Health Care Protection Under Rhode Island Law
For both Individual and Group Health Plans

How Does the Law Protect Me?

1. Coverage under a group health plan (offered by employers) cannot be denied or limited, nor can you be required to pay more because of your health status. (RIGL 27-18.6-4)
   
   
2. All group health plans in Rhode Island must limit exclusions of pre-existing conditions. (RIGL 27-18.6-3) However, individual health plans are only required to limit pre-existing exclusion periods in certain circumstances. (RIGL 27-18.5-3)
   
   
3. Your health insurance cannot be canceled because you get sick. All health insurance is guaranteed renewable. (RIGL 27-18.6-5)
   
   
4. If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This right is protected under the Consolidated Omnibus Budget Reconciliation Act of 1985. This act is referred to as COBRA and can help when individuals are between jobs or waiting for a new health plan to take effect. The following list explains the length of time you are protected under Cobra or a state continuation program (RIGL 27-19.1-1):
   
   
   • Due to termination of a job or a reduction of hours, individuals, their spouses and dependent children are guaranteed 18 months of continual coverage. You may be required to pay the group rate premium for this coverage.
     
     
   • Due to divorce or legal separation, death of an employee, and the employees' entitlement to Medicare, the spouse and dependent children are guaranteed 36 months of continual coverage. You may be required to pay the group rate premium for this coverage.
     
     
   • Due to the loss of a dependent child, the other dependent children are eligible for 36 months of continual coverage.
     
     
5. If you loose your fully insured group health insurance and meet other qualifications, you can buy a conversion policy. You will not face a new pre-existing condition exclusion period. There are no limits on what you can be charged for a conversion policy and the benefits may not be as generous. (RIGL 27-20.4-4)
   
   
6. If you have at least 12 months of prior health coverage with no gap, all individual health plans in Rhode Island must be open to you regardless of your health status. They cannot impose pre-existing condition exclusion periods for services covered under your prior health plan. (RIGL 27-18.5-3)
   
   
7. If you are federally eligible, you are guaranteed the right to buy an individual health plan from any insurance company that sells such plans in Rhode Island. Insurance companies must offer you a choice of at least two plans and cannot impose pre-existing condition exclusion periods. However, the companies may charge significantly higher premiums based upon health status, age and other factors. (RIGL 27-18.5-3) To be federally eligible, you must meet all of the requirements below:
   
   
   • You must have had 18 months of continuous creditable coverage under a group or individual health plan.
     
     
   • Your most recent group coverage must not have been terminated for nonpayment of premiums or fraud.
     
     
   • You must have used up any COBRA or state continuation coverage for which you were eligible.
     
     
   • You must not be eligible for Medicare, Medicaid or a group health plan.
     
     
   • You must not have health insurance.
     
     
   • You must apply for health insurance within 63 days of losing your prior coverage.
     
     
8. If you are a small employer buying a group health plan, you cannot be turned down because of health status, age, or any other factor that might predict the use of health services by those in your group. (RIGL 27-50-7) All health plans for small employers must be sold on a guaranteed issue basis. (RIGL 27-50-6)
   
   
9. If you are a small employer buying a group health plan, there are limits on how much your premiums can vary due to health status, age and/or other characteristics of the members in the group. However, companies can still charge significantly high premiums based upon these factors. (RIGL 27-50-5)
   
   

What Are the Limits on My Protection?

1. If you change jobs, you usually cannot take your old health benefits with you, except when you exercise your federal COBRA or state continuation rights. (RIGL 27-19.1-1)
   
   
2. If you change jobs, your new employer may not offer you health benefits. Employers are required not to make this decision based upon your health status. (RIGL 27-18.6-4)
   
   
3. If you get a new job with health benefits your coverage may not start right away. Employers and health maintenance organizations reserve the right to require waiting periods before your health coverage begins. (RIGL 27-18.6-3)
   
   
4. If you have a break in your coverage, you may have to satisfy a new pre-existing condition exclusion period when you join a new health plan. (RIGL 27-18.5-3)
   
5. Even if your coverage is continuous, there may be a pre-existing condition exclusion period for some benefits if you join a new health plan that offers benefits not covered by your old health plan. (RIGL 27-18.5-3)
   
   
6. If you are uninsured, individual health plans in Rhode Island can turn you down because of health status and other factors. (RIGL 27-18.5-3)
   
   
7. The law does not limit what you can be charged for individual health plans. (RIGL 27-18.5-3)
   
   

DISCLAIMER

This brochure was published in May of 2003. Because laws are subject to change,
the Rhode Island Cancer Council takes no responsibility if the laws
summarized here are no longer applicable.

To further research these laws you can refer to
Title 27-Insurance of Rhode Island's General Laws at the following website:
http://www.rilin.state.ri.us/Statutes/Statutes.html

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