§ 23-95-6. Insurance.
(a) As used in this section, the following words and terms shall have the following meanings:
(1) “Covered person” means a policyholder, subscriber, enrollee, member, or individual covered by a health benefit plan.
(2) “Health benefit plan” means a policy, contract, certificate, or agreement entered into, offered, or issued by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services. “Health benefit plan” shall not include a plan providing coverage for excepted benefits and short-term policies that have a term of less than twelve (12) months.
(3) “Health insurer” means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Rhode Island health insurance commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including through a health benefit plan as defined in this section, and shall include a sickness and accident insurance company, a health maintenance organization, a preferred provider organization, or any similar entity, or any other entity providing a plan of health insurance or health benefits.
(b) A health insurer that provides coverage for anatomical gifts, organ transplants, or related treatment and services shall not:
(1) Deny coverage to a covered person solely on the basis of the person’s disability;
(2) Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the health benefit plan, solely for the purpose of avoiding the requirements of this section;
(3) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide monetary or nonmonetary incentives to an attending provider, to induce the provider to provide care to an insured or enrollee in a manner inconsistent with this section; or
(4) Reduce or limit coverage benefits to a patient for the medical services or other services related to organ transplantation performed pursuant to this section as determined in consultation with the attending physician and patient.
(c) In the case of a health benefit plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers, any plan amendment made pursuant to a collective bargaining agreement relating to the plan that amends the plan solely to conform to any requirement imposed pursuant to this section shall not be treated as a termination of the collective bargaining agreement.
(d) Nothing in this section shall be deemed to require a health insurer to provide coverage for a medically inappropriate organ transplant.
History of Section.
P.L. 2021, ch. 109, § 2, effective June 30, 2021; P.L. 2021, ch. 133, § 2, effective
June 30, 2021.