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 (St@teside Published April 17, 2007)
Rhode Island:
Rhode Island Health Insurance Commissioner Christopher Koller recently unveiled new, low-premium "wellness health benefit plans" that are intended to encourage small businesses to offer health coverage to workers. These plans will include coverage for physician visits, hospitalization, preventive services, and prescriptions drugs. These new plans were developed after legislation requiring insurers to offer plans to businesses with 50 or fewer employees was passed last year. The law requires premiums to equal no more than 10 percent of the average annual wages in the state. Employee-only premiums will average $314, 18 percent lower than similar plans currently on the market. Blue Cross Blue Shield of Rhode Island and UnitedHealthcare of New England plan to offer a "basic plan" and an "advantage plan." Each employee will have the option of choosing between the two types of benefit designs with both being priced at the same level.
The design of the new lower-premium plans is intended to give incentives to enrollees to be more actively engaged in managing their own health care. The plan proposes to achieve significant cost savings though financial incentives for enrollees who improve and maintain their health through five key wellness initiatives:
- Selection of a primary care physician;
- Completion of a health risk appraisal;
- Pledge to either remain at a healthy weight or participate in weight management programs if morbidly obese;
- Pledge to either remain smoke free or participate in smoking cessation programs; and
- Pledge to participate in disease and case management programs, if applicable.
For enrollees who choose to participate in the wellness programs, it is proposed that deductibles, co-pays and co-insurance will be reduced to amounts normally seen in plans with much higher premiums.
Further cost reductions for the proposed wellness health benefit plan will be achieved through the development of tiered provider networks. The plan will encourage enrollees to select providers who have demonstrated cost effective, high quality practice patterns. Commissioner Koller estimated that between 5,000 and 10,000 small business employees will enroll in the plans.
Rhode Island
(St@teside Published June 26, 2006)
In 2006, Governor Donald Carcieri (R) signed into law a number of new health initiatives including several coverage expansions.
The coverage expansions:
- focus on providing premium relief for small businesses;
- empower the insurance commissioner to work with all involved stakeholders to develop a new, affordable health plan, called "WellCare" which is expected to reduce premiums for small businesses by approximately 25 percent through a combination of state mandated benefit flexibility, premium rating restrictions, and consumer cost sharing;
- allow low wage small businesses with average wages in the bottom quartile to save an additional 10 percent of the premium through a state sponsored reinsurance program that passed into law during the 2006 legislative session but is contingent upon the identification of a new funding source during the coming year; and
- authorize the insurance commissioner to seek federal funds for the creation of a high-risk pool in the individual market.
Other items addressed by the health care reform package include:
- The Massachusetts Reform Review Task Force, which is a panel that will explore the potential transferability of the Massachusetts reforms to the State of Rhode Island.
- The promotion of wellness through:
- the restriction of the sale of sweetened beverages in school vending machines;
- the creation of an adult flu vaccination program; and
- the encouragement of insurance coverage for tobacco cessation products.
- The expansion of quality and cost data reporting by all licensed health facilities in the state to enable patients with deductibles and co-insurance to make informed decisions.
Additional Information
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