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 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.
To obtain a 3 month supply of a prescription drug for 2 co-payments, use the forms provided in the Optum Mail Order Program.
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. To obtain reimbursement for out-of-network pharmacy claims, complete the Optum Rx Claim Form and submit as instructed on the form.
Employees may elect to waive the state medical 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.