Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Rhode Island: Making Affordable, Quality-Focused Health Coverage Available to Small Businesses

In the spring of 2006, Rhode Island's Legislature passed a bill requiring health plans that offered small group and individual market products to develop a "wellness health benefit plan" that would be available to employers with up to 50 employees as well as individuals. The law prescribed a limit to the premium, incorporation of "affordability principles," and the formation of a stakeholder group—The WellCare Advisory Group—to provide the insurers with plan requirements. Plans were directed that the average premium could not be greater than 10 percent of the average state wage, or $314 for individual plans.

The two main insurers in the state—Blue Cross Blue Shield of Rhode Island and United Healthcare of New England—had until January 12, 2007, to design a product that would create incentives for the following "affordability principles": an emphasis on primary care, prevention, and wellness; use of the most cost-effective setting for care; use of evidence-based medicine; and active management of the chronically ill. The state's goal in requiring these products is to improve quality of care, increase access to coverage among individuals and employees who may not have access to affordable products, and reduce the rate of premium cost increases through the implementation of wellness initiatives, chronic care management, and qualified provider networks. These initiatives include the selection of a primary care provider and the completion of a health risk appraisal. The plans will include the following consumer-focused strategies:

  1. remain at a healthy weight or participate in weight management program if necessary;
  2. remain smoke-free or participate in smoking cessation programs; and
  3. participate in disease and case management programs if applicable.

Speaking about the new program, Health Insurance Commissioner Christopher F. Koller said "the wellness health benefit plan is intended as an affordable commercial option for those most in danger of dropping coverage in Rhode Island—small businesses and Direct Pay subscribers. The [WellCare Advisory Committee] should be commended for trying to tackle the issue of comprehensive, affordable coverage. Health is often not a matter of personal choice, but how you choose to address it is—and that has real cost consequences for everyone."

Enrollees who participate in the wellness program will be rewarded with reduced deductibles, copayments, and coinsurance. The plans will also incorporate tiered networks for providers, with enrollees facing lower cost-sharing when they choose providers who demonstrate cost-effective, high-quality practices.

The plans, which the state expects to be open for enrollment on May 1, 2007, will be reviewed by the state's WellCare Advisory Committee (WCAC)—a group of small employers, Direct Pay (individual market) subscribers, employer organizations, health insurance brokers, consumer advocates, and labor unions. WCAC developed the plan requirements, and is pushing for a solution to increasing health care costs involving a shared commitment among providers, plans, payers, and consumers.

For More Information
Contact: Matthew Stark, Principal Policy Associate, Rhode Island Office of the Health Insurance Commissioner, [email protected], (401) 222-5424

Publication Details