Rhode Island Health Insurance Policy Requirements

Rhode Island has comprehensive health insurance regulations that protect consumers and ensure access to coverage.

Regulatory Structure

Rhode Island health coverage is regulated by:

Insurance Division

The Insurance Division of the Department of Business Regulation:

• Regulates life, health, and accident insurance companies
• Answers consumer questions and complaints
• Maintains licensing database for producers
• Reviews and approves policy forms and rates

Rhode Island Individual Mandate

Since 2020, Rhode Island requires residents to maintain health insurance coverage:

• Must have minimum essential coverage (same definition as ACA)
• Penalty for non-compliance
• Exemptions available for financial hardship and other circumstances
• Requirement enforced through state tax system

Exam Tip: Rhode Island is one of the few states that maintained an individual mandate after the federal penalty was reduced to $0.

HealthSource RI

HealthSource RI is the state's official health insurance marketplace:

Key Features

• Only place to obtain premium tax credits
• Offers qualified health plans (QHPs)
• Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)
• Integrated eligibility system with Medicaid

Open Enrollment

• Annual open enrollment: November 1 through January 31
• Special enrollment periods for qualifying life events
• Starting 2027, open enrollment will end December 31

Required Coverage

Rhode Island mandates coverage for numerous benefits:

Essential Health Benefits

All individual and small group plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

State-Specific Mandates

Rhode Island also requires coverage for:

• Autism spectrum disorder treatment
• Breast reconstruction after mastectomy
• Contraceptive services
• Diabetes supplies and education
• Infertility treatment
• Mental health parity

Mental Health Parity

Rhode Island's Mental Health Parity laws require:

• Mental health benefits equal to medical benefits
• Same copays, deductibles, and limits
• Coverage for substance use disorders
• No separate lifetime or annual limits for mental health

Pre-Existing Condition Protections

Rhode Island prohibits pre-existing condition exclusions:

Guaranteed Issue and Renewal

Rhode Island requires:

Guaranteed Issue

• Insurers must accept all applicants during open enrollment
• Cannot deny coverage based on health status
• Applies to individual and small group markets

Guaranteed Renewal

• Cannot cancel coverage except for non-payment or fraud
• Plan discontinuation requires advance notice