Consumers Frequently Asked Questions (FAQ)

The OHIC can resolve issues with commercial insurers within our jurisdiction on behalf of medical service providers and consumers. Before filing a complaint with the Office, please read the following FAQ. If your issue is not addressed here, please go to our complaints page.

In Need of Health Insurance Coverage?

Q: I am no longer eligible for health insurance from my employer. What are my health insurance options?
A:

• Find out if you are eligible for COBRA continuation of coverage (see next Q&A for details on COBRA).
• Under HIPPA, you may be eligible for immediate coverage under your spouse's or parents' (dependents Only) health insurance plan
• Find a new job with an employer offering health insurance
• Purchase health insurance directly from Blue Cross through Direct Pay plans
  External link to Blue Cross' plans for individuals and familes without access to employer sponsored coverage.
  AccessBlueExternal link to BCBSRI's premium assistance program
  
• Enroll in Medicaid
  Medicaid's RIteCare Program
(External link) if you are qualified-eligibility rules may preclude this option.

Q: What is COBRA? Mini-cobra?
A: The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 applies if an employees who have lost their job from a company that employs 20 or more employees to continue purchasing their group health insurance plan without losing or changing any of the benefits of services available when covered under the employer group.

The Rhode Island “Mini-COBRA Law”, § 27-19.1-1 (external link), applies if an employee was laid off or death or the work place ceasing to exist, or premanent reduction in workforce from his/her job. For those eligible, health insurance coverage can continue for up to 18 months. The former employee is responsible for payment of the entire premium at their former employer's group premium rate.

For more information please visit
Insurance Options - COBRA

Health insurance Coverage Policies

Q: My employer doesn’t offer health insurance. What are my options? A:

Insurance Options

Q: I can’t afford my employer’s health insurance. What are my options?
A: RI Law 27-18.5-2 does not allow you to purchase health insurance through another health insurance company. You should discuss this directly with your employer.

Q: My doctor is no longer “in network”. Is this legal?

A: Yes, Each insurance company has the right to “contract” with the Provider’s they choose. Network requirements are under the jurisdiction of the RI Dept. of Health 222-6015.

Q: I am a state employee and have questions…
A: Please contact Deb Blair at the Dept. of Administration 222-3745 or fax over your problem at 222-6391 or e-mail at dblair@hr.ri.gov

Q: I heard that insurers have to cover infertility treatments, hearing aids, cranial prosthetics, my dependants, but my employer says it is not covered. Is this legal?
A: Some health insurance coverage is exempt from state laws mandating coverage for specific benefits such as infertility treatment or hearing aids (“benefit mandates”). If you are working for an employer who is "self-insured" - ( including many companies with 500 or more employees in RI ), these employers are not required to abide by some state insurance regualtions, including benefit mandates (there are a few federal mandates that are required under federal law such as mental Illness). If you have questions regarding “self-insured” plans please contact Kevin Murphy at the US Dept. of Labor Employee Benefits Security Administration (617-565-9622) or e-mail www.dol.gov/ebsa. The United States Department of Labor. (external link)

If your company is headquartered outside of Rhode Island, it follows the laws and insurance regulations of that state. An employee should discuss benefits and coverage mandates with their human resource department or health care administrator for more information.

Q: I have questions about my Medicare and Medicare Supplemental Insurance, who do I contact?
A: Rhode Island Department of Elderly Affairs at 401-462-3000 or see RI Department of Elderly Affairs (external link)

Q: Who do I contact for my Medicare Part D?
A: Contact the SCHIP assistance people at the Rhode Island Department of Elderly Affairs at 462-3000 or 462-4444 or see RI Department of Elderly Affairs (external link)

Insurance Coverage for Dependents

Q: My child is going to be eliminated from my health insurance policy. What are our options?

A: Rhode Island Law 27-18-59, Termination of Children’s Health Benefits, allows benefits for full time or part time (4 credits and above) after the age of 19 to continue until the age of 25. After this time, the Federal Law COBRA would apply if the employer has 20 or more employees. OHIC Bulletin Number 2006-5 Coverage of Dependent Children for details.