It is enacted by the General Assembly as follows

SECTION 1. Title 27 of the General Laws entitled 'INSURANCE' is hereby amended by adding thereto the following chapters:

{ADD 27-60-1. Short title. -- ADD} {ADD This act may be cited as the Unfair Discrimination Against Subjects of Abuse in Health Benefit Plans Act. ADD}

{ADD 27-60-2. Definitions. -- ADD} {ADD For the purpose of this chapter: ADD}

{ADD (1) 'Abuse' means the occurrence of one or more of the following acts: ADD}

{ADD (a) Attempting to cause or intentionally, knowingly or recklessly causing another person, including a minor child, bodily injury, physical harm, severe emotional distress, psychological trauma, rape, sexual assault or involuntary sexual intercourse; ADD}

{ADD (b) Knowingly engaging in a course of conduct or repeatedly committing acts toward another person, including a minor child, including following the person or minor child without proper authority, under circumstances that place the person or minor child in reasonable fear of bodily injury or physical harm; ADD}

{ADD (c) Subjecting another person, including a minor child, to false imprisonment; or ADD}

{ADD (d) Attempting to cause or intentionally, knowingly, or recklessly causing damage to property so as to intimidate or attempt to control the behavior of another person, including a minor child. ADD}

{ADD (2) 'Abuse-related medical condition' means a medical condition sustained by a subject of abuse which arises in whole or part out of an act or pattern of abuse. ADD}

{ADD (3) 'Abuse status' means the fact or perception that a person is, has been, or may be a subject of abuse, irrespective of whether the person has sustained abuse-related medical conditions. ADD}

{ADD (4) 'Commissioner' means the director of the Department of Business Regulations. ADD}

{ADD (5) 'Health benefit plan' or 'plan' means a policy, contract, certificate or agreement offered by a carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. Health benefit plan includes accident only, credit health, dental, vision, Medicare supplement or long-term care insurance, coverage issued as a supplement to liability insurance, short-term and catastrophic health insurance policies, and a policy that pays on a cost-incurred basis. Health benefit plan does not include workers' compensation or similar insurance. ADD}

{ADD (6) 'Health carrier' means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation or any other entity providing a plan of health insurance, health benefits or health services. ADD}

{ADD (7) 'Insured' means a party named on a health benefit plan as the person with legal rights to the benefits provided by the health benefit plan. For group plans, 'insured' includes a person who is a beneficiary covered by a group health benefit plan. ADD}

{ADD (8) 'Subject of abuse' means a person to whom a family member, or a current or former household member, intimate partner, or caretaker, or a perpetrator of sexual assault, a stalker or a sex offender has directed an act defined in subsection 1 of this section; who has current or prior injuries, illnesses or disorders that resulted from abuse; or who seeks, may have sought or had reason to seek medical or psychological treatment for abuse or protection, court-ordered protection or shelter from abuse. ADD}

{ADD 27-60-3. Unfair discrimination against subjects of abuse prohibited. -- ADD} {ADD A health carrier shall not engage, directly or indirectly, in an unfairly discriminatory act or practice against a subject of abuse. ADD}

{ADD 27-60-4. Unfairly discriminatory acts relating to health benefit plans. -- ADD} {ADD The following acts are prohibited as unfairly discriminatory: ADD}

{ADD (A) Denying, refusing to issue, renew or reissue, canceling or otherwise terminating a health benefit plan, or restricting or excluding health benefit plan coverage or adding a premium differential to any health benefit plan on the basis of the applicant's or insured's abuse status; ADD}

{ADD (B) Excluding or limiting coverage for losses or denying a claim incurred by an insured as a result of abuse on the basis of the insured's abuse status; ADD}

{ADD (C) Terminating group coverage for a subject of abuse because coverage was originally issued in the name of the abuser and the abuser has divorced, separated from, or lost custody of the subject of abuse, or the abuser's coverage has terminated voluntarily or involuntarily. Nothing in this subsection prohibits the health carrier from requiring the subject of abuse to pay the full premium for coverage under the health plan or from requiring as a condition of coverage that the subject of abuse reside or work within its service area, if the requirements are applied to all insured of the health carrier. The health carrier may terminate group coverage after the continuation coverage required by this subsection has been in force for eighteen (18) months, if it offers conversion to an equivalent individual plan. The continuation coverage required by this section shall be satisfied by coverage required under P.L. 99-272, the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, provided to a subject of abuse and is not intended to be in addition to coverage provided under COBRA; or ADD}

{ADD (D) Disclosure or transfer by a person employed by or contracting with a health carrier of any information relating to a person's abuse status, a person's medical condition which the health carrier knows or has reason to know is abuse-related or a person's family, household, social or employment relationship with a subject of abuse, except to the extent necessary for the direct provision of health care services, compliance with abuse reporting laws or compliance with an order of the commissioner or a court of competent jurisdiction. This subsection shall not preclude a subject of abuse from obtaining his or her own medical records. This subsection shall not be construed to prohibit a health carrier from asking an applicant or insured about a medical condition, even if the condition is abuse-related, or using information thereby obtained for the purpose of acts or practices permitted by this chapter. A subject of abuse may provide evidence of abuse to a health carrier for the limited purpose of facilitating treatment of an abuse-related condition or demonstrating that a medical condition is abuse-related, and this section shall not be construed as authorizing the health carrier to disregard that information. ADD}

{ADD 27-60-5. Justification of adverse insurance decisions. ADD} -- {ADD A health carrier that takes an action that adversely affects a subject of abuse on the basis of a medical condition that the health carrier knows or has reason to know is abuse-related shall explain the reason for its action to the applicant or insured in writing and shall be able to demonstrate that its action, and any applicable plan provision: ADD}

{ADD (A) Does not have the purpose or effect of treating abuse status as a medical condition or underwriting criterion; ADD}

{ADD (B) Is not based upon any actual or perceived correlation between a medical condition and abuse; ADD}

{ADD (C) Is otherwise permissible by law and applies in the same manner and to the same extent to all applicants and insureds with a similar medical condition without regard to whether the condition or claim is abuse-related; and ADD}

{ADD (D) Is based on a determination, made in conformance with sound actuarial principles and supported by reasonable statistical evidence, that there is a correlation between the medical condition and a material increase in insurance risk. ADD}

{ADD 27-60-6. Insurance protocols for subjects of abuse. -- ADD} {ADD Health carriers shall develop, file with the commissioner and adhere to protocols specifying how health carrier employees, contractors, agents and brokers will pursue an insurance action, including claims investigation and subrogation, that may impact the safety of a subject of abuse involved with that action. ADD}

{ADD 27-60-7. Enforcement. -- ADD} {ADD Violations of this chapter shall be subject to the provisions of title 27, chapter 29, sections 8 and 9 and may include injunctive relief and/or a requirement for restitution. The powers and duties set forth in this section are in addition to all other authority of the commissioner. ADD}

{ADD 27-61-1. Short title. ADD} --{ADD This act may be cited as the Unfair Discrimination Against Subjects of Abuse in Life Insurance Act. ADD}

{ADD 27-61-2. Definitions. ADD} -- For the purposes of this chapter: {ADD (1) 'Abuse' means the occurrence of one or more of the following acts by a current or former family member, household member, intimate partner, or caretaker: ADD}

{ADD (a) Attempting to cause or intentionally, knowingly or recklessly causing another person bodily injury, physical harm, severe emotional distress, psychological trauma, rape, sexual assault or involuntary sexual intercourse; ADD}

{ADD (b) Knowingly engaging in a course of conduct or repeatedly committing acts toward another person including following the person or minor child without proper authority, under circumstances that place the person or minor child in reasonable fear of bodily injury or physical harm; ADD}

{ADD (c) Subjecting another person to false imprisonment; or ADD}

{ADD (d) Attempting to cause or intentionally, knowingly, or recklessly causing damage to property so as to intimidate or attempt to control the behavior of another person. ADD}

{ADD (2) 'Abuse-related medical condition' means a medical condition sustained by a subject of abuse which arises in whole or part out of an act or pattern of abuse. ADD}

{ADD (3) 'Abuse status' means the fact or perception that a person is, has been, or may be a subject of abuse, irrespective of whether the person has sustained abuse-related medical conditions. ADD}

{ADD (4) 'Commissioner' means the Director of the Department of Business Regulation. ADD}

{ADD (5) 'Insured' means the person whose life is covered under an insurance policy. ADD}

{ADD (6) 'Insurer' means a person or other legal entity engaged in the business of insurance in this state, including agents, brokers, adjusters or third party administrators. ADD}

{ADD (7) 'Policy' or 'certificate' means a contract of insurance or annuity issued, proposed for issuance, or intended for issuance by an insurer, including endorsements or riders. ADD}

{ADD (8) 'Subject of abuse' means a person against whom an act of abuse has been directed; who has current or prior injuries, illnesses or disorders that resulted from abuse; or who seeks, may have sought, or had reason to seek medical or psychological treatment for abuse; or protection, court-ordered protection or shelter from abuse. ADD}

{ADD 27-61-3. Unfair discrimination against subjects of abuse prohibited. -- ADD} {ADD No insurer issuing or renewing a policy of life insurance in this state shall engage in an unfairly discriminatory act or practice against a subject of abuse and such act or practice shall be deemed to be an unfair or deceptive act or practice under chapter 29 of title 27 of the general laws 27-61-4. Unfair discriminatory acts relating to life insurance. -- (A) The following acts are prohibited as unfairly discriminatory: ADD}

{ADD (1) Denying, refusing to issue, renew or reissue, canceling or otherwise terminating, restricting or excluding insurance coverage on or adding a premium differential to a life insurance policy for an applicant or insured on the basis of the applicant's or insured's abuse status; ADD}

{ADD (2) Excluding, limiting or denying benefits on a life insurance policy on the basis of an insured's abuse status except as otherwise permitted or required by the laws of this state relating to acts of abuse committed by a life insurance beneficiary; ADD}

{ADD (3)(a) When the insurer has information in its possession that clearly indicates that the insured or applicant is a subject of abuse, disclosure or transfer by a person employed by or contracting with an insurer of confidential abuse information, which is information about acts of abuse or abuse status of a subject of abuse, the address and telephone number (home and work) of a subject of abuse, or the status of an applicant or insured as a family member, employer or associate of, or a person in a relationship with, a subject of abuse, for any purpose or to any person, except: ADD}

{ADD (i) To a subject of abuse or an individual specifically designated in writing by the subject of abuse; ADD}

{ADD (ii) To a health care provider for the direct provision of health care services; ADD}

{ADD (iii) To a licensed physician identified and designated by the subject of abuse; ADD}

{ADD (iv) When ordered by the commissioner or a court of competent jurisdiction or otherwise required by law; ADD}

{ADD (v) When necessary for a valid business purpose to transfer information that includes confidential abuse information that cannot reasonably be segregated, confidential abuse information may be disclosed only to the following persons: ADD}

{ADD (1) A reinsurer that seeks to indemnify or indemnifies all or any part of a policy covering a subject of abuse and that cannot underwrite or satisfy its obligations under the reinsurance agreement without such disclosure; ADD}

{ADD (2) A party to a proposed or consummated sale, transfer, merger or consolidation of all or part of the business of the insurer; ADD}

{ADD (3) Medical or claims personnel contracting with the insurer, only where necessary to process an application or perform the insurer's duties under the policy or to protect the safety or privacy of a subject of abuse (also includes parent or affiliate companies of the insurer that have service agreements with the insurer); or ADD}

{ADD (4) With respect to address and telephone number, to entities with whom the insurer transacts business when the business cannot be transacted without the address and telephone number; ADD}

{ADD (vi) An attorney who needs the information to represent the insurer effectively, provided the insurer notifies the attorney of its obligations under this chapter and requests that the attorney exercise due diligence to protect the confidential abuse information consistent with the attorney's obligation to represent the insurer; ADD}

{ADD (vii) To the policyowner or assignee, in the course of delivery of the policy, if the policy contains information about abuse status; and ADD}

{ADD (viii) To any other entities deemed appropriate by the commissioner. ADD}

{ADD (b) This subsection does not preclude a subject of abuse from obtaining his or her insurance records. ADD}

{ADD (4) Requesting information about abuse status, or making use of such information, however obtained. ADD}

({ADD B) This section does not prohibit a life insurer from declining to issue a life insurance policy if: ADD}

{ADD (1) The applicant or prospective owner of the policy lacks an insurable interest in the insured; ADD}

{ADD (2) The applicant or prospective owner of the policy is known, on the basis of medical, police or court records, to have committed an act of abuse against the proposed insured; or ADD}

{ADD (3) The insured or prospective insured is a subject of abuse, and that person, or a person who has assumed the care of that person if a minor or incapacitated, has objected to the issuance of the policy on the ground that the policy would be issued to or for the direct or indirect benefit of the abuser. ADD}

{ADD (C) This section does not prohibit a life insurer from asking about a medical condition or from using medical information to underwrite or to carry out its duties under the policy, even if the medical information is related to a medical condition that the insurer knows or has reason to know is abuse-related, to the extent otherwise permitted under this chapter and other applicable law. ADD}

{ADD (D) A life insurer shall not be held civily or criminally liable for the death of or injury to an insured resulting from any action taken in a good faith effort to comply with the requirements of this chapter. However, this subsection does not prevent an action to investigate or enforce a violation of this chapter or to assert any other claims authorized by law. ADD}

{ADD 27-61-5. Justification of adverse insurance decisions. -- ADD} {ADD An insurer of an individual or group policy that takes an underwriting action that adversely affects a subject of abuse on the basis of a medical condition that the insurer knows is abuse-related shall explain the reason for its action to the applicant or insured in writing and shall be able to demonstrate that its action: ADD}

{ADD (A) Does not treat abuse status as a medical condition; ADD}

{ADD (B) Is otherwise permissible by law and applies in the same manner and to the same extent to all applicants and insureds with a similar medical condition without regard to whether the condition or claims abuse-related; and ADD}

{ADD (C) Is based on a determination, made in conformance with sound actuarial principles or related actual or reasonably anticipated experience, that there is a correlation between the medical condition and a material increase in insurance risk. ADD}

{ADD 27-61-6. Insurance protocols for subjects of abuse. -- ADD} {ADD Insurers shall develop and adhere to written policies specifying procedures to be followed by employees, contractors, producers, agents and brokers for the purpose of protecting the safety and privacy of a subject of abuse and otherwise implement the provisions of this chapter when taking an application, investigating a claim, pursuing subrogation or taking any other action relating to a policy or claim involving a subject of abuse. ADD}

{ADD 27-61-7. Enforcement. -- ADD} {ADD Violations of this chapter shall be subject to the provisions of title 27, chapter 29, sections 8 and 9 and may include injunctive relief and/or a requirement for restitution. The powers and duties set forth in this section are in addition to all other authority of the commissioner. ADD}

SECTION 2. This act shall take effect upon passage.