TITLE 27
Insurance
CHAPTER 27-41
Health Maintenance Organizations
SECTION 27-41-80
§ 27-41-80 Internal and external appeal of
adverse benefit determinations.
(a) The commissioner shall adopt regulations to implement standards and
procedures with respect to internal claims and appeals of adverse benefit
determinations, and with respect to external appeals of adverse benefit
determinations.
(b) The regulations adopted by the commissioner shall apply
only to those adverse benefit determinations within the jurisdiction of the
department of health pursuant to R.I. Gen. Laws § 23-17.12 et seq.
(Utilization Review Act).
(c) This section shall not apply to insurance coverage
providing benefits for: (1) Hospital confinement indemnity; (2) Disability
income; (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6)
Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily
injury or death by accident or both; and (9) Other limited benefit policies.
This section also shall not apply to grandfathered health plans.
History of Section.
(P.L. 2012, ch. 256, § 10; P.L. 2012, ch. 262, § 10.)
