Rhode Island Health Insurance Guide
Rhode Island Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
When you live in Rhode Island you can choose from a variety of private health insurance plans including plans for individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Rhode Island State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Rhode Island is a guarantee issue state for individual health insurance policies if you can demonstrate 12 months’ uninterrupted prior creditable coverage. That means you cannot be denied coverage because of any current or past health conditions and you are not subject to any exclusionary or look-back periods. If you do not qualify under these conditions, Rhode Island insurers are not obligated to guarantee you issue of an individual policy. You can be turned down for any number of reasons including your past or current health and lifestyle habits, and insurers are permitted a 12-month exclusionary period and a 36-month look-back period for pre-existing conditions. Rhode Island does not require an insurer to give you any credit for prior coverage. The state also permits health insurance provides to issue Elimination Riders that exclude coverage for specific health conditions. Premiums, which are not regulated by the state, can be based on your health, your age and lifestyle factors. Rhode Island does not require insurers to offer standardized policies for individuals.
Rhode Island is a guarantee issue state for group health plans issued to small businesses. If your Rhode Island health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. The insurer can impose a six-month exclusionary period and a six-month look-back period for pre-existing medical conditions. Your employer may impose a waiting period for eligibility for new hires, but it must be applied equally to all new hires. Premiums for small group health insurance may be underwritten and the insurer can charge a premium not to exceed 10% of its index rate if your group has a history of unfavorable health. Under Rhode Island law, if you are self-employed with no employees, you can still qualify for small group rates.
Rhode Island is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status. Your policy can be canceled if your insurer discontinues a plan or no longer sells insurance in the state.
Rhode Island Mandated Health Benefits
Rhode Island laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Blood Lead Poisoning
- Breast Reconstruction
- Cervical Cancer and HPV Screening
- Clinical Trials
- Colorectal Cancer Screening
- Contraceptives
- Diabetic Supplies
- Early Intervention Services
- Hair Prostheses
- Hearing Aids
- Home Health Care
- HPV Vaccine
- In Vitro Fertilization
- Lyme Disease
- Mammography
- Mastectomy and Mastectomy Stays
- Maternity Stays
- General and Parity Mental Health
- Newborn Hearing Screening
- Newborn Sickle-Cell Testing
- Off Label Drug Use
- Orthotics and Prosthetics
- Prostate Cancer Screening
- Second Surgical Opinion
- Well-Child Care
- Coverage for newborns under parent's policy
- Coverage for adopted children under parent's policy
- Coverage for continuation/dependents under parent's policy
- Coverage for dependent students under their parent’s policy
- Coverage for conversion to non-group
- Coverage for continuation/employees.
Types Health Insurance Plans Available in Rhode Island
The following major medical health insurance plans are generally available in Rhode Island. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Rhode Island
RIte Care
This program provides comprehensive free or low-cost health care for eligible uninsured resident children up to age 19, parents and pregnant women meet income and other eligibility requirements.
Three HMO plans are available, with modest monthly premiums and co-pays based on family income. There are no waiting periods. Enrollment is open but is subject to review and renewal every 12 months.
Regulating Agency
The Rhode Island Department of Business Regulation is responsible for regulating Rhode Island’s health insurance industry.
Get access to Rhode Island health insurance quotes from http://www.einsurance.com/health-insurance.
Rhode Island Department of Business Regulation
1511 Pontiac Ave
Cranston, RI 02920
(401) 462-9500
http://www.dbr.state.ri.us
Rite Care
110 Enterprise St
Cranston, RI 02920
(401) 462-1500
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/