |
2 | U.S.C. § 130. |
3 | (4) If the preceding provisions of this subsection are invalid or ineffective with respect to |
4 | any person or claim for any reason, the amount payable by the association with respect to the related |
5 | covered obligations shall be reduced by the amount realized by any other person with respect to the |
6 | person or claim that is attributable to the policies or contracts, or portion thereof, covered by the |
7 | association. |
8 | (5) If the association has provided benefits with respect to a covered obligation and a person |
9 | recovers amounts to which the association has rights as described in the preceding paragraphs of |
10 | this subsection, the person shall pay to the association the portion of the recovery attributable to |
11 | the policies or contracts, or portions thereof, covered by the association. |
12 | (l) In addition to the rights and powers provided in this chapter, the association may: |
13 | (1) Enter into any contracts as are necessary or proper to carry out the provisions and |
14 | purposes of this chapter; |
15 | (2) Sue or be sued, including taking any legal actions necessary or proper to recover any |
16 | unpaid assessments under § 27-34.3-9 and to settle claims or potential claims against it; |
17 | (3) Borrow money to effect the purposes of this chapter; any notes or other evidence of |
18 | indebtedness of the association not in default shall be legal investments for domestic member |
19 | insurers and may be carried as admitted assets; |
20 | (4) Employ or retain persons as are necessary or appropriate to handle the financial |
21 | transactions of the association, and to perform any other functions as become necessary or proper |
22 | under this chapter; |
23 | (5) Take such legal action that may be necessary or appropriate to avoid or recover payment |
24 | of improper claims; |
25 | (6) Exercise, for the purposes of this chapter and to the extent approved by the |
26 | commissioner, the powers of a domestic life or insurer, health insurer, or health maintenance |
27 | organization, but in no case may the association issue insurance policies or annuity contracts other |
28 | than those issued to perform its obligations under this chapter; |
29 | (7) Organize itself as a corporation or another legal form permitted by the laws of this state; |
30 | (8) Request information from a person seeking coverage from the association in order to |
31 | aid the association in determining its obligations under this chapter with respect to the person, and |
32 | the person shall promptly comply with the request; and |
33 | (9) Unless prohibited by law, in accordance with the terms and conditions of the policy or |
34 | contract, file for actuarially justified rate or premium increases for any policy or contract for which |
| LC002082 - Page 25 of 61 |
1 | it provides coverage under this chapter; and |
2 | (9)(10) Take other necessary or appropriate action to discharge its duties and obligations |
3 | under this chapter or to exercise its powers under this chapter. |
4 | (m) The association may join an organization of one or more other state associations of |
5 | similar purposes, to further the purposes and administer the powers and duties of the association. |
6 | (n)(1)(a) At any time within one hundred eighty (180) days of the date of the order of |
7 | liquidation, the association may elect to succeed to the rights and obligations of the ceding member |
8 | insurer that relate to policies, contracts or annuities covered, in whole or in part, by the association, |
9 | in each case under any one or more reinsurance contracts entered into by the insolvent insurer and |
10 | its reinsurers and selected by the association. Any such assumption shall be effective as of the date |
11 | of the order of liquidation. The election shall be effected by the association or the national |
12 | organization of life and health insurance guaranty associations (NOLHGA) on its behalf sending |
13 | written notice, return receipt requested to the affected reinsurers. |
14 | (b) To facilitate the earliest practicable decision about whether to assume any of the |
15 | contracts of reinsurance, and in order to protect the financial position of the estate, the receiver and |
16 | each reinsurer of the ceding member insurer shall make available upon request to the association |
17 | or to NOLHGA on its behalf as soon as possible after commencement of formal delinquency |
18 | proceedings: (i) Copies of in-force contracts of reinsurance and all related files and records relevant |
19 | to the determination of whether such contracts should be assumed, and (ii) Notices of any defaults |
20 | under the reinsurance contracts or any known event or condition which with the passage of time |
21 | could become a default under the reinsurance contracts. |
22 | (c) The following subparagraphs (i) through (iv) shall apply to reinsurance contracts so |
23 | assumed by the association. |
24 | (i) The association shall be responsible for all unpaid premiums due under the reinsurance |
25 | contracts for periods both before and after the date of the order of liquidation, and shall be |
26 | responsible for the performance of all other obligations to be performed after the date of the order |
27 | of liquidation, in each case which relate to policies, contracts and annuities covered, in whole or in |
28 | part, by the association. The association may charge policies, contracts and annuities covered in |
29 | part by the association, through reasonable allocation methods, the costs for reinsurance in excess |
30 | of the obligations of the association and shall provide notice and an accounting of these charges to |
31 | the liquidator; |
32 | (ii) The association shall be entitled to any amounts payable by the reinsurer under the |
33 | reinsurance contracts with respect to losses or events that occur in periods after the date of the order |
34 | of liquidation and that relate to policies or annuities covered in whole or in part, by the association |
| LC002082 - Page 26 of 61 |
1 | provided, that, upon receipt of any such amounts, the association shall be obliged to pay to the |
2 | beneficiary under the policy, contract or annuity on account of which the amounts were paid a |
3 | portion of the amount equal to the lesser of: |
4 | (A) The amount received by the association; or |
5 | (B) The excess of the amount received by the association; over the amount equal to the |
6 | benefits paid by the association on account of the policy, contract or annuity less the retention of |
7 | the insurer applicable to the loss or event; |
8 | (iii) Within thirty (30) days following the association's election (the "election date”), the |
9 | association and each reinsurer under contracts assumed by the association shall calculate the net |
10 | balance due to or from the association under each such reinsurance contract as of the election date |
11 | with respect to policies, contracts or annuities covered, in whole or in part, by the association which |
12 | calculation shall give, full credit to all items paid by either the member insurer or its receiver or the |
13 | reinsurer prior to the election date. The reinsurer shall pay the receiver any amounts due for losses |
14 | or events prior to the date of the order of liquidation, subject to any set-off for premiums unpaid |
15 | for periods prior to the date, and the association or reinsurer shall pay any remaining premiums in |
16 | each case within five (5) days of the completion of the aforementioned calculation. Any disputes |
17 | over the amounts due to either the association or the reinsurer shall be resolved by arbitration |
18 | pursuant to the terms of the affected reinsurance contracts or, if the contract contains no arbitration |
19 | clause, as otherwise provided by law. If the receiver has received any amounts due the association |
20 | pursuant to paragraph (ii), the receiver, shall remit the same to the association as promptly as |
21 | practicable. |
22 | (iv) If the association or receiver, on the association's behalf, within sixty (60) days of the |
23 | election date, pays the unpaid premiums due for periods both before and after the election date, that |
24 | relate to policies, contracts or annuities covered in whole or in part by the association the reinsurer |
25 | shall not be entitled to terminate the reinsurance contracts for failure to pay premium insofar as the |
26 | reinsurance contracts relate to policies, contracts or annuities covered in whole or in part by the |
27 | association and shall not be entitled to set off any unpaid amounts due under other contracts, or |
28 | unpaid amounts due from parties other than the association against amounts due to the association. |
29 | (2) During the period from the date of the order of liquidation until the election date (or, if |
30 | the election date does not occur, until one hundred eighty (180) days after the date of the order of |
31 | liquidation). |
32 | (a)(i) Neither the association nor the reinsurer shall have any rights or obligations under |
33 | reinsurance contracts that the association has the right to assume under subdivision (n)(1), whether |
34 | for periods prior to or after the date of the order of liquation; and |
| LC002082 - Page 27 of 61 |
1 | (ii) The reinsurer, the receiver and the association shall, to the extent practicable, provide |
2 | each other data and records reasonably requested; |
3 | (b) Provided that once the association has elected to assume a reinsurance contract, the |
4 | parties' rights and obligations shall be governed by subdivision (n)(1). |
5 | (3) If the association does not elect to assume a reinsurance contract by the election date |
6 | pursuant to subdivision (n)(1), the association shall have no rights or obligations, in each case for |
7 | periods both before and after the date of the order of liquidation, with respect to the reinsurance |
8 | contract. |
9 | (4) When policies, contracts or annuities, or covered obligations with respect thereto, are |
10 | transferred to an assuming insurer, reinsurance on the policies, contracts or annuities may also be |
11 | transferred by the association, in the case of contracts assumed under subdivision (n)(1), subject to |
12 | the following: |
13 | (a) Unless the reinsurer and the assuming insurer agree otherwise, the reinsurance contract |
14 | transferred shall not cover any new policies of insurance, contracts or annuities in addition to those |
15 | transferred; |
16 | (b) The obligations described in paragraph (n)(1) of this section shall not apply with respect |
17 | to matters arising after the effective date of the transfer; |
18 | (c) Notice shall be given in writing, return receipt requested, by the transferring party to |
19 | the affected reinsurer not less than thirty (30) days prior to the effective date of the transfer. |
20 | (5) The provisions of subsection (n) shall supersede the provisions of any state law or of |
21 | any affected reinsurance contract that provides for or requires any payment of reinsurance proceeds, |
22 | on account of losses or events that occur in periods after the date of the order of liquidation to the |
23 | receiver, of the insolvent insurer or any other person. The receiver, shall remain entitled to any |
24 | amounts payable by the reinsurer under the reinsurance contracts with respect to losses or events |
25 | that occur in periods prior to the date of the order of liquidation subject to applicable setoff |
26 | provisions. |
27 | (6) Except as otherwise provided in this section, nothing in this section (n): |
28 | Shall alter or modify the terms and conditions of any reinsurance contract. |
29 | Nothing in this section shall abrogate or limit any rights of any reinsurer to claim that it is |
30 | entitled to rescind a reinsurance contract. |
31 | Nothing in this section shall give a policy holder, contract owner, enrollee, certificate |
32 | holder or beneficiary an independent cause of action against an indemnity reinsurer that is not |
33 | otherwise set forth in the reinsurance contract. Nothing in this section shall limit or affect the |
34 | association's rights as a creditor of the estate against the assets of the estate. Nothing in this section |
| LC002082 - Page 28 of 61 |
1 | shall apply to reinsurance agreements covering property or casualty risks. |
2 | (o) The board of directors of the association shall have discretion and shall exercise |
3 | reasonable business judgment to determine the means by which the association is to provide the |
4 | benefits of this chapter in an economical and efficient manner. |
5 | (p) Where the association has arranged or offered to provide the benefits of this chapter to |
6 | a covered person under a plan or arrangement that fulfills the association's obligations under this |
7 | chapter, the person shall not be entitled to benefits from the association in addition to or other than |
8 | those provided under the plan or arrangement. |
9 | (q) Venue in a suit against the association arising under this chapter shall be in Providence |
10 | county. The association shall not be required to give an appeal bond in an appeal that relates to a |
11 | cause of action arising under this chapter. |
12 | (q)(r) In carrying out its duties in connection with guaranteeing, assuming, reissuing or |
13 | reinsuring policies or contracts under subsection (a) or (b) of this section, the association may, |
14 | subject to approval of the receivership court, issue substitute coverage for a policy or contract that |
15 | provides an interest rate, crediting rate or similar factor determined by use of an index or other |
16 | external reference stated in the policy or contract employed in calculating returns or changes in |
17 | value by issuing an alternative policy or contract in accordance with the following provisions: |
18 | (r) Venue in a suit against the association arising under this chapter shall be in Providence |
19 | County. The association shall not be required to give an appeal bond in an appeal that relates to a |
20 | cause of action arising under this chapter. |
21 | (1) In lieu of the index or other external reference provided for in the original policy or |
22 | contract, the alternative policy or contract provides for: |
23 | (i) A fixed interest rate; or |
24 | (ii) Payment of dividends with minimum guarantees; or |
25 | (iii) A different method of calculating interest or changes in value. |
26 | (2) There is no requirement for evidence of insurability, waiting period or other exclusion |
27 | that would not have applied under the replaced policy or contract; and |
28 | (3) The alternative policy or contract is substantially similar to the replaced policy or |
29 | contract in all other material terms. |
30 | 27-34.3-9. Assessments. |
31 | (a) For the purpose of providing the funds necessary to carry out the powers and duties of |
32 | the association, the board of directors shall assess the member insurers, separately for each account, |
33 | at such time and for such amounts as the board finds necessary. Assessments shall be due not less |
34 | than thirty (30) days after prior written notice to the member insurers and shall accrue interest at |
| LC002082 - Page 29 of 61 |
1 | nine percent (9%) per annum on and after the due date. |
2 | (b) There shall be two (2) classes of assessments, as follows: |
3 | (1) Class A assessments shall be authorized and called for the purpose of meeting |
4 | administrative and legal costs and other expenses. Class A assessments may be authorized and |
5 | called whether or not related to a particular impaired or insolvent insurer. |
6 | (2) Class B assessments shall be authorized and called to the extent necessary to carry out |
7 | the powers and duties of the association under § 27-34.3-8 with regard to an impaired or an |
8 | insolvent insurer. |
9 | (c)(1) The amount of any Class A assessment shall be determined by the board and may be |
10 | authorized and called on a pro rata or non-pro rata basis. If pro rata, the board may provide that it |
11 | be credited against future Class B assessments. The total of all non-pro rata assessment shall not |
12 | exceed three hundred dollars ($300) per member insurer in any one calendar year. The amount of |
13 | any Class B assessment shall be allocated for assessment purposes among the accounts pursuant to |
14 | an allocation formula that may be based on the premiums or reserves of the impaired or insolvent |
15 | insurer or any other standard deemed by the board in its sole discretion as being fair and reasonable |
16 | under the circumstances. |
17 | (2) The amount of a Class B assessment, except for assessments related to long-term care |
18 | insurance, shall be allocated for assessment purposes between the accounts and among the |
19 | subaccounts of the life insurance and annuity account, pursuant to an allocation formula which may |
20 | be based on the premiums or reserves of the impaired or insolvent insurer, or any other standard |
21 | deemed by the board in its sole discretion as being fair and reasonable under the circumstances. |
22 | (3) The amount of the Class B assessment for long-term care insurance written by the |
23 | impaired or insolvent insurer shall be allocated according to a methodology included in the plan of |
24 | operation and approved by the commissioner. The methodology shall provide for fifty percent |
25 | (50%) of the assessment to be allocated to accident and health member insurers and fifty percent |
26 | (50%) to be allocated to life and annuity member insurers. |
27 | (2)(4) Class B assessments against member insurers for each account and subaccount shall |
28 | be in the proportion that the premiums received on business in this state by each assessed member |
29 | insurer or policies or contracts covered by each account for the three (3) most recent calendar years |
30 | for which information is available preceding the year in which the insurer became insolvent, (or, in |
31 | the case of an assessment with respect to an impaired member insurer, the three (3) most recent |
32 | calendar years for which information is available preceding the year in which the member insurer |
33 | became impaired) bears to premiums received on business in this state for such calendar years by |
34 | all assessed member insurers. |
| LC002082 - Page 30 of 61 |
1 | (3)(5) Assessments for funds to meet the requirements of the Association with respect to |
2 | an impaired or insolvent insurer shall not be authorized or called until necessary to implement the |
3 | purposes of this chapter. Classification of assessments under subsection (b) of this section and |
4 | computation of assessments under this subsection shall be made with a reasonable degree of |
5 | accuracy, recognizing that exact determinations may not always be possible. The association shall |
6 | notify each member insurer of its anticipated pro rata share of an authorized assessment not yet |
7 | called within one hundred eighty (180) days after the assessment is authorized. |
8 | (d) The association may abate or defer, in whole or in part, the assessment of a member |
9 | insurer if, in the opinion of the board, payment of the assessment would endanger the ability of the |
10 | member insurer to fulfill its contractual obligations. In the event an assessment against a member |
11 | insurer is abated, or deferred in whole or in part, the amount by which the assessment is abated or |
12 | deferred may be assessed against the other member insurers in a manner consistent with the basis |
13 | for assessments set forth in this section. Once the conditions which have caused a deferral have |
14 | been removed or rectified, the member insurer shall pay all assessments that were deferred pursuant |
15 | to a repayment plan approved by the association. |
16 | (e)(1)(i) Subject to the provisions of subparagraph (ii) of this paragraph, the total of all |
17 | assessments authorized by the association with respect to a member insurer for each subaccount of |
18 | the life insurance and annuity account and for the health account shall not in any one calendar year |
19 | exceed three percent (3%) of that member insurer's average annual premiums received in this state |
20 | on the policies and contracts covered by the subaccount or account during the three (3) calendar |
21 | years preceding the year in which the member insurer became an impaired or insolvent insurer. |
22 | (ii) If two (2) or more assessments are authorized in one calendar year with respect to |
23 | member insurers that become impaired or insolvent in different calendar years, the average annual |
24 | premiums for purposes of the aggregate assessment percentage limitation referenced in |
25 | subparagraph (i) of this paragraph shall be equal and limited to the higher of the three (3) year |
26 | average annual premiums for the applicable subaccount or account as calculated pursuant to this |
27 | section. |
28 | (iii) If the maximum assessment, together with the other assets of the association in any |
29 | account, does not provide in any one year in either account an amount sufficient to carry out the |
30 | responsibilities of the association, the necessary additional funds shall be assessed as soon after this |
31 | as permitted by this chapter. |
32 | (2) The board may provide in the plan of operation a method of allocating funds among |
33 | claims, whether relating to one or more impaired or insolvent insurers, when the maximum |
34 | assessment will be insufficient to cover anticipated claims. |
| LC002082 - Page 31 of 61 |
1 | (3) If the maximum assessment for a subaccount of the life and annuity account in any one |
2 | year does not provide an amount sufficient to carry out the responsibilities of the association, then |
3 | pursuant to subdivision (c)(2) of this section, the board shall assess the other subaccounts of the |
4 | life and annuity account for the necessary additional amount, subject to the maximum stated in |
5 | subdivision (1) of this subsection. |
6 | (f) The board may, by an equitable method as established in the plan of operation, refund |
7 | to member insurers, in proportion to the contribution of each member insurer to that account, the |
8 | amount by which the assets of the account exceed the amount the board finds is necessary to carry |
9 | out during the coming year the obligations of the association with regard to that account, including |
10 | assets accruing from assignment, subrogation, net realized gains and income from investments. A |
11 | reasonable amount may be retained in any account to provide funds for the continuing expenses of |
12 | the association and for future claims. |
13 | (g) It shall be proper for any member insurer, in determining its premium rates and policy |
14 | owner dividends as to any kind of insurance or health maintenance organization business within |
15 | the scope of this chapter, to consider the amount reasonably necessary to meet its assessment |
16 | obligations under this chapter. |
17 | (h) The association shall issue to each member insurer paying an assessment under this |
18 | chapter, other than Class A assessment, a certificate of contribution, in a form prescribed by the |
19 | commissioner, for the amount of the assessment so paid. All outstanding certificates shall be of |
20 | equal dignity and priority without reference to amounts or dates of issue. A certificate of |
21 | contribution may be shown by the member insurer in its financial statement as an asset in such form |
22 | and for such amount, if any, and period of time as the commissioner may approve. |
23 | (i)(1) A member insurer that wishes to protest all or part of an assessment shall pay when |
24 | due the full amount of the assessment as set forth in the notice provided by the association. The |
25 | payment shall be available to meet association obligations during the pendency of the protest or |
26 | any subsequent appeal. Payment shall be accompanied by a statement in writing that the payment |
27 | is made under protest and setting forth a brief statement of the grounds for the protest. |
28 | (2) Within sixty (60) days following the payment of an assessment under protest by a |
29 | member insurer, the association shall notify the member insurer in writing of its determination with |
30 | respect to the protest unless the association notifies the member insurer that additional time is |
31 | required to resolve the issues raised by the protest. |
32 | (3) Within thirty (30) days after a final decision has been made, the association shall notify |
33 | the protesting member insurer in writing of that final decision. Within sixty (60) days of receipt of |
34 | notice of the final decision, the protesting member insurer may appeal that final action to the |
| LC002082 - Page 32 of 61 |
1 | commissioner. |
2 | (4) In the alternative to rendering a final decision with respect to a protest based on a |
3 | question regarding the assessment base, the association may refer the protest to the commissioner |
4 | for a final decision, with or without a recommendation from the association. |
5 | (5) If the protest or appeal on the assessment is upheld, the amount paid in error or excess |
6 | shall be returned to the member company insurer. Interest on a refund due a protesting member |
7 | insurer shall be paid at the rate actually earned by the association. |
8 | (j) The association may request information of member insurers in order to aid in the |
9 | exercise of its power under this section and member insurers shall promptly comply with a request. |
10 | 27-34.3-11. Duties and powers of the commissioner. |
11 | In addition to the duties and powers enumerated in this chapter, |
12 | (a) The commissioner shall: |
13 | (1) Upon request of the board of directors, provide the association with a statement of the |
14 | premiums in this and any other appropriate states for each member insurer; |
15 | (2) When an impairment is declared and the amount of the impairment is determined, serve |
16 | a demand upon the impaired insurer to make good the impairment within a reasonable time; notice |
17 | to the impaired insurer shall constitute notice to its shareholders, if any; the failure of the impaired |
18 | insurer to promptly comply with a demand shall not excuse the association from the performance |
19 | of its powers and duties under this chapter. |
20 | (3) [Deleted by P.L. 2009, ch. 158, § 1 and by P.L. 2009, ch. 169, § 1]. |
21 | (4) Maintain the confidentiality and privileged status of confidential association |
22 | information provided to the commissioner or department of business regulation. |
23 | (b) The commissioner may suspend or revoke, after notice and hearing, the certificate of |
24 | authority to transact insurance business in this state of any member insurer which fails to pay an |
25 | assessment when due or fails to comply with the plan of operation. As an alternative the |
26 | commissioner may levy a forfeiture on any member insurer which fails to pay an assessment when |
27 | due. The forfeiture shall not exceed five percent (5%) of the unpaid assessment per month, but no |
28 | forfeiture shall be less than one hundred dollars ($100) per month. |
29 | (c) A final action of the board of directors or the association may be appealed to the |
30 | commissioner by any member insurer if the appeal is taken within sixty (60) days of its receipt of |
31 | notice of the final action being appealed. A final action or order of the commissioner shall be subject |
32 | to judicial review. |
33 | (d) The liquidator, rehabilitator, or conservator of any impaired or insolvent insurer may |
34 | notify all interested persons of the effect of this chapter. |
| LC002082 - Page 33 of 61 |
1 | (e) The commissioner shall not participate in the association's adjudication of a protest by |
2 | an insurer pursuant to § 27-34.3-9(i). |
3 | 27-34.3-12. Prevention of insolvencies. |
4 | To aid in the detection and prevention of member insurer insolvencies or impairments: |
5 | (a) It shall be the duty of the commissioner: |
6 | (1) To notify the commissioners of all the other states, territories of the United States and |
7 | the District of Columbia within thirty (30) days following the action taken or the date the action |
8 | occurs, when the commissioner takes any of the following actions against a member insurer: |
9 | (i) Revocation of license; |
10 | (ii) Suspension of license; or |
11 | (iii) Makes a formal order that the company member insurer restrict its premium writing, |
12 | obtain additional contributions to surplus, withdraw from the state, reinsure all or any part of its |
13 | business, or increase capital, surplus, or any other account for the security of policy owners, |
14 | contract owners, certificate holders or creditors. |
15 | (2) To report to the board of directors when the commissioner has taken any of the actions |
16 | set forth in paragraph (1) of this subdivision or has received a report from any other commissioner |
17 | indicating that this action has been taken in another state. The report to the board of directors shall |
18 | contain all significant details of the action taken or the report received from another commissioner. |
19 | (3) To report to the board of directors when the commissioner has reasonable cause to |
20 | believe from any examination, whether completed or in process, of any member company insurer |
21 | that the company insurer may be an impaired or insolvent insurer. |
22 | (4) To furnish to the board of directors the NAIC insurance regulatory information system |
23 | (IRIS) ratios and listings of companies not included in the ratios developed by the national |
24 | association of insurance commissioners, and the board may use the information contained in the |
25 | ratios and listings in carrying out its duties and responsibilities under this section. The report and |
26 | the information contained in it shall be kept confidential by the board of directors until the time it |
27 | is made public by the commissioner or other lawful authority. |
28 | (b) The commissioner may seek the advice and recommendations of the board of directors |
29 | concerning any matter affecting the duties and responsibilities of the commissioner regarding the |
30 | financial condition of member insurers and companies insurers or health maintenance organizations |
31 | seeking admission to transact insurance business in this state. |
32 | (c) The board of directors may, upon majority vote, make reports and recommendations to |
33 | the commissioner upon any matter germane to the solvency, liquidation, rehabilitation or |
34 | conservation of any member insurer or germane to the solvency of any company insurer or health |
| LC002082 - Page 34 of 61 |
1 | maintenance organization seeking to do an insurance business in this state. The reports and |
2 | recommendations shall not be considered public documents. |
3 | (d) The board of directors may, upon majority vote, notify the commissioner of any |
4 | information indicating a member insurer may be an impaired or insolvent insurer. |
5 | (e) The board of directors may, upon majority vote, make recommendations to the |
6 | commissioner for the detection and prevention of member insurer insolvencies. |
7 | 27-34.3-13. Credits for assessments paid (tax offsets). |
8 | (a) A member insurer may offset against its premium, franchise or income tax liability (or |
9 | liabilities) to this state an assessment described in § 27-34.3-9(h) to the extent of ten percent (10%) |
10 | of the amount of the assessment for each of the five (5) calendar years following the year in which |
11 | the assessment was paid. In the event a member insurer should cease doing business, all uncredited |
12 | assessments may be credited against its premium, franchise, or income tax liability (or liabilities) |
13 | for the year it ceases doing business. |
14 | (b) Any sums which are acquired by refund, pursuant to § 27-34.3-9(f), from the |
15 | association by member insurers, and which have been offset against premium, franchise or income |
16 | taxes as provided in subsection (a) of this section, shall be paid by the member insurers to this state |
17 | in any manner that the tax authorities may require. The association shall notify the commissioner |
18 | that refunds have been made. |
19 | 27-34.3-14. Miscellaneous provisions. |
20 | (a) This chapter shall not be construed to reduce the liability for unpaid assessments of the |
21 | insureds of an impaired or insolvent insurer operating under a plan with assessment liability. |
22 | (b) Records shall be kept of all meetings of the board of directors to discuss the activities |
23 | of the association in carrying out its powers and duties under § 27-34.3-8. The records of the |
24 | association with respect to an impaired or insolvent insurer shall not be disclosed prior to the |
25 | termination of a liquidation, rehabilitation or conservation proceeding involving the impaired or |
26 | insolvent insurer, upon the termination of the impairment or insolvency of the insurer, or upon the |
27 | order of a court of competent jurisdiction. Nothing in this subsection shall limit the duty of the |
28 | association to render a report of its activities under § 27-34.3-15. |
29 | (c) For the purpose of carrying out its obligations under this chapter, the association shall |
30 | be deemed to be a creditor of the impaired or insolvent insurer to the extent of assets attributable |
31 | to covered policies reduced by any amounts to which the association is entitled as subrogee |
32 | pursuant to § 27-34.3-8(k). Assets of the impaired or insolvent insurer attributable to covered |
33 | policies shall be used to continue all covered policies and pay all contractual obligations of the |
34 | impaired or insolvent insurer as required by this chapter. Assets attributable to covered policies or |
| LC002082 - Page 35 of 61 |
1 | contracts, as used in this subsection, are that proportion of the assets which the reserves that should |
2 | have been established for covered policies or contracts bear to the reserves that should have been |
3 | established for all policies of insurance or health benefit plans written by the impaired or insolvent |
4 | insurer. |
5 | (d) As a creditor of the impaired or insolvent insurer as established in subsection (c) of this |
6 | section and consistent with § 27-14.3-38, the association and other similar associations shall be |
7 | entitled to receive a disbursement of assets out of the marshalled assets, from time to time as the |
8 | assets become available to reimburse it, as a credit against contractual obligations under this |
9 | chapter. If the liquidator has not, within one hundred twenty (120) days of a final determination of |
10 | insolvency of an a member insurer by the receivership court, made an application to the court for |
11 | the approval of a proposal to disperse assets out of marshalled assets to guaranty associations |
12 | having obligations because of the insolvency, then the association shall be entitled to make |
13 | application to the receivership court for approval of its own proposal to disburse these assets. |
14 | (e)(1) Prior to the termination of any liquidation, rehabilitation or conservation proceeding, |
15 | the court may take into consideration the contributions of the respective parties, including the |
16 | association, the shareholders, contract owners, certificate holders, enrollees and policy owners of |
17 | the insolvent insurer, and any other party with a bona fide interest, in making an equitable |
18 | distribution of the ownership rights of the insolvent insurer. In that determination, consideration |
19 | shall be given to the welfare of the policy owners, contract owners, certificate holders, enrollees of |
20 | the continuing or successor member insurer. |
21 | (2) No distribution to stockholders, if any, of an impaired or insolvent insurer shall be made |
22 | until and unless the total amount of valid claims of the association with interest on the claims for |
23 | funds expended in carrying out its powers and duties under § 27-34.3-8 with respect to the member |
24 | insurer have been fully recovered by the association. |
25 | (f)(1) If an order for liquidation or rehabilitation of an a member insurer domiciled in this |
26 | state has been entered, the receiver appointed under the order shall have a right to recover on behalf |
27 | of the member insurer, from any affiliate that controlled it, the amount of distributions, other than |
28 | stock dividends paid by the member insurer on its capital stock, made at any time during the five |
29 | (5) years preceding the petition for liquidation or rehabilitation subject to the limitations of |
30 | subdivisions (2) — (4) of this subsection. |
31 | (2) No distribution shall be recoverable if the member insurer shows that when paid the |
32 | distribution was lawful and reasonable, and that the member insurer did not know and could not |
33 | reasonably have known that the distribution might adversely affect the ability of the member insurer |
34 | to fulfill its contractual obligations. |
| LC002082 - Page 36 of 61 |
1 | (3) Any person who was an affiliate that controlled the member insurer at the time the |
2 | distributions were paid shall be liable up to the amount of distributions received. Any person who |
3 | was an affiliate who controlled the member insurer at the time the distributions were declared, shall |
4 | be liable up to the amount of distributions which would have been received if they had been paid |
5 | immediately. If two (2) or more persons are liable with respect to the same distributions, they shall |
6 | be jointly and severally liable. |
7 | (4) The maximum amount recoverable under this subsection shall be the amount needed in |
8 | excess of all other available assets of the insolvent insurer to pay the contractual obligations of the |
9 | insolvent insurer. |
10 | (5) If any person liable under subdivision (3) of this subsection is insolvent, all its affiliates |
11 | that controlled it at the time the distribution was paid, shall be jointly and severally liable for any |
12 | resulting deficiency in the amount recovered from the insolvent affiliate. |
13 | 27-34.3-19. Prohibited advertisement of insurance guaranty association act in |
14 | insurance sales — Notice to policy owners. |
15 | (a) No person, including an a member insurer, agent, producer, or affiliate of an insurer |
16 | shall make, publish, disseminate, circulate or place before the public, or cause directly or indirectly, |
17 | to be made, published, disseminated, circulated or placed before the public, in any newspaper, |
18 | magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or in |
19 | the form of e-mail or an electronic website, or over any radio station or television station, or in any |
20 | other way, any advertisement, announcement or statement, written or oral, which uses the existence |
21 | of the insurance guaranty association of this state for the purpose of sales, solicitation or |
22 | inducement to purchase any form of insurance or other coverage covered by the Rhode Island life |
23 | and health insurance guaranty association act; provided, that this section shall not apply to the |
24 | association or any other entity which does not sell or solicit insurance or other coverage by a health |
25 | maintenance organization. The use of the protection afforded by this chapter, other than as provided |
26 | by this section, by any person in the sale, marketing or advertising of insurance constitutes unfair |
27 | methods of competition and unfair or deceptive acts or practices under chapter 29 of this title and |
28 | is subject to the sanctions imposed in that chapter. |
29 | (b) The association shall prepare a summary document describing the general purposes and |
30 | current limitations of this chapter in compliance with subsection (c) of this section. This document |
31 | shall be submitted to the commissioner for approval. At the expiration of the sixty (60) days after |
32 | the date on which the commissioner approves the document, an a member insurer may not deliver |
33 | a policy or contract to a policy owner, or contract owner, certificate holder or enrollee unless the |
34 | summary document is delivered to the policy owner, or contract owner, certificate holder or |
| LC002082 - Page 37 of 61 |
1 | enrollee at the time of delivery of the policy or contract. The document shall also be available upon |
2 | request by a policy owner, contract owner, certificate holder or enrollee. The distribution, delivery |
3 | or contents or interpretation of this document does not guarantee that either the policy or the policy |
4 | owner, contract owner, certificate holder or enrollee contract or the owner of the policy or contract |
5 | policy owner, contract owner, certificate holder or enrollee is covered in the event of the |
6 | impairment or insolvency of a member insurer. The summary document shall be revised by the |
7 | association as amendments to this chapter may require. Failure to receive this document does not |
8 | give the policy owner, contract owner, certificate holder, enrollee or insured any greater rights than |
9 | those stated in this act. |
10 | (c) The summary document prepared under subsection (b) of this section shall contain a |
11 | clear and conspicuous disclaimer on its face. The commissioner shall establish the form and content |
12 | of the disclaimer. The disclaimer shall: |
13 | (1) State the name and address of the association and the insurance department; |
14 | (2) Prominently warn the policy or contract owner, contract owner, certificate holder or |
15 | enrollee that the association may not cover the policy or, if coverage is available, it will be subject |
16 | to substantial limitations and exclusions and conditioned on continued residence in this state; |
17 | (3) State the types of policies or contracts for which guaranty funds will provide coverage; |
18 | (4) State that the member insurer and its agents are prohibited by law from using the |
19 | existence of the association for the purpose of sales, solicitation or inducement to purchase any |
20 | form of insurance or health maintenance organization coverage; |
21 | (5) State that the policy or contract owner policy owner, contract owner, certificate holder |
22 | or enrollee should not rely on coverage under the association when selecting an insurer or health |
23 | maintenance organization; |
24 | (6) Explain rights available and procedures for filing a complaint to allege a violation of |
25 | any provisions of this chapter; and |
26 | (7) Provide other information as directed by the commissioner including, but not limited |
27 | to, sources for information about the financial condition of insurers provided that the information |
28 | is not proprietary and is subject to disclosure under chapter 2 of title 38. |
29 | (d) A member insurer shall retain evidence of compliance with subsection (b) for so long |
30 | as the policy or contract for which the notice is given remains in effect. |
31 | 27-34.3-20. Prospective application. |
32 | This chapter shall not apply to any member insurer that is insolvent or unable to fulfill its |
33 | contractual obligations prior to January 1, 1996, and any such insurer shall be subject to the |
34 | provisions under chapter 34.1 of this title. Nothing in this chapter shall be construed to require an |
| LC002082 - Page 38 of 61 |
1 | insurer to recompute its assessment bases for any year prior to January 1, 2005, and any assessment |
2 | bases computed between January 1, 1966 and December 31, 2004 are hereby acknowledged and |
3 | recognized as factual on the basis of premium date collected from or reported by member insurers |
4 | with respect to those years. |
5 | SECTION 5. Section 42-14-5 of the General Laws in Chapter 42-14 entitled "Department |
6 | of Business Regulation" is hereby amended to read as follows: |
7 | 42-14-5. Superintendents of banking and insurance. |
8 | (a) The superintendents of banking and insurance shall administer the functions of the |
9 | department relating to the regulation and control of banking and insurance. |
10 | (b) Wherever the words "banking administrator” or "banking commissioner” or "insurance |
11 | administrator” or "insurance commissioner” occur in this chapter or any general law, public law, |
12 | act, or resolution of the general assembly or department regulation, they shall be construed to mean |
13 | superintendent of banking and superintendent of insurance except as delineated in subsection (d) |
14 | below. |
15 | (c) "Health insurance” shall mean "health insurance coverage,” as defined in §§ 27-18.5-2 |
16 | and 27-18.6-2, "health benefit plan,” as defined in § 27-50-3 and a "medical supplement policy,” |
17 | as defined in § 27-18.2-1 or coverage similar to a Medicare supplement policy that is issued to an |
18 | employer to cover retirees, and dental coverage, including, but not limited to, coverage provided |
19 | by a nonprofit dental service plan as defined in § 27-20.1-1(3). |
20 | (d) Whenever the words "commissioner,” "insurance commissioner,” "health insurance |
21 | commissioner” or "director” appear in Title 27 or Title 42, those words shall be construed to mean |
22 | the health insurance commissioner established pursuant to § 42-14.5-1 with respect to all matters |
23 | relating to health insurance. The health insurance commissioner shall have sole and exclusive |
24 | jurisdiction over enforcement of those statutes with respect to all matters relating to health |
25 | insurance except for purposes of producer licensing or producer appointments. |
26 | (e) Whenever the word "director” appears or is a defined term in title 19, this word shall |
27 | be construed to mean the superintendent of banking established pursuant to this section. |
28 | (f) Whenever the word "director” or "commissioner” appears or is a defined term in title |
29 | 27, this word shall be construed to mean the superintendent of insurance established pursuant to |
30 | this section except as delineated in subsection (d) of this section. |
31 | SECTION 6. Chapter 27-2.4 of the General Laws entitled "Producer Licensing Act" is |
32 | hereby amended by adding thereto the following section: |
33 | 27-2.4-14.1. Appointments. |
34 | (a) An insurance producer shall not act as an agent of an insurer unless the insurance |
| LC002082 - Page 39 of 61 |
1 | producer becomes an appointed agent of that insurer. An insurance producer who is not acting as |
2 | an agent of an insurer is not required to become appointed. |
3 | (b) To appoint a producer as its agent, the appointing insurer shall file, in a format approved |
4 | by the insurance commissioner, a notice of appointment within fifteen (15) days from the date the |
5 | first insurance application is submitted. An insurer may also elect to appoint a producer to all or |
6 | some insurers within the insurer's holding company system or group by the filing of a single |
7 | appointment request. |
8 | (c) An insurer shall pay an appointment fee, in the amount and method of payment set forth |
9 | in a regulation promulgated for that purpose, for each insurance producer appointed by the insurer. |
10 | (d) An insurer shall remit, in a manner prescribed by the insurance commissioner, a renewal |
11 | appointment fee in the amount set forth in a regulation promulgated for that purpose. |
12 | SECTION 7. Chapter 27-9 of the General Laws entitled "Casualty Insurance Rating" is |
13 | hereby amended by adding thereto the following section: |
14 | 27-9-57. Unfair discrimination. |
15 | (a) No individual or entity subject to this chapter shall, because of race, color, creed, |
16 | national origin, or disability: |
17 | (1) Make any distinction or discrimination between persons as to the premiums or rates |
18 | charged for insurance policies. |
19 | (2) Demand or require a greater premium from any persons than it requires at that time |
20 | from others in similar cases. |
21 | (3) Insert in the policy any condition, or make any stipulation, whereby the insured binds |
22 | themselves, or their heirs, executors, administrators, or assigns, to accept any sum or service less |
23 | than the full value or amount of such policy in case of a claim thereon except such conditions and |
24 | stipulations as are imposed upon others in similar cases; and any such stipulation or condition so |
25 | made or inserted shall be void. |
26 | SECTION 8. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by |
27 | adding thereto the following chapter: |
28 | CHAPTER 1.3 |
29 | INSURANCE DATA SECURITY ACT |
30 | 27-1.3-1. Title. |
31 | This chapter shall be known and may be cited as the "Insurance Data Security Act." |
32 | 27-1.3-2. Purpose and intent. |
33 | (a) The purpose and intent of this chapter is to establish standards for data security and |
34 | standards for the investigation of, and notification to the commissioner of, a cybersecurity event |
| LC002082 - Page 40 of 61 |
1 | applicable to licensees, as defined in § 27-1.3-3. Notwithstanding any other provision of law, this |
2 | chapter establishes the exclusive state standards applicable to licensees for data security, the |
3 | investigation of a cybersecurity event as defined in § 27-1.3-3, and notification to the |
4 | commissioner. These provisions do not affect a licensee's responsibility to notify consumers in |
5 | accordance with § 27-1.3-6(c). |
6 | (b) This chapter may not be construed to create or imply a private cause of action for |
7 | violation of its provisions nor may it be construed to curtail a private cause of action which would |
8 | otherwise exist in the absence of this chapter. |
9 | 27-1.3-3. Definitions. |
10 | As used in this chapter, the following terms shall have the following meanings: |
11 | (1) "Authorized individual" means an individual known to and screened by the licensee |
12 | and determined to be necessary and appropriate to have access to the nonpublic information held |
13 | by the licensee and its information systems. |
14 | (2) "Commissioner" shall have the meaning established in § 42-14-5. |
15 | (3) "Consumer" means an individual, including, but not limited to, applicants, |
16 | policyholders, insureds, beneficiaries, claimants, and certificate holders who is a resident of this |
17 | state and whose nonpublic information is in a licensee's possession, custody or control. |
18 | (4) "Cybersecurity event" means an event resulting in unauthorized access to, disruption |
19 | or misuse of, an information system or nonpublic information stored on such information system. |
20 | (i) The term "cybersecurity event" does not include the unauthorized acquisition of |
21 | encrypted nonpublic information if the encryption, process or key is not also acquired, released or |
22 | used without authorization. |
23 | (ii) The term "cybersecurity event" does not include an event with regard to which the |
24 | licensee has determined that the nonpublic information accessed by an unauthorized person has not |
25 | been used or released and has been returned or destroyed. |
26 | (5) "Department" means the department of business regulation, division of insurance. |
27 | (6) "Encrypted" means the transformation of data into a form which results in a low |
28 | probability of assigning meaning without the use of a protective process or key. |
29 | (7) "Information security program" means the administrative, technical, and physical |
30 | safeguards that a licensee uses to access, collect, distribute, process, protect, store, use, transmit, |
31 | dispose of, or otherwise handle nonpublic information. |
32 | (8) "Information system" means a discrete set of electronic information resources |
33 | organized for the collection, processing, maintenance, use, sharing, dissemination, or disposition |
34 | of electronic information, as well as any specialized system such as industrial/process controls |
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1 | systems, telephone switching and private branch exchange systems, and environmental control |
2 | systems. |
3 | (9) "Licensee" means any person licensed, authorized to operate, or registered, or required |
4 | to be licensed, authorized, or registered pursuant to the insurance laws of this state, but shall not |
5 | include a purchasing group or a risk retention group chartered and licensed in a state other than this |
6 | state or a licensee that is acting as an assuming insurer that is domiciled in another state or |
7 | jurisdiction. |
8 | (10) "Multi-factor authentication" means authentication through verification of at least two |
9 | (2) of the following types of authentication factors: |
10 | (i) Knowledge factors, such as a password; or |
11 | (ii) Possession factors, such as a token or text message on a mobile phone; or |
12 | (iii) Inherence factors, such as a biometric characteristic. |
13 | (11) "Nonpublic information" means information that is not publicly available information |
14 | and is: |
15 | (i) Business related information of a licensee the tampering with which, or unauthorized |
16 | disclosure, access or use of which, would cause a material adverse impact to the business, |
17 | operations or security of the licensee; |
18 | (ii) Any information concerning a consumer which because of name, number, personal |
19 | mark, or other identifier can be used to identify such consumer, in combination with any one or |
20 | more of the following data elements: |
21 | (A) Social security number; |
22 | (B) Driver's license number or non-driver identification card number; |
23 | (C) Account number, credit or debit card number; |
24 | (D) Any security code, access code or password that would permit access to a consumer's |
25 | financial account; or |
26 | (E) Biometric records; |
27 | (iii) Any information or data, except age or gender, in any form or medium created by or |
28 | derived from a health care provider or a consumer and that relates to: |
29 | (A) The past, present or future physical, mental, behavioral health or medical condition of |
30 | any consumer or a member of the consumer's family; |
31 | (B) The provision of health care to any consumer; or |
32 | (C) Payment for the provision of health care to any consumer. |
33 | (12) "Person" means any individual or any non-governmental entity, including, but not |
34 | limited to, any non-governmental partnership, corporation, limited liability company, branch, |
| LC002082 - Page 42 of 61 |
1 | agency or association. |
2 | (13) "Publicly available information" means any information that a licensee has a |
3 | reasonable basis to believe is lawfully made available to the general public from: federal, state or |
4 | local government records; widely distributed media; or disclosures to the general public that are |
5 | required to be made by federal, state or local law: |
6 | (i) For the purposes of this definition, a licensee has a reasonable basis to believe that |
7 | information is lawfully made available to the general public if the licensee has taken steps to |
8 | determine: |
9 | (A) That the information is of the type that is available to the general public; and |
10 | (B) Whether a consumer can direct that the information not be made available to the general |
11 | public and the consumer has not done so. |
12 | (14) "Risk assessment" means the procedure that each licensee is required to complete |
13 | under § 27-1.3-4(c). |
14 | (15) "State" means the State of Rhode Island. |
15 | (16) "Third-party service provider" means a person, not otherwise defined as a licensee, |
16 | that contracts with a licensee to maintain, process, store or otherwise is permitted access to |
17 | nonpublic information through its provision of services to the licensee. |
18 | 27-1.3-4. Information security program. |
19 | (a) Implementation of an information security program. Commensurate with the size and |
20 | complexity of a licensee, the nature and scope of a licensee's activities, including its use of third- |
21 | party service providers, and the sensitivity of the nonpublic information used by the licensee or in |
22 | the licensee's possession, custody or control, shall develop, implement, and maintain a |
23 | comprehensive written information security program, based on the licensee's risk assessment and |
24 | that contains administrative, technical, and physical safeguards for the protection of nonpublic |
25 | information and the licensee's information system. |
26 | (b) Objectives of information security program. A licensee's information security program |
27 | shall be designed to: |
28 | (1) Protect the security and confidentiality of nonpublic information and the security of the |
29 | information system; |
30 | (2) Protect against any threats or hazards to the security or integrity of nonpublic |
31 | information and the information system; |
32 | (3) Protect against unauthorized access to or use of nonpublic information, and minimize |
33 | the likelihood of harm to any consumer; and |
34 | (4) Define and periodically reevaluate a schedule for retention of nonpublic information |
| LC002082 - Page 43 of 61 |
1 | and a mechanism for its destruction when no longer needed. |
2 | (c) Risk assessment. The licensee shall: |
3 | (1) Designate one or more employees, an affiliate, or an outside vendor designated to act |
4 | on behalf of the licensee who is responsible for the information security program; |
5 | (2) Identify reasonably foreseeable internal or external threats that could result in |
6 | unauthorized access, transmission, disclosure, misuse, alteration or destruction of nonpublic |
7 | information, including the security of information systems and nonpublic information that are |
8 | accessible to, or held by, third-party service providers; |
9 | (3) Assess the likelihood and potential damage of these threats, taking into consideration |
10 | the sensitivity of the nonpublic information; |
11 | (4) Assess the sufficiency of policies, procedures, information systems and other |
12 | safeguards in place to manage these threats, including consideration of threats in each relevant area |
13 | of the licensee's operations, including: |
14 | (i) Employee training and management; |
15 | (ii) Information systems, including network and software design, as well as information |
16 | classification, governance, processing, storage, transmission, and disposal; and |
17 | (iii) Detecting, preventing, and responding to attacks, intrusions, or other systems failures; |
18 | and |
19 | (5) Implement information safeguards to manage the threats identified in its ongoing |
20 | assessment, and no less than annually, assess the effectiveness of the safeguards' key controls, |
21 | systems, and procedures. |
22 | (d) Risk management. Based on its risk assessment, the licensee shall: |
23 | (1) Design its information security program to mitigate the identified risks, commensurate |
24 | with the size and complexity of the licensee's activities, including its use of third-party service |
25 | providers, and the sensitivity of the nonpublic information used by the licensee or in the licensee's |
26 | possession, custody or control; |
27 | (2) Determine which security measures listed below are appropriate and implement such |
28 | security measures: |
29 | (i) Place access controls on information systems, including controls to authenticate and |
30 | permit access only to authorized individuals to protect against the unauthorized acquisition of |
31 | nonpublic information; |
32 | (ii) Identify and manage the data, personnel, devices, systems, and facilities that enable the |
33 | organization to achieve business purposes in accordance with their relative importance to business |
34 | objectives and the organization's risk strategy; |
| LC002082 - Page 44 of 61 |
1 | (iii) Restrict access at physical locations containing nonpublic information only to |
2 | authorized individuals; |
3 | (iv) Protect, by encryption or other appropriate means, all nonpublic information while |
4 | being transmitted over an external network and all nonpublic information stored on a laptop |
5 | computer or other portable computing or storage device or media; |
6 | (v) Adopt secure development practices for in-house developed applications utilized by the |
7 | licensee and procedures for evaluating, assessing or testing the security of externally developed |
8 | applications utilized by the licensee; |
9 | (vi) Modify the information system in accordance with the licensee's information security |
10 | program; |
11 | (vii) Utilize effective controls, which may include multi-factor authentication procedures |
12 | for any individual accessing nonpublic information; |
13 | (viii) Regularly test and monitor systems and procedures to detect actual and attempted |
14 | attacks on, or intrusions into, information systems; |
15 | (ix) Include audit trails within the information security program designed to detect and |
16 | respond to cybersecurity events and designed to reconstruct material financial transactions |
17 | sufficient to support normal operations and obligations of the licensee; |
18 | (x) Implement measures to protect against destruction, loss, or damage of nonpublic |
19 | information due to environmental hazards, such as fire and water damage or other catastrophes or |
20 | technological failures; and |
21 | (xi) Develop, implement, and maintain procedures for the secure disposal of nonpublic |
22 | information in any format; |
23 | (3) Include cybersecurity risks in the licensee's enterprise risk management process; |
24 | (4) Stay informed regarding emerging threats or vulnerabilities and utilize reasonable |
25 | security measures when sharing information relative to the character of the sharing and the type of |
26 | information shared; and |
27 | (5) Provide its personnel with cybersecurity awareness training that is updated as necessary |
28 | to reflect risks identified by the licensee in the risk assessment. |
29 | (e) Oversight by board of directors. If the licensee has a board of directors, the board or an |
30 | appropriate committee of the board shall, at a minimum: |
31 | (1) Require the licensee's executive management, or designees, to develop, implement, and |
32 | maintain the licensee's information security program; |
33 | (2) Require the licensee's executive management, or designees, to report in writing at least |
34 | annually, the following information: |
| LC002082 - Page 45 of 61 |
1 | (i) The overall status of the information security program and the licensee's compliance |
2 | with this chapter; and |
3 | (ii) Material matters related to the information security program, addressing issues such as |
4 | risk assessment, risk management and control decisions, third-party service provider arrangements, |
5 | results of testing, cybersecurity events or violations and management's responses thereto, or |
6 | recommendations for changes in the information security program; and |
7 | (3) If executive management delegates any of its responsibilities pursuant to this section, |
8 | it shall oversee the development, implementation and maintenance of the licensee's information |
9 | security program prepared by the designee(s) and shall receive a report from the designee(s) |
10 | complying with the requirements of the report to the board of directors. |
11 | (f) Oversight of third-party service provider arrangements. |
12 | (1) A licensee shall exercise due diligence in selecting its third-party service provider; and |
13 | (2) A licensee shall take reasonable steps to request a third-party service provider to |
14 | implement appropriate administrative, technical, and physical measures to protect and secure the |
15 | information systems and nonpublic information that are accessible to, or held by, the third-party |
16 | service provider. |
17 | (g) Program adjustments. The licensee shall monitor, evaluate and adjust, as appropriate, |
18 | the information security program consistent with any relevant changes in technology, the sensitivity |
19 | of its nonpublic information, internal or external threats to information, and the licensee's own |
20 | changing business arrangements, such as mergers and acquisitions, alliances and joint ventures, |
21 | outsourcing arrangements and changes to information systems. |
22 | (h) Incident response plan: |
23 | (1) As part of its information security program, each licensee shall establish a written |
24 | incident response plan designed to promptly respond to, and recover from, any cybersecurity event |
25 | that compromises the confidentiality, integrity or availability of nonpublic information in its |
26 | possession, the licensee's information systems, or the continuing functionality of any aspect of the |
27 | licensee's business or operations; |
28 | (2) Such incident response plan shall address the following areas: |
29 | (i) The internal process for responding to a cybersecurity event; |
30 | (ii) The goals of the incident response plan; |
31 | (iii) The definition of clear roles, responsibilities and levels of decision-making authority; |
32 | (iv) External and internal communications and information sharing; |
33 | (v) Identification of requirements for the remediation of any identified weaknesses in |
34 | information systems and associated controls; |
| LC002082 - Page 46 of 61 |
1 | (vi) Documentation and reporting regarding cybersecurity events and related incident |
2 | response activities; and |
3 | (vii) The evaluation and revision as necessary of the incident response plan following a |
4 | cybersecurity event. |
5 | (i) Annual certification to commissioner of domiciliary state. Annually, each insurer |
6 | domiciled in this state shall submit to the commissioner a written statement by April 15 certifying |
7 | that the insurer is in compliance with the requirements set forth in this section. Each insurer shall |
8 | maintain for examination by the department all records, schedules and data supporting this |
9 | certificate for a period of five (5) years. To the extent an insurer has identified areas, systems or |
10 | processes that require material improvement, updating or redesign, the insurer shall document the |
11 | identification and the remedial efforts planned and underway to address such areas, systems or |
12 | processes. This documentation must be available for inspection by the commissioner. |
13 | 27-1.3-5. Investigation of a cybersecurity event. |
14 | (a) If the licensee learns that a cybersecurity event has or may have occurred, the licensee, |
15 | or an outside vendor and/or service provider designated to act on behalf of the licensee, shall |
16 | conduct a prompt investigation. |
17 | (b) During the investigation, the licensee, or an outside vendor and/or service provider |
18 | designated to act on behalf of the licensee, shall, at a minimum, determine as much of the following |
19 | information as possible: |
20 | (1) Whether a cybersecurity event has occurred; |
21 | (2) Assess the nature and scope of the cybersecurity event; |
22 | (3) Identify any nonpublic information that may have been involved in the cybersecurity |
23 | event; and |
24 | (4) Perform or oversee reasonable measures to restore the security of the information |
25 | systems compromised in the cybersecurity event in order to prevent further unauthorized |
26 | acquisition, release or use of nonpublic information in the licensee's possession, custody or control. |
27 | (c) If the licensee learns that a cybersecurity event has or may have occurred in a system |
28 | maintained by a third-party service provider, and it has or may have impacted the licensee's |
29 | nonpublic information, the licensee shall make reasonable efforts to complete the steps set forth in |
30 | subsection (b) of this section or make reasonable efforts to confirm and document that the third- |
31 | party service provider has completed those steps. |
32 | (d) The licensee shall maintain records concerning all cybersecurity events for a period of |
33 | at least five (5) years from the date of the cybersecurity event and shall produce those records upon |
34 | demand of the commissioner. |
| LC002082 - Page 47 of 61 |
1 | 27-1.3-6. Notification of a cybersecurity event. |
2 | (a) Notification to the commissioner. Each licensee shall notify the commissioner as |
3 | promptly as possible but in no event later than three (3) business days from a determination that a |
4 | cybersecurity event has occurred when either of the following criteria has been met: |
5 | (1) This state is the licensee's state of domicile, in the case of an insurer, or this state is the |
6 | licensee's home state, in the case of a producer, as those terms are defined in § 27-2.4-2; or |
7 | (2) The licensee reasonably believes that the nonpublic information involved affects two |
8 | hundred fifty (250) or more consumers residing in this state and that either of the following apply: |
9 | (i) A cybersecurity event impacting the licensee of which notice is required to be provided |
10 | to any government body, self-regulatory agency or any other supervisory body pursuant to any state |
11 | or federal law; or |
12 | (ii) A cybersecurity event that has a reasonable likelihood of materially harming: |
13 | (A) Any consumer residing in this state; or |
14 | (B) Any material part of the normal operation(s) of the licensee. |
15 | (b) The licensee shall provide any information required by this section in electronic form |
16 | as directed by the commissioner. The licensee shall have a continuing obligation to update and |
17 | supplement initial and subsequent notifications to the commissioner concerning the cybersecurity |
18 | event. The licensee shall provide as much of the following information as possible: |
19 | (1) Date of the cybersecurity event; |
20 | (2) Description of how the information was exposed, lost, stolen, or breached, including |
21 | the specific roles and responsibilities of third-party service providers, if any; |
22 | (3) How the cybersecurity event was discovered; |
23 | (4) Whether any lost, stolen, or breached information has been recovered and if so, how |
24 | this recovery was achieved; |
25 | (5) The identity of the source of the cybersecurity event; |
26 | (6) Whether the licensee has filed a police report or has notified any regulatory, government |
27 | or law enforcement agencies and, if so, when such notification was provided; |
28 | (7) Description of the specific types of information acquired without authorization. |
29 | Specific types of information consisting of particular data elements including, for example, types |
30 | of medical information, types of financial information or types of information allowing |
31 | identification of the consumer; |
32 | (8) The period during which the information system was compromised by the cybersecurity |
33 | event; |
34 | (9) The number of total consumers in this state affected by the cybersecurity event. The |
| LC002082 - Page 48 of 61 |
1 | licensee shall provide the best estimate in the initial report to the commissioner and update this |
2 | estimate with each subsequent report to the commissioner pursuant to this section; |
3 | (10) The results of any internal review identifying a lapse in either automated controls or |
4 | internal procedures, or confirming that all automated controls or internal procedures were followed; |
5 | (11) Description of efforts being undertaken to remediate the situation which permitted the |
6 | cybersecurity event to occur; |
7 | (12) A copy of the licensee's privacy policy and a statement outlining the steps the licensee |
8 | will take to investigate and notify consumers affected by the cybersecurity event; and |
9 | (13) Name of a contact person who is both familiar with the cybersecurity event and |
10 | authorized to act for the licensee. |
11 | (c) Notification to consumers. A licensee shall comply with chapter 49.3 of title 11, as |
12 | applicable, and provide a copy of the notice sent to consumers under that chapter to the |
13 | commissioner, when a licensee is required to notify the commissioner under subsection (a) of this |
14 | section. |
15 | (d) Notice regarding cybersecurity events of third-party service providers: |
16 | (1) In the case of a cybersecurity event involving a licensee's nonpublic information in a |
17 | system maintained by a third-party service provider, of which the licensee has become aware, the |
18 | licensee shall treat that event as it would under subsection (a) of this section; |
19 | (2) The computation of the licensee's deadlines shall begin on the day after the third-party |
20 | service provider notifies the licensee of the cybersecurity event or the licensee otherwise has actual |
21 | knowledge of the cybersecurity event, whichever is sooner; |
22 | (3) Nothing in this chapter shall prevent or abrogate an agreement between a licensee and |
23 | another licensee, a third-party service provider or any other party to fulfill any of the investigation |
24 | requirements imposed under § 27-1.3-5 or notice requirements imposed under this section. |
25 | (e) Notice regarding cybersecurity events of reinsurers to insurers: |
26 | (1)(i) In the case of a cybersecurity event involving nonpublic information that is used by |
27 | the licensee that is acting as an assuming insurer or in the possession, custody or control of a |
28 | licensee that is acting as an assuming insurer and that does not have a direct contractual relationship |
29 | with the affected consumers, the assuming insurer shall notify its affected ceding insurers and the |
30 | commissioner of its state of domicile within seventy-two (72) hours of making the determination |
31 | that a cybersecurity event has occurred; |
32 | (ii) The ceding insurers that have a direct contractual relationship with affected consumers |
33 | shall fulfill the consumer notification requirements imposed under chapter 49.3 of title 11 ("identity |
34 | theft protection act of 2015"), and any other notification requirements relating to a cybersecurity |
| LC002082 - Page 49 of 61 |
1 | event imposed under this section; |
2 | (2)(i) In the case of a cybersecurity event involving nonpublic information that is in the |
3 | possession, custody or control of a third-party service provider of a licensee that is an assuming |
4 | insurer, the assuming insurer shall notify its affected ceding insurers and the commissioner of its |
5 | state of domicile within seventy-two (72) hours of receiving notice from its third-party service |
6 | provider that a cybersecurity event has occurred; |
7 | (ii) The ceding insurers that have a direct contractual relationship with affected consumers |
8 | shall fulfill the consumer notification requirements imposed under chapter 49.3 of title 11 and any |
9 | other notification requirements relating to a cybersecurity event imposed under this section. |
10 | (f) Notice regarding cybersecurity events of insurers to producers of record. |
11 | (1) In the case of a cybersecurity event involving nonpublic information that is in the |
12 | possession, custody or control of a licensee that is an insurer or its third-party service provider and |
13 | for which a consumer accessed the insurer's services through an independent insurance producer, |
14 | the insurer shall notify the producers of record of all affected consumers as soon as practicable as |
15 | directed by the commissioner. |
16 | (2) The insurer is excused from this obligation for those instances in which it does not have |
17 | the current producer of record information for any individual consumer. |
18 | 27-1.3-7. Power of commissioner. |
19 | (a) The commissioner shall have power to examine and investigate into the affairs of a |
20 | licensee to determine whether the licensee has been or is engaged in any conduct in violation of |
21 | this chapter. This power is in addition to the powers which the commissioner has pursuant to |
22 | chapter 13.1 of title 27 and any such investigation or examination shall be conducted pursuant to |
23 | chapter 13.1 of title 27. |
24 | (b) Whenever the commissioner has reason to believe that a licensee has been or is engaged |
25 | in conduct in this state which violates this chapter, the commissioner may take action that is |
26 | necessary or appropriate to enforce the provisions of this chapter. |
27 | 27-1.3-8. Confidentiality. |
28 | (a) Any documents, materials or other information in the control or possession of the |
29 | department that are furnished by a licensee or an employee or agent thereof acting on behalf of a |
30 | licensee pursuant to §§ 27-1.3-4(i) and 27-1.3-6(b)(2), (b)(3), (b)(4), (b)(5), (b)(8), (b)(10), and |
31 | (b)(11), or that are obtained by the commissioner in an investigation or examination pursuant to § |
32 | 27-1.3-7 shall be confidential by law and privileged, shall not be subject to chapter 2 of title 38, |
33 | shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in |
34 | any private civil action; provided, however, the commissioner is authorized to use the documents, |
| LC002082 - Page 50 of 61 |
1 | materials or other information in the furtherance of any regulatory or legal action brought as a part |
2 | of the commissioner's duties. |
3 | (b) Neither the commissioner nor any person who received documents, materials or other |
4 | information while acting under the authority of the commissioner shall be permitted or required to |
5 | testify in any private civil action concerning any confidential documents, materials, or information |
6 | subject to subsection (a) of this section. |
7 | (c) In order to assist in the performance of the commissioner's duties under this chapter, |
8 | the commissioner: |
9 | (1) May share documents, materials or other information, including the confidential and |
10 | privileged documents, materials or information subject to subsection (a) of this section, with other |
11 | state, federal, and international regulatory agencies, with the National Association of Insurance |
12 | Commissioners, its affiliates or subsidiaries, and with state, federal, and international law |
13 | enforcement authorities; provided that, the recipient agrees in writing to maintain the |
14 | confidentiality and privileged status of the document, material or other information; |
15 | (2) May receive documents, materials or information, including otherwise confidential and |
16 | privileged documents, materials or information, from the National Association of Insurance |
17 | Commissioners, its affiliates or subsidiaries and from regulatory and law enforcement officials of |
18 | other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any |
19 | document, material or information received with notice or the understanding that it is confidential |
20 | or privileged under the laws of the jurisdiction that is the source of the document, material or |
21 | information; |
22 | (3) May share documents, materials or other information subject to subsection (a) of this |
23 | section, with a third-party consultant or vendor provided the consultant agrees in writing to |
24 | maintain the confidentiality and privileged status of the document, material or other information; |
25 | and |
26 | (4) May enter into agreements governing sharing and use of information consistent with |
27 | this subsection. |
28 | (d) No waiver of any applicable privilege or claim of confidentiality in the documents, |
29 | materials, or information shall occur as a result of disclosure to the commissioner under this section |
30 | or as a result of sharing as authorized in subsection (c) of this section. |
31 | (e) Nothing in this chapter shall prohibit the commissioner from releasing final, adjudicated |
32 | actions that are open to public inspection pursuant to chapter 2 of title 38 to a database or other |
33 | clearinghouse service maintained by the National Association of Insurance Commissioners, its |
34 | affiliates or subsidiaries. |
| LC002082 - Page 51 of 61 |
1 | 27-1.3-9. Exceptions. |
2 | (a) The following exceptions shall apply to this chapter: |
3 | (1) A licensee meeting one of the following criteria is exempt from § 27-1.3-4: |
4 | (1) A licensee with fewer than twenty-five (25) employees, including any independent |
5 | contractors with access to the licensee's nonpublic information; or |
6 | (2) A licensee with less than five million dollars ($5,000,000) in gross annual revenue; or |
7 | (3) A licensee with less than ten million dollars ($10,000,000) in assets, measured at the |
8 | end of the licensee's fiscal year. |
9 | (4) A licensee subject to and in compliance with Pub. L. 104-191, 110 Stat. 1936, enacted |
10 | August 21, 1996 (Health Insurance Portability and Accountability Act) and related privacy, security |
11 | and breach notification regulations pursuant to Code of Federal Regulations, Parts 160 and 164, |
12 | and Pub. L. 111-5, 123 Stat. 226, enacted February 17, 2009 (Health Information Technology) is |
13 | considered to meet the requirements of this chapter, other than the requirements of §§ 27-1.3-6(a) |
14 | and (b) regarding notification to the commissioner, if: |
15 | (i) The licensee maintains a program for information security and breach notification that |
16 | treats all nonpublic information relating to consumers in this state in the same manner as protected |
17 | health information; |
18 | (ii) The licensee annually submits to the commissioner a written statement certifying that |
19 | the licensee is in compliance with the requirements of this subsection; and |
20 | (iii) The commissioner has not issued a determination finding that the applicable federal |
21 | regulations are materially less stringent than the requirements of this chapter. |
22 | (5) An employee, agent, representative or designee of a licensee, who is also a licensee, is |
23 | exempt from § 27-1.3-4 and need not develop its own information security program to the extent |
24 | that the employee, agent, representative or designee is covered by the information security program |
25 | of the other licensee. |
26 | (b) In the event that a licensee ceases to qualify for an exception, the licensee shall have |
27 | one hundred eighty (180) days to comply with this chapter. |
28 | 27-1.3-10. Penalties. |
29 | If any provision of this chapter or the application thereof to any person or circumstance is |
30 | for any reason held to be invalid, the remainder of the chapter and the application of such provision |
31 | to other persons or circumstances shall not be affected thereby. |
32 | 27-1.3-11. Severability. |
33 | If any provision of this chapter or the application thereof to any person or circumstance is |
34 | for any reason held to be invalid, the remainder of the chapter and the application of such provision |
| LC002082 - Page 52 of 61 |
1 | to other persons or circumstances shall not be affected thereby. |
2 | SECTION 9. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by |
3 | adding thereto the following chapter: |
4 | CHAPTER 82 |
5 | PET INSURANCE ACT |
6 | 27-82-1. Short Title. |
7 | This act shall be known and may be cited as the "Pet Insurance Act." |
8 | 27-82-2. Scope and Purpose. |
9 | (a) The purpose of this act is to promote the public welfare by creating a comprehensive |
10 | legal framework within which pet insurance may be sold in this state. |
11 | (b) The requirements of this act shall apply to pet insurance policies that are issued to any |
12 | resident of this state and are sold, solicited, negotiated, or offered in this state, and policies or |
13 | certificates that are delivered or issued for delivery in this state. |
14 | (c) All other applicable provisions of this state's insurance laws shall continue to apply to |
15 | pet insurance except that the specific provisions of this act shall supersede any general provisions |
16 | of law that would otherwise be applicable to pet insurance. |
17 | 27-82-3. Definitions. |
18 | (a) If a pet insurer uses any of the terms in this chapter in a policy of pet insurance, the pet |
19 | insurer shall use the definition of each of those terms as set forth herein and include the definition |
20 | of the term(s) in the policy. The pet insurer shall also make the definition available through a clear |
21 | and conspicuous link on the main page of the pet insurer or pet insurer's program administrator's |
22 | website. |
23 | (b) Nothing in this chapter shall in any way prohibit or limit the types of exclusions pet |
24 | insurers may use in their policies or require pet insurers to have any of the limitations or exclusions |
25 | defined below. |
26 | (c) As used in this chapter: |
27 | (1) "Chronic condition" means a condition that can be treated or managed, but not cured. |
28 | (2) "Congenital anomaly or disorder" means a condition that is present from birth, whether |
29 | inherited or caused by the environment, which may cause or contribute to illness or disease. |
30 | (3) "Hereditary disorder" means an abnormality that is genetically transmitted from parent |
31 | to offspring and may cause illness or disease. |
32 | (4) "Orthopedic" refers to conditions affecting the bones, skeletal muscle, cartilage, |
33 | tendons, ligaments, and joints. It includes, but is not limited to, elbow dysplasia, hip dysplasia, |
34 | intervertebral disc degeneration, patellar luxation, and ruptured cranial cruciate ligaments. It does |
| LC002082 - Page 53 of 61 |
1 | not include cancers or metabolic, hemopoietic, or autoimmune diseases. |
2 | (5) "Pet insurance" means a property insurance policy that provides coverage for accidents |
3 | and illnesses of pets. |
4 | (6) "Preexisting condition" means any condition for which any of the following are true |
5 | prior to the effective date of a pet insurance policy or during any waiting period: |
6 | (i) A veterinarian provided medical advice; |
7 | (ii) The pet received previous treatment; or |
8 | (iii) Based on information from verifiable sources, the pet had signs or symptoms directly |
9 | related to the condition for which a claim is being made. |
10 | (iv) A condition for which coverage is afforded on a policy cannot be considered a |
11 | preexisting condition on any renewal of the policy. |
12 | (7) "Renewal" means to issue and deliver at the end of an insurance policy period a policy |
13 | which supersedes a policy previously issued and delivered by the same pet insurer or affiliated pet |
14 | insurer and which provides types and limits of coverage substantially similar to those contained in |
15 | the policy being superseded. |
16 | (8) "Veterinarian" means an individual who holds a valid license to practice veterinary |
17 | medicine from the appropriate licensing entity in the jurisdiction in which he or she practices. |
18 | (9) "Veterinary expenses" means the costs associated with medical advice, diagnosis, care, |
19 | or treatment provided by a veterinarian, including, but not limited to, the cost of drugs prescribed |
20 | by a veterinarian. |
21 | (10) "Waiting period" means the period of time specified in a pet insurance policy that is |
22 | required to transpire before some or all of the coverage in the policy can begin. Waiting periods |
23 | may not be applied to renewals of existing coverage. |
24 | (11) "Wellness program" means a subscription or reimbursement-based program that is |
25 | separate from an insurance policy that provides goods and services to promote the general health, |
26 | safety, or wellbeing of the pet. If any wellness program: |
27 | (i) Pays or indemnifies another as to loss from certain contingencies called "risks," |
28 | including through reinsurance; |
29 | (ii) Pays or grants a specified amount or determinable benefit to another in connection with |
30 | ascertainable risk contingencies; or |
31 | (iii) Acts as a surety, it is transacting in the business of insurance and is subject to the |
32 | insurance code, as defined in § 27-54.1-1. This definition is not intended to classify a contract |
33 | directly between a service provider and a pet owner that only involves the two (2) parties as being |
34 | "the business of insurance," unless other indications of insurance also exist. |
| LC002082 - Page 54 of 61 |
1 | 27-82-4. Disclosures. |
2 | (a) A pet insurer transacting pet insurance shall disclose the following to consumers: |
3 | (1) If the policy excludes coverage due to any of the following: |
4 | (i) A preexisting condition; |
5 | (ii) A hereditary disorder; |
6 | (iii) A congenital anomaly or disorder; or |
7 | (iv) A chronic condition. |
8 | (2) If the policy includes any other exclusions, the following statement: "Other exclusions |
9 | may apply. Please refer to the exclusions section of the policy for more information." |
10 | (3) Any policy provision that limits coverage through a waiting or affiliation period, a |
11 | deductible, coinsurance, or an annual or lifetime policy limit. |
12 | (4) Whether the pet insurer reduces coverage or increases premiums based on the insured's |
13 | claim history, the age of the covered pet or a change in the geographic location of the insured. |
14 | (5) If the underwriting company differs from the brand name used to market and sell the |
15 | product. |
16 | (b) Right to examine and return the policy. |
17 | (1) Unless the insured has filed a claim under the pet insurance policy, pet insurance |
18 | applicants shall have the right to examine and return the policy, certificate or rider to the company |
19 | or an agent/insurance producer of the company within fifteen (15) days of its receipt and to have |
20 | the premium refunded if, after examination of the policy, certificate or rider, the applicant is not |
21 | satisfied for any reason. |
22 | (2) Pet insurance policies, certificates and riders shall have a notice prominently printed on |
23 | the first page or attached thereto including specific instructions to accomplish a return. The |
24 | following free look statement or language substantially similar shall be included: |
25 | "You have fifteen (15) days from the day you receive this policy, certificate, or rider to |
26 | review it, and return it to the company if you decide not to keep it. You do not have to tell the |
27 | company why you are returning it. If you decide not to keep it, simply return it to the company at |
28 | its administrative office, or you may return it to the agent/insurance producer that you bought it |
29 | from as long as you have not filed a claim. You must return it within fifteen (15) days of the day |
30 | you first received it. The company will refund the full amount of any premium paid within thirty |
31 | (30) days after it receives the returned policy, certificate, or rider. The premium refund will be sent |
32 | directly to the person who paid it. The policy, certificate, or rider will be void as if it had never |
33 | been issued." |
34 | (c) A pet insurer shall clearly disclose a summary description of the basis or formula on |
| LC002082 - Page 55 of 61 |
1 | which the pet insurer determines claim payments under a pet insurance policy within the policy, |
2 | prior to policy issuance, and through a clear and conspicuous link on the main page of the pet |
3 | insurer's or pet insurer's program administrator's website. |
4 | (d) A pet insurer that uses a benefit schedule to determine claim payment under a pet |
5 | insurance policy shall do both of the following: |
6 | (1) Clearly disclose the applicable benefit schedule in the policy. |
7 | (2) Disclose all benefit schedules used by the pet insurer under its pet insurance policies |
8 | through a clear and conspicuous link on the main page of the pet insurer's or pet insurer's program |
9 | administrator's website. |
10 | (e) A pet insurer that determines claim payments under a pet insurance policy based on |
11 | usual and customary fees, or any other reimbursement limitation based on prevailing veterinary |
12 | service provider charges, shall do both of the following: |
13 | (1) Include a usual and customary fee limitation provision in the policy that clearly |
14 | describes the pet insurer's basis for determining usual and customary fees and how that basis is |
15 | applied in calculating claim payments. |
16 | (2) Disclose the pet insurer's basis for determining usual and customary fees through a clear |
17 | and conspicuous link on the main page of the pet insurer's or pet insurer's program administrator's |
18 | website. |
19 | (f) If any medical examination by a licensed veterinarian is required to effectuate coverage, |
20 | the pet insurer shall clearly and conspicuously disclose the required aspects of the examination |
21 | prior to purchase and disclose that examination documentation may result in a preexisting condition |
22 | exclusion. |
23 | (g) Waiting periods and the requirements applicable to them, must be clearly and |
24 | prominently disclosed to consumers prior to the policy purchase. |
25 | (h) The pet insurer shall include a summary of all policy provisions required in subsections |
26 | (a) through (g) of this section, inclusive, in a separate document titled "insurer disclosure of |
27 | important policy provisions." |
28 | (i) The pet insurer shall post the "insurer disclosure of important policy provisions" |
29 | document required in subsection (h) of this section through a clear and conspicuous link on the |
30 | main page of the pet insurer's or pet insurer's program administrator's website. |
31 | (j) In connection with the issuance of a new pet insurance policy, the pet insurer shall |
32 | provide the consumer with a copy of the "insurer disclosure of important policy provisions" |
33 | document required pursuant to subsection (h) of this section in at least twelve-point (12-point) type |
34 | when the policy is delivered. |
| LC002082 - Page 56 of 61 |
1 | (k) At the time a pet insurance policy is issued or delivered to a policyholder, the pet insurer |
2 | shall include a written disclosure with the following information, printed in twelve-point (12-point) |
3 | boldface type: |
4 | (1) The address and customer service telephone number of the pet insurer or the agent or |
5 | broker of record. |
6 | (2) If the policy was issued or delivered by an agent or broker, a statement advising the |
7 | policyholder to contact the broker or agent for assistance. |
8 | (l) The disclosures required in this section shall be in addition to any other disclosures |
9 | required by law or regulation. |
10 | 27-82-5. Policy Conditions. |
11 | (a) A pet insurer may issue policies that exclude coverage on the basis of one or more |
12 | preexisting conditions with appropriate disclosure to the consumer. The pet insurer has the burden |
13 | of proving that the preexisting condition exclusion applies to the condition for which a claim is |
14 | being made. |
15 | (b) A pet insurer may issue policies that impose waiting periods upon effectuation of the |
16 | policy that do not exceed thirty (30) days for illnesses or orthopedic conditions not resulting from |
17 | an accident. Waiting periods for accidents are prohibited. However, an insurer may issue coverage |
18 | to be effective at 12:01 a.m. on the second calendar day after the purchase, subject only to the |
19 | following exceptions. |
20 | (1) If an insurer elects to conduct individualized underwriting on a specific pet, then |
21 | coverage must be effective by 12:01 a.m. on the second calendar day after the insurer has |
22 | determined such pet is eligible for coverage. |
23 | (2) An insurer may delay coverage from becoming effective to establish a method for the |
24 | consumer or group administrator to pay the premium. |
25 | (3) For pet insurance coverage acquired by an individual through an employer or |
26 | organization, the coverage effective date of such pet insurance may be delayed to align with the |
27 | eligibility and effective date requirements of the employer's or organization's benefit plan. |
28 | (4) A pet insurer utilizing a waiting period permitted in subsection (b) of this section shall |
29 | include a provision in its contract that allows the waiting periods to be waived upon completion of |
30 | a medical examination. Pet insurers may require the examination to be conducted by a licensed |
31 | veterinarian after the purchase of the policy. |
32 | (i) A medical examination under subsection (b)(1) of this section shall be paid for by the |
33 | policyholder, unless the policy specifies that the pet insurer will pay for the examination. |
34 | (ii) A pet insurer can specify elements to be included as part of the examination and require |
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1 | documentation thereof; provided, the specifications do not unreasonably restrict a consumer's |
2 | ability to waive the waiting periods in subsection (b) of this section. |
3 | (5) Waiting periods, and the requirements applicable to them, must be clearly and |
4 | prominently disclosed to consumers prior to the policy purchase. |
5 | (6) If a policy does not include a waiting period for an illness or orthopedic condition, an |
6 | insurer may set a policy effectuation date that is up to fifteen (15) calendar days after purchase, so |
7 | long as such policy effectuation date is clearly disclosed and no premium is charged before the |
8 | policy becomes effective. |
9 | (c) A pet insurer must not require a veterinary examination of the covered pet for the |
10 | insured to have their policy renewed. |
11 | (d) If a pet insurer includes any prescriptive, wellness, or non-insurance benefits in the |
12 | policy form, then it is made part of the policy contract and must follow all applicable laws and |
13 | regulations in the insurance code. |
14 | (e) An insured's eligibility to purchase a pet insurance policy must not be based on |
15 | participation, or lack of participation, in a separate wellness program. |
16 | 27-82-6. Sales practices for wellness programs. |
17 | (a) A pet insurer and/or producer shall not do the following: |
18 | (1) Market a wellness program as pet insurance; |
19 | (2) Market a wellness program during the sale, solicitation, or negotiation of pet insurance. |
20 | (b) If a wellness program is sold by a pet insurer and/or producer: |
21 | (1) The purchase of the wellness program shall not be a requirement to the purchase of pet |
22 | insurance. |
23 | (2) The costs of the wellness program shall be separate and identifiable from any pet |
24 | insurance policy sold by a pet insurer and/or producer. |
25 | (3) The terms and conditions for the wellness program shall be separate from any pet |
26 | insurance policy sold by a pet insurer and/or producer. |
27 | (4) The products or coverages available through the wellness program shall not duplicate |
28 | products or coverages available through the pet insurance policy; |
29 | (5) The advertising of the wellness program shall not be misleading and shall be in |
30 | accordance with subsection (b) of this section; and |
31 | (6) A pet insurer and/or producer shall clearly disclose the following to consumers, printed |
32 | in twelve-point (12-point) boldface type: |
33 | (i) That wellness programs are not insurance. |
34 | (ii) The address and customer service telephone number of the pet insurer or producer or |
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1 | broker of record. |
2 | (c) Coverages included in the pet insurance policy contract described as "wellness" benefits |
3 | are insurance. |
4 | 27-82-7. Insurance producer training. |
5 | (a) An insurance producer shall not sell, solicit, or negotiate a pet insurance product until |
6 | after the producer is appropriately licensed and has completed the required training identified in |
7 | subsection (c) of this section. |
8 | (b) Insurers shall ensure that its producers are trained under subsection (c) of this section |
9 | and that its producers have been appropriately trained on the coverages and conditions of its pet |
10 | insurance products. |
11 | (c) The training required under this subsection shall include information on the following |
12 | topics: |
13 | (1) Preexisting conditions and waiting periods; |
14 | (2) The differences between pet insurance and noninsurance wellness programs; |
15 | (3) Hereditary disorders, congenital anomalies or disorders and chronic conditions and how |
16 | pet insurance policies interact with those conditions or disorders; and |
17 | (4) Rating, underwriting, renewal, and other related administrative topics. |
18 | (d) The satisfaction of the training requirements of another state that are substantially |
19 | similar to the provisions of subsection (c) of this section shall be deemed to satisfy the training |
20 | requirements in this state. |
21 | 27-82-8. Violations. |
22 | Violations of this chapter shall be subject to penalties pursuant to § 42-14-16. |
23 | SECTION 10. Sections 1 through 3 and sections 5 through 9 of this act shall take effect on |
24 | January 1, 2024, and section 4 shall take effect upon passage, provided: |
25 | (1) The provisions of this act in effect before the effective date of this act shall continue to |
26 | apply to and govern all matters, including all past, present and future assessments, credits and |
27 | refunds, relating to any member insurer that either: |
28 | (i) Was an insolvent insurer prior to the effective date of this act; or |
29 | (ii) Was an impaired insurer for which the association formally exercised its powers under |
30 | § 27-34.3-8 to provide coverage to the policyholders of the impaired insurer prior to the effective |
31 | date of this act; and |
32 | (2) The provisions of this act in effect on and after the effective date of this act shall apply |
33 | to and govern all matters, including assessments, credits and refunds, relating to all insolvent |
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1 | insurers and impaired insurers not identified in subsection (1) of this effective date section. |
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| LC002082 - Page 60 of 61 |
EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- PRODUCER LICENSING ACT | |
*** | |
1 | This act would amend the statutory provisions regarding insurance producer appointments |
2 | to provide for an efficient electronic process clarify language relating to insurance claims adjusters, |
3 | add elements to unfair discrimination prohibitions, amend the Rhode Island life and health |
4 | guarantee association act, and add an insurance data security act and a pet insurance act. |
5 | Sections 1 through 3 and sections 5 through 9 of this act would take effect on January 1, |
6 | 2024 and section 4 would take effect upon passage, provided: |
7 | (1) The provisions of this act in effect before the effective date of this act would continue |
8 | to apply to and govern all matters, including all past, present and future assessments, credits and |
9 | refunds, relating to any member insurer that either: |
10 | (i) Was an insolvent insurer prior to the effective date of this act; or |
11 | (ii) Was an impaired insurer for which the association formally exercised its powers under |
12 | § 27-34.3-8 to provide coverage to the policyholders of the impaired insurer prior to the effective |
13 | date of this act; and |
14 | (2) The provisions of this act in effect on and after the effective date of this act would apply |
15 | to and govern all matters, including assessments, credits and refunds, relating to all insolvent |
16 | insurers and impaired insurers not identified in subsection (1) of this effective date section. |
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