§ 27-50-10.1 - Basic benefit health plan. [Expires December 31, 2010.]. - Rhode Island Statutes

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 sellbasic benefit health plans developed pursuant to this section on and after July1, 2007. Basic benefit health plans authorized under this section shall beexempt from any law requiring the coverage of a health care service or benefitor requiring the reimbursement, utilization, or inclusion of a specificcategory of licensed health care practitioner; provided, however, coverage forthe medical treatment of mental illness and substance abuse shall be providedin accordance with chapter 38.2 of this title;

   (b) Basic benefits health plans shall provide affordablehealth care coverage through flexible products that provide access to basichealth services. Basic benefits health plans shall provide limited, flexiblecoverage for the following services:

   (i) Inpatient hospitalization;

   (ii) Outpatient surgery and diagnostics;

   (iii) Outpatient physician coverage, including preventativeoffice visits;

   (iv) Accidental injury and emergency coverage;

   (v) Prescription drug coverage.

   (c) Small employer carriers may utilize cost containmentmechanisms 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 forout-of-network services.

   (d) The annual deductible shall not exceed two thousanddollars ($2,000) per individual and four thousand dollars ($4,000) per family.

   (e) Basic benefit health plans shall be available only touninsured small employers, provided, however, that once a small employerenrolls in a basic benefit health plan such small employer shall be guaranteedrenewability of such basic benefit health plan coverage.

   (f) The average annualized individual premium rate for abasic 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 Islanddepartment of labor and training, in their report entitled "Quarterly Census ofRhode Island Employment and Wages." In the event that this report is no longeravailable or the office of the health insurance commissioner ("OHIC")determines that it is no longer appropriate for the determination of maximumannualized premium, an alternative method shall be adopted in regulation by theOHIC. The maximum annualized individual premium rate shall be determined nolater than August 1st of each year, to be applied to the subsequent calendaryear premium rates.

   (g) The health insurance commissioner shall issue a report tothe general assembly as to the status and market impact of the basic benefithealth plan program and shall make recommendation to the general assemblyregarding the expansion, continuation or termination of the program on orbefore March 1, 2010.

   (h) The authority provided to small employer carriers to sellbasic benefit health plans pursuant to this section shall take effect on July1, 2007.