Rhode Island Health Study Guide

What separates Rhode Island’s health material from a national course is instrument rather than substance. Chapter 27-18 gives you thirteen required provisions and then stays silent on the two numbers candidates look for first: the individual free look sits in the Department’s form rules, and the grace period is a blank in the statute’s own model text. On this paper, ask which document holds a rule before you memorise the number.

The individual free look is not in the General Laws

The individual accident and health free look is 10 days from delivery, with a full premium refund — and it is not in the statute at all. It lives in the form rules at 230-RICR-20-30-1 section 1.7.4(A)(11), whose carve-out is narrow: “All contracts, except single premium nonrenewable contracts.”

The reason is the interesting half. R.I. Gen. Laws section 27-18-3(a) enumerates thirteen required provisions, from Entire Contract through Medical Services Definition — and a right to return the policy is not among them. Medicare supplement is the mirror image: that free look is 30 days and statutory, at section 27-18.2-7, on a notice printed prominently on the first page, with the refund paid directly to the applicant.

Thirteen provisions — and the one the statute leaves blank

Section 27-18-3(a)(3) prescribes the grace period as model text reading “A grace period of ____ days” — an actual blank, left for the insurer to fill subject to filing. There is no figure to memorise, and the trap is importing one: the 31 days candidates reach for belongs to individual life at section 27-4-6.2(a)(1). Three neighbours carry qualifiers that wrong answers strip:

• Notice of claim — 20 days after the occurrence or commencement of loss, “or as soon after this as is reasonably possible” (section 27-18-3(a)(5)).
• Proofs of loss — 90 days, but from two different events (section 27-18-3(a)(7)): from termination of the period for which the insurer is liable on a periodic-payment loss, and from the date of loss on anything else.
• Time limit on certain defenses — 3 years, with the clock tolled: section 27-18-3(a)(2) excludes “any period during which the insured is disabled.”

State continuation is not a mini-COBRA

Other states train the instinct that a continuation statute fills the gap under the federal law. COBRA applies at 20 or more employees; section 27-19.1-1 sits alongside it rather than beneath it, carrying no employer-size threshold and no carve-out for employers subject to COBRA. An answer reading “applies to employers under twenty” is wrong, and so is “under fifty.”

The fifty-member line is real, but it routes payment: continuees from plans of 50 members or fewer pay the carrier directly, and those leaving larger plans pay the employer (section 27-19.1-1(c)). The premium is the same monthly group rate or subscription fee, with no administrative loading in the statute; and if the employer collects and fails to remit, it is liable for benefits as the carrier would have been (section 27-19.1-1(d)).

Duration is where the rest of the rule hides. Coverage runs up to 18 months, but the same sentence caps it three ways: not to exceed the shorter of the period of continuous employment preceding termination, or the time until the person becomes employed by another group and eligible under another group plan (section 27-19.1-1(a)). Four months of service buys four months of continuation. Election is the individual’s: the qualifying person may elect within 30 days of qualification, and the employer’s duty is only to post a conspicuous notice of the options (section 27-19.1-1(c), (f)).

Prompt pay — a per-claim duty and a portfolio test at once

Under section 27-18-61(a), (b) a clean claim must be paid within 40 calendar days on paper and 30 calendar days electronically, with written notice of denial or pended status inside 30 days. Miss it and 12 percent interest per annum runs from the 31st day after a complete electronic claim or the 41st after a complete written one (section 27-18-61(d)). Subsection (e)(4) then adds a book-wide measure: substantial compliance means “processing and paying ninety-five percent (95%) or more of all claims within the time frame provided for in subsections (a) and (b).”

External review and the long-term care gate

The independent review organization’s decision binds the plan: section 27-18.9-8 provides it “shall be binding on the healthcare entity and/or review agent,” while an aggrieved person keeps a right to judicial review. A standard review runs two clocks at once under 230-RICR-20-30-14: no more than 10 calendar days from receipt of all necessary information and no more than 45 calendar days from the request. Expedited reviews run 72 hours.

And a health licence alone does not put long-term care on your shelf. Section 27-34.2-21 requires no less than 8 hours of training once, then no less than 4 hours every 24 months, before you may sell, solicit or negotiate long-term care insurance — and provides that the hours “may be approved as continuing education courses.”