§ 42-62-12. Minimum standards. (a) It is the duty of all corporations or other legal entities providing for payment for health services under any contract entered into with an employer, person, state, or a political subdivision of the state, pursuant to the requirements of this chapter, to comply with minimum standards established by regulations promulgated by the director of business regulation. The director of business regulation shall promulgate the regulations within one year of January 1, 1975.

(b) The minimum standards shall be designed to carry out the following purposes:

(1) The reasonable standardization and simplification of coverage to facilitate consumer understanding and comparisons;

(2) The elimination of provisions which may be misleading or unreasonably confusing to the consumer in connection with the purchase of coverage or with the settlement of claims;

(3) The elimination of deceptive practices in connection with the sale of coverage;

(4) The elimination of provisions, which may be contrary to the health needs of the public;

(5) The availability of qualified plans to persons residing in the state who apply therefor regardless of age, sex, race, occupational status, or medical condition;

(6) The promotion of efficient management of health services within the state;

(7) The elimination of coverage which are limited in scope as to be of no substantial economic value to the holders of the coverage; and

(8) The addition of coverage, the sale of which is required by the public interest to protect the health of persons residing in the state.

(c) Within two hundred and seventy (270) days after the promulgation of the minimum standard regulations by the director of business regulation, each insurer or other entity referred to in this section shall file with the director of business regulation a sample of each of the contracts which it proposes to use. A notice of a receipt of filing shall be delivered to the consumer protection unit of the department of attorney general. If requested by the consumer protection unit of the department of attorney general, 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 to the filing party and to the consumer protection unit of the department of attorney general. The director shall review the contract and shall insure a written decision as soon as is reasonably possible following the review. The director may approve, disapprove or modify the contract offered by the filing party. Thereafter, all insurers or other entities referred to in this section shall file any modifications of contracts, which they propose to offer with the director of business regulation. The director shall thereupon follow the procedure prescribed by this subsection.

(d) No insurer or health maintenance organization as defined in § 42-62-4 shall prohibit a subscriber or insured from first contacting the 911 emergency system when that subscriber or insured reasonably believes that an emergency medical condition exists which places in serious jeopardy that person's health, or a person's health on whose behalf the 911 call is made; provided, however, that nothing in this chapter shall be construed to require reimbursement for this service.

History of Section. (P.L. 1974, ch. 50, § 1; P.L. 1976, ch. 151, § 1; P.L. 2000, ch. 480, § 1.)