2021 -- H 5607

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LC001291

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Cardillo, Costantino, Corvese, Batista, Perez, and
Solomon

     Date Introduced: February 15, 2021

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

Policies" is hereby amended by adding thereto the following section:

     27-18-85. Waiver of primary care provider referral requirement to a healthcare

professional or specialist.

     (a) Every individual or group hospital or medical expense insurance policy or individual

or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued

for delivery or renewed in this state, on or after January 1, 2022, shall not require that the subscriber

or any dependent obtain a referral from their primary care provider to a health care professional or

specialist under the following circumstances:

     (1) Upon the retirement, death, incapacity, loss of license, relocation out of state or

cessation of practice of medicine by the subscriber's or dependent's treating health care professional

or specialist;

     (2) When the subscriber or dependent has an ongoing relationship with the health care

professional or specialist for a pre-existing condition, notwithstanding any gap of treatment

requirement imposed by the policy, plan or contract; or

     (3) Whenever a subscriber or a dependent without a primary care provider requires a

referral to a health care professional or specialist from a hospital emergency room or emergency

care facility.

     (b) 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.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-77. Waiver of primary care provider referral requirement to a healthcare

professional or specialist.

     (a) Every individual or group hospital or medical expense insurance policy or individual

or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued

for delivery or renewed in this state, on or after January 1, 2022, shall not require that the subscriber

or any dependent obtain a referral from their primary care provider to a health care professional or

specialist under the following circumstances:

     (1) Upon the retirement, death, incapacity, loss of license, relocation out of state or

cessation of practice of medicine by the subscriber's or dependent's treating health care professional

or specialist;

     (2) When the subscriber or dependent has an ongoing relationship with the health care

professional or specialist for a pre-existing condition, notwithstanding any gap of treatment

requirement imposed by the policy, plan or contract; or

     (3) Whenever a subscriber or a dependent without a primary care provider requires a

referral to a health care professional or specialist from a hospital emergency room or emergency

care facility.

     (b) 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;

LC001291 - Page 2 of 5

     (7) Specified disease indemnity;

     (8) Sickness or bodily injury or death by accident or both; and

     (9) Other limited benefit policies.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-73. Waiver of primary care provider referral requirement to a healthcare

professional or specialist.

     (a) Every individual or group hospital or medical expense insurance policy or individual

or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued

for delivery or renewed in this state, on or after January 1, 2022, shall not require that the subscriber

or any dependent obtain a referral from their primary care provider to a health care professional or

specialist under the following circumstances:

     (1) Upon the retirement, death, incapacity, loss of license, relocation out of state or

cessation of practice of medicine by the subscriber's or dependent's treating health care professional

or specialist;

     (2) When the subscriber or dependent has an ongoing relationship with the health care

professional or specialist for a pre-existing condition, notwithstanding any gap of treatment

requirement imposed by the policy, plan or contract; or

     (3) Whenever a subscriber or a dependent without a primary care provider requires a

referral to a health care professional or specialist from a hospital emergency room or emergency

care facility.

     (b) 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.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-90. Waiver of primary care provider referral requirement to a healthcare

LC001291 - Page 3 of 5

professional or specialist.

     (a) Every individual or group hospital or medical expense insurance policy or individual

or group hospital or medical services plan contract, plan or certificate of insurance delivered, issued

for delivery or renewed in this state, on or after January 1, 2022, shall not require that the subscriber

or any dependent obtain a referral from their primary care provider to a health care professional or

specialist under the following circumstances:

     (1) Upon the retirement, death, incapacity, loss of license, relocation out of state or

cessation of practice of medicine by the subscriber's or dependent's treating health care professional

or specialist;

     (2) When the subscriber or dependent has an ongoing relationship with the health care

professional or specialist for a pre-existing condition, notwithstanding any gap of treatment

requirement imposed by the policy, plan or contract; or

     (3) Whenever a subscriber or a dependent without a primary care provider requires a

referral to a health care professional or specialist from a hospital emergency room or emergency

care facility.

     (b) 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.

     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would waive the primary care provider referral requirement to a health care

professional or specialist under certain conditions.

     This act would take effect upon passage.

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LC001291

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