§ 27-19-5 - Contracts with subscribers, hospitals, and other eligible entities. - Rhode Island Statutes

SECTION 27-19-5

   § 27-19-5  Contracts with subscribers,hospitals, and other eligible entities. – (a) Each nonprofit hospital service corporation may contract with itssubscribers and with any eligible hospital for hospital service to be renderedby the contracting hospital to the subscribers and as to the nature and extentof those services. Each corporation may also contract with any of thefollowing: (1) any hospital or medical service corporation incorporated in thisor another state for the joint administration of their business and may enterinto reciprocal arrangements with those corporations for the mutual benefit ofthe subscribers of each; (2) corporations paying or organized for payment ofmedical, dental, optometric, or legal benefits, for the administration of theirbusiness including, without limiting the generality of the foregoing,corporations organized under chapters 20, 20.1, 20.2, and 20.3 of this title;(3) the federal government, the state, county, city, town, or otherquasi-municipal corporations or their agencies; and (4) employers,associations, and other third-parties for the administration and underwritingof stop loss or catastrophe insurance, for fully and partially self-insuredhealth benefit plans sponsored by such employers, associations and thirdparties.

   (b) Services for which coverage or benefits may be providedto subscribers by any of the corporations referred to in subsection (a)(2) ofthis section may also be provided for or underwritten by each nonprofithospital service corporation.

   (c) No contract between a nonprofit hospital servicecorporation and a dentist for the provisions of services to patients mayrequire that the dentist indemnify or hold harmless the nonprofit hospitalservice corporation for any expenses and liabilities, including withoutlimitation, judgments, settlements, attorneys' fees, court costs, and anyassociated charges, incurred in connection with any claim or action broughtagainst the nonprofit hospital service corporation based on the nonprofithospital service corporation's management decision, or utilization reviewprovisions for any patient.

   (d) The rates proposed to be charged by any corporationorganized under this chapter for stop-loss or catastrophe insurance shall befiled by the corporation at the office of the health insurance commissioner.The health insurance commissioner shall review such rates to determine if theyare actuarially sound and may hold a public hearing on such rates upon not lessthan ten (10) days written notice prior to the hearing. The health insurancecommissioner, upon the hearing, may administer oaths, examine and cross-examinewitnesses, receive oral and documentary evidence, and shall have the power tosubpoena witnesses, compel their attendance, and require the production ofbooks, papers, records, correspondence, or other documents which he or shedeems relevant. The director shall issue a decision as soon as is reasonablypossible following the completion of the hearing. The decision may approve,disapprove, or modify the rates proposed to be charged by the applicant.