The bill amends sections of the General Laws related to health insurance, specifically targeting the use of annual and lifetime limits on essential health benefits. It allows for restricted annual limits on essential health benefits for plan or policy years beginning before January 1, 2014, with minimum thresholds of $1,250,000 and $2,000,000 for specific timeframes. However, for plan or policy years starting on or after January 1, 2014, the bill prohibits any annual limits on essential health benefits, with certain exceptions. Lifetime limits on the dollar value of essential health benefits are banned for any individual, but lifetime limits on non-essential benefits are permitted if they comply with federal laws. The bill also removes a subsection that would suspend these provisions if the corresponding federal Patient Protection and Affordable Care Act (PPACA) provisions were invalidated or repealed.

The bill clarifies that the prohibitions on lifetime and annual limits apply to all health insurance carriers providing coverage under individual or group health plans, including grandfathered plans. It exempts certain types of insurance coverage from these provisions and introduces new sections to the General Laws for nonprofit medical service corporations and health maintenance organizations. The bill includes a deletion of a provision that would suspend the effectiveness of these sections if the PPACA was invalidated or repealed, and an insertion that requires the commissioner to report to the general assembly if any PPACA provision related to essential health benefits or annual and lifetime limits is repealed or invalidated. The act would take effect upon passage and repeals the authority of the health insurance commissioner to enforce any act of Congress or a federal court decision that invalidates or repeals the prohibition of annual and lifetime limits on health insurance as it pertains to Rhode Island.

Statutes affected:
7091  SUB A: 27-18-73, 27-19-63, 27-20-59, 27-41-76, 42-14.5-3.1
7091: 27-18-73, 27-19-63, 27-20-59, 27-41-76