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§27-50-10.1  Basic Benefit Health Plan. [Expires December 31, 2010.]. –

Published: 2015

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Small Employer Health Insurance Availability Act

SECTION 27-50-10.1

   § 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 health care service or benefit

or requiring the reimbursement, utilization, or inclusion of a specific

category of licensed health care 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

health care 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;


   (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.

History of Section.

(P.L. 2007, ch. 221, § 2.)