Rhode Island Health Insurance

Rhode Island (RI)

Individual Health Insurance Regulations

Medical insurance is an important precaution that one cannot afford live without. Being the main earning member of the family, your interests lie in the protection of your family against unforeseen circumstances such as illness or injury. Before choosing a particular health plan, a detailed evaluation of your family's healthcare needs and your personal finances is crucial. If you reside in Rhode Island, you have the option to choose from various product alternatives. The Rhode Island Department of Business Regulation regulates the legislature under which the Rhode Island health insurers can sell private medical insurance to individuals and families.
In Rhode Island, individual medical insurance is provided on a guarantee issue basis to individuals who have 12 months of prior coverage, with no break in that coverage. Health coverage sought on a guarantee issue basis may not be declined due to past or present medical conditions and is protected from any look back or exclusionary period on the part of the insurance carrier. Individuals, not previously covered under a plan, are subject to medical underwriting as per the laws of the State of Rhode Island. Medical underwriting provides the carrier an opportunity to examine the past and present medical status of the applicant. Upon review of the applicant's medical history, the carrier may provide coverage under the terms of the individual plan; or offer modified coverage under the terms of the plan, with specific limitations and exclusions; or deny coverage based upon medical history. On all medically underwritten health plans, the insurance carrier is permitted a 36 month look back and 12-month exclusionary period limit on pre-existing conditions and is not required to give credit for prior creditable coverage.
Search for plans and the costs associated with them using the search box above. We provide individual, family, group and student health plan quotes for you to compare on all states and zip codes. Remember that having coverage leads to a healthier lifestyle as you are able to get regular doctor checkups and therefore a low-cost premium.

Rhode Island (RI)

Small Group Health Insurance Regulations

For purposes of small group health insurance, the State of Rhode Island defines a small group as an employer with 1 to 50 employees. All small group insurance coverage, including groups of 1, must be offered on a guarantee issue basis. Guarantee issue coverage provides that no group, regardless of its past or current health status, may be declined coverage. Under Rhode Island laws, health insurers are permitted to look back in the 6-month health history of the applicant and issue 6-month exclusion period for any pre-existing conditions when offering small group health coverage. Qualified employees may be subjected to a waiting period before becoming eligible to join the employer sponsored group health plan. Waiting periods are determined by the employer and must be consistent for each employee. Small group rates will vary, based upon the health, size and location of the group, as Rhode Island permits rates to be medically underwritten. Rhode Island small group rates are based at plus or minus 10% of the insurance company's index rate.

Rhode Island COBRA and Continuation Coverage

Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) employees and/or their dependents are permitted to temporarily continue coverage of their employer-sponsored group health insurance benefits for a specified time and as a result of a qualifying event. Rhode Island has adopted a state mini-COBRA law that mirrors the federal guidelines with a few exceptions. The state continuation of coverage eligibility requirements are more limiting in that an employee must have been laid off from work involuntarily, as where federal COBRA is available to persons that voluntarily leave their place of employment. Under state continuation, you may be eligible to remain on your group health plan for up to 18 months. Coverage length may be reduced to the length of time that the employee was on the group policy before they were laid off. Notice of election for continuation of coverage must be made in writing within 30 days of the date of termination. Premium payments in their entirety are the sole responsibility of the COBRA recipient. Options to convert your group coverage into an individual health plan are available instead of electing COBRA, but the premiums are usually much higher. For those exhausting their COBRA coverage, individual plans in Rhode Island are guaranteed issue coverage for those that have had 12 months of continuous coverage.