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| 5 | 5 | | 2023 -- H 5538 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC001899 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S TATE OF RHODE IS LAND |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2023 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO INSURANCE -- THIRD PARTY HEALTH INSURANCE |
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| 16 | 16 | | ADMINISTRATORS |
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| 17 | 17 | | Introduced By: Representatives Kennedy, and Diaz |
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| 18 | 18 | | Date Introduced: February 15, 2023 |
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| 19 | 19 | | Referred To: House Corporations |
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| 20 | 20 | | |
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| 21 | 21 | | |
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| 22 | 22 | | It is enacted by the General Assembly as follows: |
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| 23 | 23 | | SECTION 1. Section 27-20.7-7 of the General Laws in Chapter 27-20.7 entitled "Third 1 |
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| 24 | 24 | | Party Health Insurance Administrators" is hereby amended to read as follows: 2 |
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| 25 | 25 | | 27-20.7-7. Responsibilities of the insurer. 3 |
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| 26 | 26 | | (a) If an insurer utilizes the services of an administrator, the insurer shall be responsible for 4 |
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| 27 | 27 | | determining the benefits, premium rates, underwriting criteria and claims payment procedures 5 |
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| 28 | 28 | | applicable to the coverage and for securing reinsurance, if any. The rules pertaining to these matters 6 |
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| 29 | 29 | | must be provided, in writing, by the insurer to the administrator. The responsibilities of the 7 |
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| 30 | 30 | | administrator as to any of these matters shall be set forth in the written agreement between the 8 |
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| 31 | 31 | | administrator and the insurer. 9 |
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| 32 | 32 | | (b) It is the sole responsibility of the insurer to provide for competent administration of its 10 |
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| 33 | 33 | | programs. 11 |
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| 34 | 34 | | (c) In cases where an administrator administers benefits for more than one hundred (100) 12 |
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| 35 | 35 | | certificate holders on behalf of an insurer, the insurer shall, at least semi-annually, conduct a review 13 |
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| 36 | 36 | | of the operations of the administrator. At least one of these reviews shall be an on-site audit of the 14 |
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| 37 | 37 | | operations of the administrator. 15 |
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| 38 | 38 | | SECTION 2. This act shall take effect upon passage. 16 |
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| 39 | 39 | | ======== |
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| 40 | 40 | | LC001899 |
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| 41 | 41 | | ======== |
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| 42 | 42 | | |
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| 43 | 43 | | |
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| 44 | 44 | | LC001899 - Page 2 of 2 |
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| 45 | 45 | | EXPLANATION |
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| 46 | 46 | | BY THE LEGISLATIVE COUNCIL |
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| 47 | 47 | | OF |
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| 48 | 48 | | A N A C T |
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| 49 | 49 | | RELATING TO INSURANCE -- THIRD PARTY HEALTH INSURANCE |
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| 50 | 50 | | ADMINISTRATORS |
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| 51 | 51 | | *** |
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| 52 | 52 | | This act would repeal the requirement that at least one of the semiannual reviews performed 1 |
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| 53 | 53 | | by the insurer shall be an on-site audit of the operations of the administrator of benefits. 2 |
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| 54 | 54 | | This act would take effect upon passage. 3 |
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| 55 | 55 | | ======== |
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| 56 | 56 | | LC001899 |
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| 57 | 57 | | ======== |
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