§ 27-41-14 - Prohibited practices.
SECTION 27-41-14
§ 27-41-14 Prohibited practices. –(a) No health maintenance organization, or representative of a healthmaintenance organization, may cause or knowingly permit the use of advertisingwhich is untrue or misleading, solicitation which is untrue or misleading, orany form of evidence of coverage which is deceptive. For the purposes of thischapter:
(1) A statement or item of information shall be deemed to beuntrue if it does not conform to fact in any respect that is or may besignificant to an enrollee of, or a person considering enrollment with, ahealth maintenance organization;
(2) A statement or item of information shall be deemed to bemisleading, whether or not it may be literally untrue, if, in the total contextin which the statement is made or the item of information is communicated, thestatement or item of information may be reasonably understood by a reasonableperson, not possessing special knowledge regarding health care coverage, asindicating any benefit or advantage or the absence of any exclusion,limitation, or disadvantage of possible significance to an enrollee of, or aperson considering enrollment in, a health maintenance organization, if thebenefit or advantage or absence of limitation, exclusion, or disadvantage doesnot in fact exist; and
(3) An evidence of coverage shall be deemed to be deceptiveif the evidence of coverage taken as a whole, and with consideration given totypography, format and language, shall be such as to cause a reasonable person,not possessing special knowledge regarding health maintenance organizations andevidences of coverage for them, to expect benefits, services, charges, or otheradvantages which the evidence of coverage does not provide or which the healthmaintenance organization issuing the evidence of coverage does not regularlymake available for enrollees covered under the evidence of coverage.
(b) Section 42-62-12 and regulations pursuant to that sectionand chapter 29 of this title, relating to unfair competition and practices,shall be construed to apply to health maintenance organizations and evidencesof coverage except to the extent that the director of business regulationdetermines that the nature of health maintenance organizations, and evidencesof coverage, render those sections clearly inappropriate.
(c) An enrollee may not be cancelled or nonrenewed except forreasons stated in the rules of the health maintenance organization applicableto all enrollees, for the failure to pay the charge for coverage, or for theother reasons as may be approved by the director of business regulation.
(d) No health maintenance organization, unless licensed as aninsurer, may use in its name, contracts, or literature any of the words"insurance", "casualty", "surety", or "mutual", or any words descriptive of theinsurance, casualty, or surety business or deceptively similar to the name ordescription of any insurance or surety corporation doing business in this state.
(e) No person, unless in possession of a valid license as ahealth maintenance organization pursuant to the laws of this state, shall holdhimself or herself out as a health maintenance organization or HMO or shall dobusiness as a health maintenance organization or a HMO in the state of RhodeIsland, and no person shall do business in this state under a name deceptivelysimilar to the name of any health maintenance organization possessing a validlicense pursuant to this chapter.
(f) No health maintenance organization shall fail to contractwith any provider who is licensed by this state to provide the servicesdelineated in § 27-41-2(h)(1) solely because that provider is a podiatristas defined in chapter 29 of title 5.
(g) Except as provided in § 27-41-13(i), no contractbetween a health maintenance organization and a physician for the provision ofservices to patients may require that the physician indemnify or hold harmlessthe health maintenance organization for any expenses and liabilities, includingwithout limitation, judgments, settlements, attorneys' fees, court costs, andany associated charges, incurred in connection with any claim or action broughtagainst the plan based on the health maintenance organization's managementdecisions or utilization review provisions for any patient.