§ 27-41-27. Offer of health maintenance organization alternative to employees.
(a)(1) In accordance with regulations promulgated by the director of the department of business
regulation: (i) Each employer that during any calendar quarter employed an average
number of employees of not less than twenty-five (25), and (ii) The state and each
political subdivision of the state that during any calendar quarter employed an average
number of employees of not less than twenty-five (25), shall include in any benefits
plan, offered to their employees in the calendar year beginning after that calendar
quarter, the option of membership in licensed health maintenance organizations (HMOs)
that are qualified under the provisions of § 42-62-9 and that are engaged in the provision of basic health services in health maintenance
organization (HMO) service areas in which at least twenty-five (25) of those employees
reside.
(2) If any of the employees of an employer or the state or political subdivision of the
state described in subsection (a)(1) of this section are represented by a collective
bargaining representative or other employee representative designated or selected
under the law, the offer of a membership in a licensed health maintenance organization
(HMO), required by subsection (a)(1) of this section to be made in a health benefits
plan offered to those employees:
(i) Shall be first made to that collective bargaining representative or other employee
representative; and
(ii) If that offer is accepted by that representative, it shall then be made to each employee.
(b) If there is more than one licensed and qualified health maintenance organization engaged
in the provision of health services in the area in which the employees of an employer
reside and if:
(1) One or more of those organizations provides health services through professionals
who are employed members of the staff of the organization or through an organized
medical group or groups on a contractual basis; and
(2) One or more of those organizations provides those services through an individual practice
association or associations; then of the licensed and qualified health maintenance
organizations included in a health benefits plan of that employer pursuant to subsection
(a) of this section at least one shall be an organization that provides health services
as described in subsection (b)(1) of this section and at least one shall be an organization
that provides health services as described in subsection (b)(2) of this section.
(c) An employer shall offer the option of membership in additional licensed and qualified
health maintenance organizations if the additional licensed and qualified health maintenance
organizations demonstrate that their service areas include the residence areas of
employees:
(1) Who do not reside in the service area of licensed health maintenance organizations
already included in the employer's health benefits plans; or
(2) To whom membership in licensed and qualified health maintenance organizations already
included in the health benefits plans is not available because those organizations
have closed their enrollment of eligible employees of that employer.
(d) An employer is not required to include in the health benefits plan offered to eligible
employees the option of membership in the specific licensed and qualified health maintenance
organization that initiated the request for inclusion in the health benefits plan;
provided, that the employer selects, in a manner consistent with this section, one
or more other licensed and qualified health maintenance organizations that may not
have made a request but are willing to be included; provided, that these latter health
maintenance organizations are of the same type, i.e., the type described in subsection
(b)(1) of this section or the type described in subsection (b)(2) of this section,
and serve, or will serve at a minimum, the same area in which the employer's or public
entity's employees reside individually or collectively as the health maintenance organization
that submitted the timely request.
(e) No employer shall be required to pay more for health benefits as a result of the application
of this section than would otherwise be required by any prevailing collective bargaining
agreement or legally enforceable contract for the provision of health benefits between
the employer and its employees; provided, that the annual per employee absolute dollar
contribution by the employer for any alternative health maintenance organization coverage
shall in no event be required by this section to exceed the employer's per employee
absolute dollar contribution to any other health benefits plan offered by the employer.
Each employer that provides payroll deductions as a means of paying employees' contributions
for health benefits or that provides a health benefits plan, and that is required
by subsection (a) to offer his or her employees the option of membership in a licensed
and qualified health maintenance organization (HMO), shall, with the consent of an
employee who exercises that option, arrange for the employee's contribution for that
membership to be paid through payroll deductions.