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Rhode Island Health Insurance

To ensure a safe and secure financial future of your family, your main agenda should be having a health insurance policy, protecting your family’s healthcare needs. However, buying suitable health insurance coverage for your family can be costly, but it also requires a good consideration of all future risks and its influence on your finances. More than 47 million Americans are uninsured, majority of whom are the working families. These families, especially children, often cornered into a financial rut when it comes to paying huge medical expenses due to the lack of proper health coverage. However, for those families who are not covered under their employers’ group plan, there are low-cost state sponsored health insurance programs.

According to the America's 2008 Health Rankings, Rhode Island has maintained its 11th position since past two years. The state was ranked 13th healthiest state in 2006. Predominantly, low geographical disparity, low violent crime rate, low prevalence of smoking and less number of uninsured populations have been the strong features of the state. Rhode Island, having the population of more than one million citizens, boasts of both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced health coverage to the uninsurable residents of Rhode Island who meet specific eligibility requirements.

The Rhode Island Department of Business Regulation is in charge of regulating all types of insurance sold in the state of Rhode Island including health insurance policies offered by private-market health insurers or public health coverage programs. However, approximately 9.7% of the population remains uninsured, as the Rhode Island lawmakers strive to tackle the high prevalence of binge drinking. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 39.5% uninsured Rhode Island residents come under the above 200% FPL category.

Health insurance is an inevitable alternative and choosing a health plan can be quite tedious and confusing. Before buying a particular health policy, get in touch with a licensed health insurance agent/broker to avail the benefits of various health insurance alternatives.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Rhode Island. These regulations apply to all insurance companies offering individual or family health insurance in Rhode Island:

Medical Underwriting

Yes

Pre-Existing Condition Exclusion Period

12 months

Look Back Period

36 months

Look Back Standard

Prudent person

Mandatory Benefits

Cancer screening for women including screening of breast and cervical cancer, mastectomy stay of 48 hours, reconstructive surgery after mastectomy, direct access to OB/GYNs, eating disorder parity, infertility treatment

Market Rate Restrictions

None

Guaranteed Issue Options

None

Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Rhode Island. These regulations apply to all insurance companies offering small group health insurance in Rhode Island:

Small Group Size

1-50

Employee Qualifications

Two employees must work for at least 6 months out of the year, and work 20 hours per week

Guaranteed Issue

Yes

Premium Rating Factors

Adjusted Community Rating

Rate Adjustment Factors

10%

Look-Back Period

6 months

Pre-existing condition exclusionary period

6 months

Mandatory Benefits

Same as Individual

State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Rhode Island. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option

Yes

Eligible Group Sizes

2-19

Extension of Benefits Period - Standard

18 months

Extension of Benefits Period - Disabled

18 months

Maximum Premium Increase

100%

State Legislation Reference

Rhode Island Continuation Law

Additional Notes

State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Rhode Island to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Rhode Island does not have a high risk pool for its medically uninsurable residents.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Rhode Island provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name

RIte Care

Website

http://www.dhs.state.ri.us/dhs/famchild/shcare.htm

Phone Number

401-462-5300

Apply Online

Yes

Age Limits

Under 19

Insurance Carrier

Neighborhood Health Plan of Rhode Island, United Healthcare of New England, and Blue Cross and Blue Shield of Rhode Island.

Length of Coverage

Dependent on Continuous Eligibility

Residency Requirements

Rhode Island resident, U.S. citizen and qualified immigrant

Other Eligibility Requirements

Families should meet the income guidelines

Pre-Existing Condition Exclusions

None

Cost

Families pay monthly premium of $61, $77, or $92, depending on their income.

Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Rhode Island:

Governing Agency

Department of Human Services

Website

http://www.dhs.state.ri.us/

Phone Number

401-462-5300

Residency Requirements

Rhode Island resident, U.S. citizen

Federal Poverty Line Income Limits

Pregnant women and children ages 0-19: 250% FPL
Working Parents: 192% FPL
Non-working Parents: 185% FPL
Aged, blind and disabled: 100% FPL
Medically Needy individual: 69% FPL;
Medically Needy couple: 87% FPL
Supplemental Security Income Recipients: 74% FPL

Additional Resources

Rhode Island Health Care Options Matrix™ Guide

Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Rhode Island’s public and private health care choices for individuals and groups with various demographic profiles.

Family Health Insurance Guide by HealthInsuranceFinders.com

The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.

Rhode Island: At-A-Glance

Provides all-inclusive health data of Rhode Island. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.


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