§ 42-62-12 - Minimum standards.
SECTION 42-62-12
§ 42-62-12 Minimum standards. – (a) It is the duty of all corporations or other legal entities providing forpayment for health services under any contract entered into with an employer,person, state, or a political subdivision of the state, pursuant to therequirements of this chapter, to comply with minimum standards established byregulations promulgated by the director of business regulation. The director ofbusiness regulation shall promulgate the regulations within one year of January1, 1975.
(b) The minimum standards shall be designed to carry out thefollowing purposes:
(1) The reasonable standardization and simplification ofcoverage to facilitate consumer understanding and comparisons;
(2) The elimination of provisions which may be misleading orunreasonably confusing to the consumer in connection with the purchase ofcoverage or with the settlement of claims;
(3) The elimination of deceptive practices in connection withthe sale of coverage;
(4) The elimination of provisions, which may be contrary tothe health needs of the public;
(5) The availability of qualified plans to persons residingin the state who apply therefor regardless of age, sex, race, occupationalstatus, or medical condition;
(6) The promotion of efficient management of health serviceswithin the state;
(7) The elimination of coverage which are limited in scope asto be of no substantial economic value to the holders of the coverage; and
(8) The addition of coverage, the sale of which is requiredby the public interest to protect the health of persons residing in the state.
(c) Within two hundred and seventy (270) days after thepromulgation of the minimum standard regulations by the director of businessregulation, each insurer or other entity referred to in this section shall filewith the director of business regulation a sample of each of the contractswhich it proposes to use. A notice of a receipt of filing shall be delivered tothe consumer protection unit of the department of attorney general. Ifrequested by the consumer protection unit of the department of attorneygeneral, the director shall hold a hearing upon not less than ten (10) days'written notice prior to the hearing. A notice of the hearing shall be sent tothe filing party and to the consumer protection unit of the department ofattorney general. The director shall review the contract and shall insure awritten decision as soon as is reasonably possible following the review. Thedirector may approve, disapprove or modify the contract offered by the filingparty. Thereafter, all insurers or other entities referred to in this sectionshall file any modifications of contracts, which they propose to offer with thedirector of business regulation. The director shall thereupon follow theprocedure prescribed by this subsection.
(d) No insurer or health maintenance organization as definedin § 42-62-4 shall prohibit a subscriber or insured from first contactingthe 911 emergency system when that subscriber or insured reasonably believesthat an emergency medical condition exists which places in serious jeopardythat person's health, or a person's health on whose behalf the 911 call ismade; provided, however, that nothing in this chapter shall be construed torequire reimbursement for this service.