§ 42-7.4-2. Definitions.
The following words and phrases as used in this chapter shall have the following meaning:
(1)(i) "Contribution enrollee� means an individual residing in this state, with respect to
whom an insurer administers, provides, pays for, insures, or covers healthcare services,
unless excepted by this section.
(ii) "Contribution enrollee� shall not include an individual whose healthcare services
are paid or reimbursed by Part A or Part B of the Medicare program, a Medicare supplemental
policy as defined in section 1882(g)(1) of the Social Security Act, 42 U.S.C. §â€‚1395ss(g)(1), or Medicare managed care policy, the federal employees' health benefit program,
the Veterans' healthcare program, the Indian health service program, or any local
governmental corporation, district, or agency providing health benefits coverage on
a self-insured basis.
(iii) Delayed applicability for state employees, retirees, and dependents and not-for-profit
healthcare corporations. An individual whose healthcare services are paid or reimbursed
by the state of Rhode Island pursuant to chapter 12 of title 36 or a not-for-profit healthcare corporation that controls or operates hospitals licensed
under chapter 17 of title 23 or a not-for-profit healthcare corporation that controls or operates hospitals licensed
under chapter 17 of title 23, and facilities and programs providing rehabilitation, psychological support, and
social guidance to individuals who are alcoholic, drug abusers, mentally ill, or who
are persons with developmental disabilities or cognitive disabilities, such as brain
injury, licensed under chapter 24 of title 40.1 shall not be treated as a "contribution enrollee� until July 1, 2016.
(2) "Healthcare services funding contribution� means the per capita amount each contributing
insurer must contribute to support the programs funded by the method established under
this section, with respect to each contribution enrollee; provided, however, that,
with respect to an insurer that is a Medicaid managed care organization offering managed
Medicaid, the healthcare funding services contribution for any contribution enrollee
whose healthcare services are paid or reimbursed under Title XIX of the Social Security
Act (Medicaid) shall not include the children's health services funding requirement
described in §â€‚42-12-29.
(3)(i) "Insurer� means all persons offering, administering, and/or insuring healthcare services,
including, but not limited to:
(A) Policies of accident and sickness insurance, as defined by chapter 18 of title 27:
(B) Nonprofit hospital or medical service plans, as defined by chapters 19 and 20 of title
27;
(C) Any person whose primary function is to provide diagnostic, therapeutic, or preventive
services to a defined population on the basis of a periodic premium;
(D) All domestic, foreign, or alien insurance companies, mutual associations, and organizations;
(E) Health maintenance organizations, as defined by chapter 41 of title 27;
(F) All persons providing health benefits coverage on a self-insurance basis;
(G) All third-party administrators described in chapter 20.7 of title 27; and
(H) All persons providing health benefit coverage under Title XIX of the Social Security
Act (Medicaid) as a Medicaid managed care organization offering managed Medicaid.
(ii) "Insurer� shall not include any nonprofit dental service corporation as defined in
§â€‚27-20.1-2, nor any insurer offering only those coverages described in §â€‚42-7.4-13.
(4) "Person� means any individual, corporation, company, association, partnership, limited
liability company, firm, state governmental corporations, districts, and agencies,
joint stock associations, trusts, and the legal successor thereof.
(5) "Secretary� means the secretary of health and human services.