2025 -- H 6368

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LC002772

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Kislak, Donovan, Speakman, McGaw, Potter, Caldwell,
Cortvriend, Fogarty, Cotter, and Handy

     Date Introduced: May 28, 2025

     Referred To: House Health & Human Services

     (Attorney General)

It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-25 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-25. Unfair discrimination prohibited.

     Notwithstanding any provision of any policy of insurance, certificate, or service contract

issued in this state, whenever the insurance policy, certificate, or service contract provides for

reimbursement for any services that may be legally performed by any person licensed under the

provisions of chapters 29, 30, 35 and 37 of title 5, reimbursement under the insurance policy,

certificate, or service contract shall be based upon a determination of medical necessity and shall

not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair

discrimination against particular individuals or persons licensed under chapters 29, 30, 35 and 37

of title 5.

     (a) For the purposes of this section, the following terms are defined as follows:

     (1) “Health-benefit plan” or “health plan” means a policy, contract, certificate, or

agreement entered into, offered, or issued by a healthcare entity to provide, deliver, arrange for,

pay for, or reimburse any of the costs of healthcare services, and includes individual and group

plans.

     (2) “Healthcare entity” means an insurance company licensed, or required to be licensed,

by the State of Rhode Island or other entity subject to the jurisdiction of the commissioner or the

jurisdiction of the department of business regulation pursuant to chapter 62 of title 42, that contracts

or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or

reimburse any of the costs of healthcare services including, without limitation: a for-profit or

nonprofit hospital, medical or dental service corporation or plan; a health maintenance

organization; a health insurance company; or any other entity providing a plan of health insurance,

accident and sickness insurance, health benefits, or healthcare services.

     (b) An individual may not be excluded from participation in, be denied benefits of, or

otherwise be subject to discrimination under any health-benefit plan on the basis of actual or

perceived: race; ethnicity; color; religion; national origin, including language; sex, including sex

characteristics, sexual orientation, gender identity, gender expression, and pregnancy, childbirth,

or related conditions; age; disability; or any combination thereof.

     (c) No healthcare entity may, in offering, providing, or administering a health plan:

     (1) Deny, cancel, delay, limit, or refuse to issue or renew a health-benefit plan on the basis

of actual or perceived: race; ethnicity; color; religion; national origin, including language; sex,

including sex characteristics, sexual orientation, gender identity, gender expression, and pregnancy,

childbirth, or related conditions; age; disability; or any combination thereof;

     (2) Have or implement marketing practices or benefit designs that discriminate on the basis

of actual or perceived: race; ethnicity; color; religion; national origin, including language; sex,

including sex characteristics, sexual orientation, gender identity, gender expression, and pregnancy,

childbirth, or related conditions; age; disability; or any combination thereof;

     (3) Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost

sharing or other limitations or restrictions on coverage, to an individual on the basis of actual or

perceived: race; ethnicity; color; religion; national origin, including language; sex, including sex

characteristics, sexual orientation, gender identity, gender expression, and pregnancy, childbirth,

or related conditions; age; disability; or any combination thereof;

     (4) Have or implement a categorical coverage exclusion or limitation for all health services

related to gender transition or other gender-affirming care, or reproductive health care;

     (5) Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose

additional cost sharing or other limitations or restrictions on coverage, for specific health services

related to gender transition or other gender-affirming care if such denial, limitation, or restriction

results in discrimination against a member of protected class, as described in subsection (b) of this

section; or

     (6) Have or implement benefit designs that do not provide or administer health insurance

coverage in the most integrated setting appropriate to the needs of qualified individuals with

disabilities, including practices that result in the serious risk of institutionalization or segregation.

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     (d) Nothing in this section requires coverage of any health service where the healthcare

entity has a legitimate, nondiscriminatory reason for denying or limiting coverage of the health

service or determining that such health service fails to meet applicable coverage requirements,

including reasonable medical management techniques such as medical necessity requirements.

Such coverage denial or limitation must not be based on unlawful animus or bias, or constitute a

pretext for discrimination.

     (e) The enumeration of specific forms of discrimination in subsection (c) of this section

does not limit the general applicability of the prohibition in subsection (b) of this section.

     (f) No healthcare entity may discriminate with respect to participation under a health-

benefit plan or coverage against any healthcare professional who is acting within the scope of that

healthcare professional’s license or certification under applicable state law, on the basis of that

healthcare professional’s actual or perceived: race; ethnicity; color; religion; national origin,

including language; sex, including sex characteristics, sexual orientation, gender identity, gender

expression, and pregnancy, childbirth, or related conditions; age; disability; or any combination

thereof.

     SECTION 2. Section 27-19-75 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-75. Unfair discrimination prohibited.

     Notwithstanding any provision of any policy of insurance, certificate, or service contract

issued in this state, whenever the insurance policy, certificate, or service contract provides for

reimbursement for any services that may be legally performed by any person licensed under the

provisions of chapters 29, 30, 35 [repealed], and 37 of title 5, reimbursement under the insurance

policy, certificate, or service contract shall be based upon a determination of medical necessity and

shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair

discrimination against particular individuals or persons licensed under chapters 29, 30, 35

[repealed], and 37 of title 5.

     (a) For the purposes of this section, the following terms are defined as follows:

     (1) “Health-benefit plan” or “health plan” means a policy, contract, certificate, or

agreement entered into, offered, or issued by a healthcare entity to provide, deliver, arrange for,

pay for, or reimburse any of the costs of healthcare services, and includes individual and group

plans.

     (2) “Healthcare entity” means an insurance company licensed, or required to be licensed,

by the State of Rhode Island or other entity subject to the jurisdiction of the commissioner or the

jurisdiction of the department of business regulation pursuant to chapter 62 of title 42, that contracts

LC002772 - Page 3 of 10

or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or

reimburse any of the costs of healthcare services including, without limitation: a for-profit or

nonprofit hospital, medical or dental service corporation or plan; a health maintenance

organization; a health insurance company; or any other entity providing a plan of health insurance,

accident and sickness insurance, health benefits, or healthcare services.

     (b) An individual may not be excluded from participation in, be denied benefits of, or

otherwise be subject to discrimination under any health-benefit plan on the basis of actual or

perceived: race; ethnicity; color; religion; national origin, including language; sex, including sex

characteristics, sexual orientation, gender identity, gender expression, and pregnancy, childbirth,

or related conditions; age; disability; or any combination thereof.

     (c) No healthcare entity may, in offering, providing, or administering a health plan:

     (1) Deny, cancel, delay, limit, or refuse to issue or renew a health-benefit plan on the basis

of actual or perceived: race; ethnicity; color; religion; national origin, including language; sex,

including sex characteristics, sexual orientation, gender identity, gender expression, and pregnancy,

childbirth, or related conditions; age; disability; or any combination thereof;

     (2) Have or implement marketing practices or benefit designs that discriminate on the basis

of actual or perceived: race; ethnicity; color; religion; national origin, including language; sex,

including sex characteristics, sexual orientation, gender identity, gender expression, and pregnancy,

childbirth, or related conditions; age; disability; or any combination thereof;

     (3) Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost

sharing or other limitations or restrictions on coverage, to an individual on the basis of actual or

perceived: race; ethnicity; color; religion; national origin, including language; sex, including sex

characteristics, sexual orientation, gender identity, gender expression, and pregnancy, childbirth,

or related conditions; age; disability; or any combination thereof;

     (4) Have or implement a categorical coverage exclusion or limitation for all health services

related to gender transition or other gender-affirming care, or reproductive health care;

     (5) Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose

additional cost sharing or other limitations or restrictions on coverage, for specific health services

related to gender transition or other gender-affirming care if such denial, limitation, or restriction

results in discrimination against a member of protected class, as described in subsection (b) of this

section; or

     (6) Have or implement benefit designs that do not provide or administer health insurance

coverage in the most integrated setting appropriate to the needs of qualified individuals with

disabilities, including practices that result in the serious risk of institutionalization or segregation.

LC002772 - Page 4 of 10

     (d) Nothing in this section requires coverage of any health service where the healthcare

entity has a legitimate, nondiscriminatory reason for denying or limiting coverage of the health

service or determining that such health service fails to meet applicable coverage requirements,

including reasonable medical management techniques such as medical necessity requirements.

Such coverage denial or limitation must not be based on unlawful animus or bias, or constitute a

pretext for discrimination.

     (e) The enumeration of specific forms of discrimination in subsection (c) of this section

does not limit the general applicability of the prohibition in subsection (b) of this section.

     (f) No healthcare entity may discriminate with respect to participation under a health-

benefit plan or coverage against any healthcare professional who is acting within the scope of that

healthcare professional’s license or certification under applicable state law, on the basis of that

healthcare professional’s actual or perceived: race; ethnicity; color; religion; national origin,

including language; sex, including sex characteristics, sexual orientation, gender identity, gender

expression, and pregnancy, childbirth, or related conditions; age; disability; or any combination

thereof.

     SECTION 3. Section 27-20-71 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-71. Unfair discrimination prohibited.

     Notwithstanding any provision of any policy of insurance, certificate, or service contract

issued in this state, whenever the insurance policy, certificate, or service contract provides for

reimbursement for any services that may be legally performed by any person licensed under the

provisions of chapters 29, 30, 35 [repealed], and 37 of title 5, reimbursement under the insurance

policy, certificate, or service contract shall be based upon a determination of medical necessity and

shall not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair

discrimination against particular individuals or persons licensed under chapters 29, 30, 35

[repealed], and 37 of title 5.

     (a) For the purposes of this section, the following terms are defined as follows:

     (1) “Health-benefit plan” or “health plan” means a policy, contract, certificate, or

agreement entered into, offered, or issued by a healthcare entity to provide, deliver, arrange for,

pay for, or reimburse any of the costs of healthcare services, and includes individual and group

plans.

     (2) “Healthcare entity” means an insurance company licensed, or required to be licensed,

by the State of Rhode Island or other entity subject to the jurisdiction of the commissioner or the

jurisdiction of the department of business regulation pursuant to chapter 62 of title 42, that contracts

LC002772 - Page 5 of 10

or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or

reimburse any of the costs of healthcare services including, without limitation: a for-profit or

nonprofit hospital, medical or dental service corporation or plan; a health maintenance

organization; a health insurance company; or any other entity providing a plan of health insurance,

accident and sickness insurance, health benefits, or healthcare services.

     (b) An individual may not be excluded from participation in, be denied benefits of, or

otherwise be subject to discrimination under any health-benefit plan on the basis of actual or

perceived: race; ethnicity; color; religion; national origin, including language; sex, including sex

characteristics, sexual orientation, gender identity, gender expression, and pregnancy, childbirth,

or related conditions; age; disability; or any combination thereof.

     (c) No healthcare entity may, in offering, providing, or administering a health plan:

     (1) Deny, cancel, delay, limit, or refuse to issue or renew a health-benefit plan on the basis

of actual or perceived: race; ethnicity; color; religion; national origin, including language; sex,

including sex characteristics, sexual orientation, gender identity, gender expression, and pregnancy,

childbirth, or related conditions; age; disability; or any combination thereof;

     (2) Have or implement marketing practices or benefit designs that discriminate on the basis

of actual or perceived: race; ethnicity; color; religion; national origin, including language; sex,

including sex characteristics, sexual orientation, gender identity, gender expression, and pregnancy,

childbirth, or related conditions; age; disability; or any combination thereof;

     (3) Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost

sharing or other limitations or restrictions on coverage, to an individual on the basis of actual or

perceived: race; ethnicity; color; religion; national origin, including language; sex, including sex

characteristics, sexual orientation, gender identity, gender expression, and pregnancy, childbirth,

or related conditions; age; disability; or any combination thereof;

     (4) Have or implement a categorical coverage exclusion or limitation for all health services

related to gender transition or other gender-affirming care, or reproductive health care;

     (5) Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose

additional cost sharing or other limitations or restrictions on coverage, for specific health services

related to gender transition or other gender-affirming care if such denial, limitation, or restriction

results in discrimination against a member of protected class, as described in subsection (b) of this

section; or

     (6) Have or implement benefit designs that do not provide or administer health insurance

coverage in the most integrated setting appropriate to the needs of qualified individuals with

disabilities, including practices that result in the serious risk of institutionalization or segregation.

LC002772 - Page 6 of 10

     (d) Nothing in this section requires coverage of any health service where the healthcare

entity has a legitimate, nondiscriminatory reason for denying or limiting coverage of the health

service or determining that such health service fails to meet applicable coverage requirements,

including reasonable medical management techniques such as medical necessity requirements.

Such coverage denial or limitation must not be based on unlawful animus or bias, or constitute a

pretext for discrimination.

     (e) The enumeration of specific forms of discrimination in subsection (c) of this section

does not limit the general applicability of the prohibition in subsection (b) of this section.

     (f) No healthcare entity may discriminate with respect to participation under a health-

benefit plan or coverage against any healthcare professional who is acting within the scope of that

healthcare professional’s license or certification under applicable state law, on the basis of that

healthcare professional’s actual or perceived: race; ethnicity; color; religion; national origin,

including language; sex, including sex characteristics, sexual orientation, gender identity, gender

expression, and pregnancy, childbirth, or related conditions; age; disability; or any combination

thereof.

     SECTION 4. Section 27-41-88 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-88. Unfair discrimination prohibited.

     Notwithstanding any provision of any policy of insurance, certificate, or service contract

issued in this state, whenever the insurance policy, certificate, or service contract provides for

reimbursement for any services that may be legally performed by any person licensed under the

provisions of chapters 29, 30, 35, and 37 of title 5, reimbursement under the insurance policy,

certificate, or service contract shall be based upon a determination of medical necessity and shall

not be denied because of race, color, or creed, nor shall any insurer make or permit any unfair

discrimination against particular individuals or persons licensed under chapters 29, 30, 35, and 37

of title 5.

     (a) For the purposes of this section, the following terms are defined as follows:

     (1) “Health-benefit plan” or “health plan” means a policy, contract, certificate, or

agreement entered into, offered, or issued by a healthcare entity to provide, deliver, arrange for,

pay for, or reimburse any of the costs of healthcare services, and includes individual and group

plans.

     (2) “Healthcare entity” means an insurance company licensed, or required to be licensed,

by the State of Rhode Island or other entity subject to the jurisdiction of the commissioner or the

jurisdiction of the department of business regulation pursuant to chapter 62 of title 42, that contracts

LC002772 - Page 7 of 10

or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or

reimburse any of the costs of healthcare services including, without limitation: a for-profit or

nonprofit hospital, medical or dental service corporation or plan; a health maintenance

organization; a health insurance company; or any other entity providing a plan of health insurance,

accident and sickness insurance, health benefits, or healthcare services.

     (b) An individual may not be excluded from participation in, be denied benefits of, or

otherwise be subject to discrimination under any health-benefit plan on the basis of actual or

perceived: race; ethnicity; color; religion; national origin, including language; sex, including sex

characteristics, sexual orientation, gender identity, gender expression, and pregnancy, childbirth,

or related conditions; age; disability; or any combination thereof.

     (c) No healthcare entity may, in offering, providing, or administering a health plan:

     (1) Deny, cancel, delay, limit, or refuse to issue or renew a health-benefit plan on the basis

of actual or perceived: race; ethnicity; color; religion; national origin, including language; sex,

including sex characteristics, sexual orientation, gender identity, gender expression, and pregnancy,

childbirth, or related conditions; age; disability; or any combination thereof;

     (2) Have or implement marketing practices or benefit designs that discriminate on the basis

of actual or perceived: race; ethnicity; color; religion; national origin, including language; sex,

including sex characteristics, sexual orientation, gender identity, gender expression, and pregnancy,

childbirth, or related conditions; age; disability; or any combination thereof;

     (3) Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost

sharing or other limitations or restrictions on coverage, to an individual on the basis of actual or

perceived: race; ethnicity; color; religion; national origin, including language; sex, including sex

characteristics, sexual orientation, gender identity, gender expression, and pregnancy, childbirth,

or related conditions; age; disability; or any combination thereof;

     (4) Have or implement a categorical coverage exclusion or limitation for all health services

related to gender transition or other gender-affirming care, or reproductive health care;

     (5) Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose

additional cost sharing or other limitations or restrictions on coverage, for specific health services

related to gender transition or other gender-affirming care if such denial, limitation, or restriction

results in discrimination against a member of protected class, as described in subsection (b) of this

section; or

     (6) Have or implement benefit designs that do not provide or administer health insurance

coverage in the most integrated setting appropriate to the needs of qualified individuals with

disabilities, including practices that result in the serious risk of institutionalization or segregation.

LC002772 - Page 8 of 10

     (d) Nothing in this section requires coverage of any health service where the healthcare

entity has a legitimate, nondiscriminatory reason for denying or limiting coverage of the health

service or determining that such health service fails to meet applicable coverage requirements,

including reasonable medical management techniques such as medical necessity requirements.

Such coverage denial or limitation must not be based on unlawful animus or bias, or constitute a

pretext for discrimination.

     (e) The enumeration of specific forms of discrimination in subsection (c) of this section

does not limit the general applicability of the prohibition in subsection (b) of this section.

     (f) No healthcare entity may discriminate with respect to participation under a health-

benefit plan or coverage against any healthcare professional who is acting within the scope of that

healthcare professional’s license or certification under applicable state law, on the basis of that

healthcare professional’s actual or perceived: race; ethnicity; color; religion; national origin,

including language; sex, including sex characteristics, sexual orientation, gender identity, gender

expression, and pregnancy, childbirth, or related conditions; age; disability; or any combination

thereof.

     SECTION 5. This act shall take effect upon passage.

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LC002772

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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 amend unfair discrimination statutes to encompass more protected

categories and protect against additional forms of discrimination.

     This act would take effect upon passage.

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LC002772

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LC002772 - Page 10 of 10