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Rhode Island Health Insurance

Rhode Island’s health insurance market is filled with intrigue!  It took me quite a while to understand what companies even offered health insurance plans there as the Google organic rankings are filled with lead vendors.  In other words, don’t bother filling out your personal information to get a Rhode Island health insurance quote because I couldn’t find a company that was able to show me any quotes.

Before we get started on the details of the Rhode Island health insurance industry, here is a link to download the Georgetown University Rhode Island Health Insurance Guide which is a 40 plus page in depth guide to the Rhode Island Health Insurance market.  This is for people needing more in-depth information then we are providing on this page.


Rhode Island Health Insurance Laws

Rhode Island is a hybrid of health insurance protection laws, including the federal guidelines of the Affordable Care Act. Under health reform, your medical status cannot prevent you from qualifying for the everyday health insurance plans, but predating the health law, Rhode Island offered guarantee issue plans that must accept everyone regardless of medical conditions. The previous statewide guarantee issue program merged with the Obamacare marketplaces in 2013 to offer ACA-compliant plans with coverage for everyone including unhealthy and uninsured Rhode Islanders.

It is extremely important to always maintain your health insurance plan in Rhode Island by paying your premiums, and if you are unable to pay your premiums you should march right down to the Medicaid office or call 401 462 5300, or enroll in the marketplace as you likely qualify for financial assistance.

There are also one man group health insurance plans available from the Blue Cross Blue Shield of Rhode Island if you prefer that over the individual market.

HIPAA eligibility seems to be totally unnecessary in Rhode Island due to the fact that anyone can qualify for individual plans on a guarantee issue basis anyways.  The HIPAA conditions do include the standard 18 months of prior coverage, not being eligible for any other coverage including Medicaid, Medicare, or a group plan, not having current health insurance, and be within the 63 day window of not having coverage.

HIPAA eligibility ends when you enroll in an individual plan, because the last day of your continuous health coverage must have been in a group plan.  You can become HIPAA eligible again by maintaining continuous coverage and rejoining a group health plan.

In Rhode Island, you do not need to meet all of these requirements in order to have protections when buying individual coverage.  If you plan on leaving Rhode Island, you may need to be HIPAA eligible to be guaranteed the right to buy individual health insurance in another state.

Rhode Island Health Insurance

  • HealthSource RI, the insurance marketplace is required to offer subsidized individual health insurance to any resident on a guaranteed issue basis during an annual open enrollment period. These policies do not impose any pre-existing condition exclusion period. In addition, premiums for these polices will be based on community rating.
  • Other policies sold by Rhode Island insurers such as Blue Cross Blue Shield also offer these protections. You cannot be turned down or charged more based on your health status and policies cannot exclude coverage for pre-existing conditions under the federal health law.
  • Under Rhode Island state law, newborns and adopted children are automatically covered under their parents’ individual health insurance policy for the first 31 days after birth or the start of the adoption bonding period. The insurer may require that the parent enroll the child within the 31 days in order to continue coverage beyond the 31 days
  • Under Rhode Island law, adult dependents who are physically disabled or mentally retarded are, at the option of the insured, able to stay on their parents’ fully insured group health plan or be issued a separate conversion policy after they have reached the age at which the plan usually cancels dependent coverage. In order to be eligible, the adult dependent must be incapable of self-support and must be dependent on the policyholder for support. Proof of incapacity must be provided to the insurer within 31 days of reaching the limiting age.


What will my individual health insurance policy cover?

  • It depends on what you buy. Health insurance companies design policies and you will have to read and compare them carefully. However, Rhode Island does require all health plans to cover certain benefits – such as treatment for diabetes and post-delivery hospital stays. Check with the Rhode Island Insurance Division for more information about mandated benefits.


What about coverage for my pre-existing condition?

  • Under federal law, all Rhode Island residents can obtain coverage for their pre-existing conditions on the individual and group markets.
  • If your policy is not guaranteed issue, there are different ways that individual health insurance can exclude a pre-existing condition.

The insurer can impose an elimination rider, which is an amendment to your health insurance contract that permanently excludes coverage for a health condition, body part, or body system. The policy can also include a 12-month pre-existing condition period on any pre-existing condition.

Pre-existing conditions are any conditions for which you received medical advice, care or diagnosis in the last 36 months.  In addition, insurers can count any condition for which the plan believes most people would have sought care. This is called the prudent person rule. If you make a claim for treatment of a condition during the first year of coverage under our individual policy, your insurance may investigate your medical records for evidence that the condition was pre-existing.

In Rhode Island, pregnancy can be considered a pre-existing condition in individual health insurance.  However, genetic information cannot be considered a pre-existing condition in the absence of a diagnosis.

  • Blue Cross & Blue Shield of Rhode Island typically imposes shorter pre-existing condition exclusions or does not impose them at all.


What can I be charged for an individual health insurance policy?

  • In Rhode Island, there are limits on how much individual premiums can vary due to age, location, and tobacco use only, when policies are first issued or at renewal. Health status, gender, and other factors are no longer considered when determining premiums.


Can my individual health insurance policy be canceled?

  • In Rhode Island like every other state, it is illegal to cancel your health insurance policy or rescind unless there are fraud issues. This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of managed care plans, continue to live in the plan service area.
  • Some insurance companies sell short-term (or temporary) health insurance policies. Short-term policies are not guaranteed renewable. They will only cover you for a limited time, such as 6 months. If you want to renew coverage under a short-term policy after it expires, you will have to reapply and there is no guarantee that coverage will be re-issued at all or at the same price. If you purchase a short-term policy, you should keep in mind that it will not count for purposes of guaranteed issue if it was the last policy you had.
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