The State of Rhode Island’s medical plan is administered by UnitedHealthcare (UHC). Coverage for eligible employees who elect to participate in the medical plan is effective on the first day of state employment. Medical elections and changes can only occur at the time of hire or during the annual open enrollment period unless a status change occurs during the year.
For a brief outline of the plan, see the 2015 Summary of Benefits and Coverage (SBC). SBC terms in bold blue type are defined in the Uniform Glossary of Coverage and Medical Terms. Complete descriptions regarding the terms of coverage, including exclusions and limitations, are provided in the Summary Plan Description.
To find a participating doctor or hospital or to check on the status of a claim, go to myuhc.com or call the toll-free customer service number on the back of your UHC ID card: 866-202-0434.
In-network providers will file your claims directly with UHC while out-of-network medical claims need to be submitted on the UHC Out-of-Network Claim Form.
The State of Rhode Island's pharmacy plan is administered by CVS Caremark. Prescriptions can be filled at any in-network pharmacy. For details regarding pharmacy coverage see the Summary of Coverage or contact CVS Caremark at www.caremark.com or call the customer service number: 1-800-307-5432. Complete descriptions regarding the terms of coverage, including exclusions and limitations, are provided in the Summary Plan Description.
To obtain a 3 month supply of a prescription drug for 2 co-payments, use the form provided for the CVS Caremark Mail Order Program.
To obtain reimbursement for out-of-network pharmacy claims, complete the CVS Caremark Rx Claim Form and submit as instructed on the form.
Employees may elect to waive the state medical and pharmacy coverage if they have other coverage by completing the Waiver of Coverage Form. Waiver elections and changes can only occur at the time of hire or during the annual open enrollment period unless a status change occurs during the year. The annual waiver checks issued in early December of each year will be pro-rated at an accrual rate of $38.50 per biweekly pay period, up to the $1,001 maximum per year.
Note: If two state employed spouses are hired into state service on or after June 29, 2014, and both are eligible for health insurance, the health co-share rates will be based on the income of the higher earning spouse and the other spuse will not receive any waiver payment.