§ 27-38.2-2. Definitions.
For the purposes of this chapter, the following words and terms have the following
meanings:
(1) "Financial requirements� means deductibles, copayments, coinsurance, or out-of-pocket
maximums.
(2) "Group health planâ€� means an employee welfare benefit plan as defined in 29 U.S.C. § 1002(1) to the extent that the plan provides health benefits to employees or their dependents
directly or through insurance, reimbursement, or otherwise. For purposes of this chapter,
a group health plan shall not include a plan that provides health benefits directly
to employees or their dependents, except in the case of a plan provided by the state
or an instrumentality of the state.
(3) "Health insurance plan� means health insurance coverage offered, delivered, issued
for delivery, or renewed by a health insurer.
(4) "Health insurers� means all persons, firms, corporations, or other organizations offering
and assuring health services on a prepaid or primarily expense-incurred basis, including
but not limited to, policies of accident or sickness insurance, as defined by chapter
18 of this title; nonprofit hospital or medical service plans, whether organized under
chapter 19 or 20 of this title or under any public law or by special act of the general
assembly; health maintenance organizations, or any other entity that insures or reimburses
for diagnostic, therapeutic, or preventive services to a determined population on
the basis of a periodic premium. Provided, this chapter does not apply to insurance
coverage providing benefits for:
(i) Hospital confinement indemnity;
(ii) Disability income;
(iii) Accident only;
(iv) Long-term care;
(v) Medicare supplement;
(vi) Limited benefit health;
(vii) Specific disease indemnity;
(viii) Sickness or bodily injury or death by accident or both; and
(ix) Other limited benefit policies.
(5) "Mental health or substance use disorder� means any mental disorder and substance
use disorder that is listed in the most recent revised publication or the most updated
volume of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) published
by the American Psychiatric Association or the International Classification of Disease
Manual (ICO) published by the World Health Organization; provided, that tobacco and
caffeine are excluded from the definition of "substance� for the purposes of this
chapter.
(6) "Non-quantitative treatment limitations� means: (i) Medical management standards;
(ii) Formulary design and protocols; (iii) Network tier design; (iv) Standards for
provider admission to participate in a network; (v) Reimbursement rates and methods
for determining usual, customary, and reasonable charges; and (vi) Other criteria
that limit scope or duration of coverage for services in the treatment of mental health
and substance use disorders, including restrictions based on geographic location,
facility type, and provider specialty.
(7) "Quantitative treatment limitations� means numerical limits on coverage for the treatment
of mental health and substance use disorders based on the frequency of treatment,
number of visits, days of coverage, days in a waiting period, or other similar limits
on the scope or duration of treatment.