§ 27-41-27 - Offer of health maintenance organization alternative to employees. - Rhode Island Statutes

SECTION 27-41-27

   § 27-41-27  Offer of health maintenanceorganization alternative to employees. – (a) In accordance with regulations promulgated by the director of thedepartment of business regulation: (i) each employer which during any calendarquarter employed an average number of employees of not less than twenty-five(25), and (ii) the state and each political subdivision of the state whichduring any calendar quarter employed an average number of employees of not lessthan twenty-five (25), shall include in any benefits plan, offered to theiremployees in the calendar year beginning after that calendar quarter, theoption of membership in licensed health maintenance organizations (HMOs) whichare qualified under the provisions of § 42-62-9 and which are engaged inthe 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 orpolitical subdivision of the state described in subdivision (1) of thissubsection are represented by a collective bargaining representative or otheremployee representative designated or selected under the law, the offer of amembership in a licensed health maintenance organization (HMO), required bysubdivision (1) of this subsection to be made in a health benefits plan offeredto those employees:

   (i) Shall be first made to that collective bargainingrepresentative or other employee representative; and

   (ii) If that offer is accepted by that representative, itshall then be made to each employee.

   (b) If there is more than one licensed and qualified healthmaintenance organization which is engaged in the provision of health servicesin the area in which the employees of an employer reside and if: (1) one ormore of those organizations provides health services through professionals whoare employed members of the staff of the organization or through an organizedmedical group or groups on a contractual basis; and

   (2) one or more of those organizations provides thoseservices through an individual practice association or associations; then ofthe licensed and qualified health maintenance organizations included in ahealth benefits plan of that employer pursuant to subsection (a) of thissection at least one shall be an organization which provides health services asdescribed in subdivision (1) of this subsection and at least one shall be anorganization which provides health services as described in subdivision (2) ofthis subsection.

   (c) An employer shall offer the option of membership inadditional licensed and qualified health maintenance organizations if theadditional licensed and qualified health maintenance organizations demonstratethat their service areas include the residence areas of employees:

   (1) Who do not reside in the service area of licensed healthmaintenance organizations already included in the employer's health benefitsplans; or

   (2) To whom membership in licensed and qualified healthmaintenance organizations already included in the health benefits plans is notavailable because those organizations have closed their enrollment of eligibleemployees of that employer.

   (d) An employer is not required to include in the healthbenefits plan offered to eligible employees the option of membership in thespecific licensed and qualified health maintenance organization which initiatedthe request for inclusion in the health benefits plan; provided, that theemployer selects, in a manner consistent with this section, one or more otherlicensed and qualified health maintenance organizations that may not have madea request but are willing to be included; provided, that these latter healthmaintenance organizations are of the same type, i.e., the type described insubdivision (b)(1) of this section or the type described in subdivision (b)(2)of this section, and serve, or will serve at a minimum, the same area in whichthe employer's or public entity's employees reside individually or collectivelyas the health maintenance organization which submitted the timely request.

   (e) No employer shall be required to pay more for healthbenefits as a result of the application of this section than would otherwise berequired by any prevailing collective bargaining agreement or legallyenforceable contract for the provision of health benefits between the employerand its employees; provided, that the annual per employee absolute dollarcontribution by the employer for any alternative health maintenanceorganization coverage shall in no event be required by this section to exceedthe employer's per employee absolute dollar contribution to any other healthbenefits plan offered by the employer. Each employer which provides payrolldeductions as a means of paying employees' contributions for health benefits orwhich provides a health benefits plan, and which is required by subsection (a)to offer his or her employees the option of membership in a licensed andqualified health maintenance organization (HMO), shall, with the consent of anemployee who exercises that option, arrange for the employee's contribution forthat membership to be paid through payroll deductions.