§ 27-50-4 - Applicability and scope. - Rhode Island Statutes

SECTION 27-50-4

   § 27-50-4  Applicability and scope. –(a) This chapter applies to any health benefit plan that provides coverage tothe employees of a small employer in this state, whether issued directly by acarrier or through a trust, association, or other intermediary, and regardlessof issuance or delivery of the policy, if any of the following conditions aremet:

   (1) Any portion of the premium or benefits is paid by or onbehalf of the small employer;

   (2) An eligible employee or dependent is reimbursed, whetherthrough wage adjustments or otherwise, by or on behalf of the small employerfor any portion of the premium;

   (3) The health benefit plan is treated by the employer or anyof the eligible employees or dependents as part of a plan or program for thepurposes of Section 162, Section 125, or Section 106 of the United StatesInternal Revenue Code, 26 U.S.C. § 162, 125, or 106; or

   (4) The health benefit plan is marketed to individualemployees through an employer.

   (b) Except as provided in subdivision (2) of this subsection,for the purposes of this chapter, carriers that are affiliated companies orthat are eligible to file a consolidated tax return shall be treated as onecarrier and any restrictions or limitations imposed by this chapter shall applyas if all health benefit plans delivered or issued for delivery to smallemployers in this state by the affiliated carriers were issued by one carrier.

   (2) An affiliated carrier that is a health maintenanceorganization having a license under chapter 41 of this title or a healthmaintenance organization as defined in chapter 62 of title 42 may be consideredto be a separate carrier for the purposes of this chapter.

   (3) Unless otherwise authorized by the director, a smallemployer carrier shall not enter into one or more ceding arrangements withrespect to health benefit plans delivered or issued for delivery to smallemployers in this state if those arrangements would result in less than fiftypercent (50%) of the insurance obligation or risk for the health benefit plansbeing retained by the ceding carrier. The department of business regulation'sstatutory provisions under this title shall apply if a small employer carriercedes or assumes all of the insurance obligation or risk with respect to one ormore health benefit plans delivered or issued for delivery to small employersin this state.