§ 27-18.4-3 - Nondiscrimination in enrollment – Claims submission. - Rhode Island Statutes

SECTION 27-18.4-3

   § 27-18.4-3  Nondiscrimination inenrollment – Claims submission. – (a) An insurer shall not deny enrollment of a child under any health plan ofthe child's parent on the grounds that:

   (1) The child was born out of wedlock;

   (2) The child is not claimed as a dependent on the parent'sfederal tax return; or

   (3) The child does not reside with the parent or in theinsurer's service area.

   (b) Where a child has health coverage through an insurer of anoncustodial parent the insurer shall:

   (1) Provide any information to the custodial parent as may benecessary for the child to obtain benefits through that coverage;

   (2) Permit the custodial parent (or the provider, with thecustodial parent's approval) to submit claims for covered services without theapproval of the noncustodial parent; and

   (3) Make payments on claims submitted in accordance withsubsection (b)(2) of this section directly to the custodial parent, theprovider or the department of human services.

   (c) Where a parent is required by a court or administrativeorder to provide health coverage for a child, and the parent is eligible forfamily health coverage, the insurer is required:

   (1) To permit the parent to enroll, under the familycoverage, a child who is eligible for the coverage without regard to anyenrollment season restrictions;

   (2) If the parent is enrolled but fails to make applicationto obtain coverage for the child, to enroll the child under family coverageupon application of the child's other parent, or the department of humanservices which administers the Medicaid program and the child supportenforcement program under 42 U.S.C. § 651 et seq.; and

   (3) Not to disenroll (or eliminate coverage of) the childunless the insurer is provided satisfactory written evidence that:

   (i) The court or administrative order is no longer in effect;or

   (ii) The child is or will be enrolled in comparable healthcoverage through another insurer that will take effect not later than theeffective date of disenrollment.

   (d) An insurer may not impose requirements on the departmentof human services, which has been assigned the rights of an individual eligiblefor medical assistance pursuant to § 40-6-9 and covered for healthbenefits from the insurer, that are different from requirements applicable toan agent or assignee of any other covered individual.