RI.gov R.I. Government Agencies | Privacy Policy |

Medical/Pharmacy Coverage

Medical

The State of Rhode Island’s medical plans are 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. The Health Coverage Enrollment/Status Change Form must be completed for enrollments, elections and status changes.

The State of Rhode Island offers 2 medical plans:

Choice Plus Plan with a Health Savings Account (HSA) - Available to all eligible employees except members of the Rhode Island Brotherhood of Correctional Officers. The HSA Optum Bank Application must be completed in order to open a health savings account. If you want to contribute to your Health Savings Account, you must complete an HSA Employee Payroll Deduction Authorization Form. You may start, change or stop payroll deductions for contributions to your HSA anytime during the year. Click below for more information regarding the "HSA Plan".

2014 Active Plan - Available to all eligible employees.

For a brief outline of the plans, see the Summary of Benefits and Coverage (SBC) listed below. 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 (SPD) listed below.

2014 Active Plan Summary of Benefits and Coverage (SBC)

2014 Active Summary Plan Description (SPD)

Choice Plus Plan with a Health Savings Account (HSA) Summary of Benefits and Coverage (SBC)

Choice Plus Plan with a Health Savings Account (HSA) Summary Plan Description (SPD)

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 or contact the UHC Local Service Team at (401) 732-7249 or Ri_serviceteam@uhc.com.

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.  

Pharmacy

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.

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. Additionally, please note that the Mandatory Maintenance Choice (w/opt-out) program begins January 1, 2017. Please see the Summary of Coverage for program details.

To obtain reimbursement for out-of-network pharmacy claims, complete the CVS Caremark Rx Claim Form and submit as instructed on the form.

Medical/Pharmacy Waiver

Employees may elect to waive the state medical and pharmacy coverage if they have other coverage by completing the Waiver of Medical/Pharmacy 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 spouse will not receive any waiver payment. Completion of the Dual State-Employed Spouses Declaration Form will be required of any state employee applying for the waiver if their spouse is also a state employee.