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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.

Q: I just lost my job (I had coverage from my employer). What are my health insurance options?
A: First, find out if you are eligible for COBRA continuation of coverage (see next Q&A for details on COBRA). Once COBRA runs out, your options include:

Q: What is COBRA? Mini-cobra?
A: The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 applies if an employee loses his/her job from an employer with 20 or more employees. It allows coverage to continue for up to 18 months. Those eligible for COBRA are responsible for payment of the entire premium at their former employer's group premium rate. For more information contact your former employer or the United States Department of Labor COBRA division at 1-866-444-3272 for more information.

An Employee's Guide to Health Benefits Under COBRA (external link)
U.S. Department of Labor's COBRA web page (external link)

The Rhode Island “Mini-COBRA Law”, § 27-19.1-1 (external link), applies if an employee was laid off 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.

Those eligible should contact the insurance company they had with their former employer, let the insurance company know they have been laid off, and request continuation of their benefits.

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.

See OHIC Bulletin Number 2006-5 Coverage of Dependent Children for details.

Q: I can’t afford my employer’s health insurance. What are my options?
A:
Medicaid – income and other eligibility factors apply, Medicare (age 65 or older only). Unfortunately, there are specific requirements for each employer under RI Laws that apply to participation. 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 employer doesn’t offer health insurance. What are my options?
A:
Individual health insurance or family insurance may be purchased through Blue Cross and Blue Shield of Rhode island (401) 459-5000. Blue Cross does have a premium assistance program which you may qualify. Rhode Island’s health care assistance may also apply if you are low income, please contact Rite Care at 462-1300.
External link to Blue Cross' plans for individuals and familes without access to employer sponsored coverage.

External link to Blue Cross' premium assistance program, AccessBlue.

Q: As an employer, can I get a special rate through a chamber of commerce?
A:
No, All Small Businesses in Rhode Island are subject to Rhode Island Law 27-50 in which they have specific rating factor’s that apply equally to all small businesses.

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 The Office of Employee Benefits (external link) the Dept. of Administration 222-3160 or fax over your question to 222-2964.

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:

a) “self-insured” - Many companies with 500 or more employees are self insured and as such, are not required to abide by some state insurance laws, including benefit mandates (there are a few federal mandates that are required under federal law such as mental Illness).

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.

b) Many companies with headquarters outside Rhode Island follow the laws in the state where they are headquartered. An employee should discuss this with their human resource department, or health care administrator.

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

Q: Who do I contact for my Medicare Part D?
A:
The SCHIP assistance people at 462-4444


HEALTH INSURANCE CONSUMER ALERT
RED FLAGS
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FEDERAL HEALTH REFORM  

IMPROVING PRIMARY CARE IN RHODE ISLAND
THE CSI PROJECT
 

RI's AFFORDABILITY STANDARDS FOR COMMERCIAL INSURERS

HEALTH INSURANCE ADVISORY COUNCIL 

HEALTHpact PLAN