§ 27-50-10.1. Basic benefit health plan. [Expires December 31, 2010.]
(a) Small employer carriers are hereby authorized to actively market and sell basic benefit
health plans developed pursuant to this section on and after July 1, 2007. Basic benefit
health plans authorized under this section shall be exempt from any law requiring
the coverage of a healthcare service or benefit or requiring the reimbursement, utilization,
or inclusion of a specific category of licensed healthcare practitioner; provided,
however, coverage for the medical treatment of mental illness and substance abuse
shall be provided in accordance with chapter 38.2 of this title.
(b) Basic benefits health plans shall provide affordable healthcare coverage through flexible
products that provide access to basic health services. Basic benefits health plans
shall provide limited, flexible coverage for the following services:
(i) Inpatient hospitalization;
(ii) Outpatient surgery and diagnostics;
(iii) Outpatient physician coverage, including preventative office visits;
(iv) Accidental injury and emergency coverage;
(v) Prescription drug coverage.
(c) Small employer carriers may utilize cost containment mechanisms to control the cost
of such services including, but not limited to, the following;
(i) Primary care gatekeepers;
(ii) Preadmission certification;
(iii) Mandatory second opinion prior to elective surgery;
(iv) Preauthorization for specified services;
(v) Concurrent utilization review and management;
(vi) Discharge planning for hospital care;
(vii) Deductibles and copayments;
(viii) Less costly alternatives to inpatient care;
(ix) Annual limits or maximums for each category of service; and
(x) Restricted networks with limited coverage for out-of-network services.
(d) The annual deductible shall not exceed two thousand dollars ($2,000) per individual
and four thousand dollars ($4,000) per family.
(e) Basic benefit health plans shall be available only to uninsured small employers, provided,
however, that once a small employer enrolls in a basic benefit health plan such small
employer shall be guaranteed renewability of such basic benefit health plan coverage.
(f) The average annualized individual premium rate for a basic benefit health plan shall
be less than seven and one-half percent (7.5%) of the average annual statewide wage,
as reported by the Rhode Island department of labor and training, in their report
entitled "Quarterly Census of Rhode Island Employment and Wages.� In the event that
this report is no longer available or the office of the health insurance commissioner
("OHIC�) determines that it is no longer appropriate for the determination of maximum
annualized premium, an alternative method shall be adopted in regulation by the OHIC.
The maximum annualized individual premium rate shall be determined no later than August
1st of each year, to be applied to the subsequent calendar year premium rates.
(g) The health insurance commissioner shall issue a report to the general assembly as
to the status and market impact of the basic benefit health plan program and shall
make recommendation to the general assembly regarding the expansion, continuation
or termination of the program on or before March 1, 2010.
(h) The authority provided to small employer carriers to sell basic benefit health plans
pursuant to this section shall take effect on July 1, 2007.