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§27-41-80  Internal and external appeal of adverse benefit determinations. –

Published: 2015

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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


   (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.)