Medical Coverage (2014-2018) Overview The State of Rhode Island offers eligible active employees two medical plans—the Choice Plus Plan with HSA and the 2014 Active Plan. Both plans are administered by UnitedHealthcare (UHC). Coverage for participating employees is effective on the first day of state employment. Click on the tabs below to learn more about your medical coverage options. See Prescription Coverage if you want more information on the prescription coverage that accompanies your medical coverage. Alert! Classified and unclassified State employees: The Choice Plus Plan and the 2014 Plan are no longer available starting 2019. Visit the new Medical page to see your 2019 plan options. Coverage Details Coverage Information Which Medical Plans are Available to Me? You can enroll in either the Choice Plus Plan with HSA or the 2014 Active Plan. For a brief outline of the plans, see the respective Summary of Benefits and Coverage (SBC) below. For a complete descriptions regarding the terms of coverage, including exclusions and limitations, see the respective Summary Plan Description (SPD). Did You Know? Both plans offer identical health coverage; they only differ in the cost-sharing structure Both plans cover certain preventive care services at 100%. See the UHC Preventive Care Guidelines for a full list of qualifying services. (Certain preventive prescriptions and products are also covered at 100%; see Prescription Coverage for more information.) Choice Plus Plan with HSA Lower premium Higher deductible/out-of-pocket maximum (OOPM) Eligible to open a Health Savings Account (HSA), where you can save and invest money through retirement on a tax-free basis to pay for qualified medical expenses Receive State contributions—$1,500/$3,000 for individual/family coverage*—and make pre-tax payroll contributions when you are enrolled in an HSA Prescriptions: Except for qualifying preventive drugs, you pay the full price of medications until you reach the annual deductible, after which you only pay the co-pays until you reach the OOPM. For qualifying preventive drugs, you pay only the co-pay even if you have not yet met your deductible. Summary of Benefits for Choice Plus Plan PDF file, about 2mbmegabytes Choice Plus Plan Summary Plan Description PDF file, about 2mbmegabytes 2014 Active Plan Higher premium Lower deductible/out-of-pocket maximum (OOPM) Not eligible to open an HSA, which causes you to miss out on an opportunity to receive State contributions towards your health savings and to save for medical expenses for the long run Prescriptions: You pay co-pays for your medications regardless of whether you have reached the annual medical deductible. There is no deductible for prescriptions, but your co-pays apply to a separate prescription OOPM. 2014 Active Plan Summary of Benefits and Coverage PDF file, about 2mbmegabytes 2014 Active Plan Summary Plan Description PDF file, about 2mbmegabytes 2014 Active Plan FAQ PDF file, less than 1mbmegabytes *For the 2018 plan year. Contributions are made biannually with half deposited on January 1, 2018 and the other half deposited on July 1, 2018. The State's HSA contributions are not pro-rated for employees who enroll after those dates. Need Help Choosing Your Plan? Talk to ALEX®, the host of a unique online experience that will help you better understand your plan options and make the best choice for you and your family. Eligibility Any State employee that satisfies all of the following criteria is eligible to enroll: Holds a non-seasonal position Scheduled to work at least 20 hours per week Not on leave without pay (LWOP) The following dependents are also eligible for enrollment: Spouse Domestic partner Children (Up to the end of the month in which they reach age 26. At that time, COBRA continuation coverage will be offered.) Enrollment / Waiver Enrollment Periods Employees may enroll in medical coverage during one of the following periods*: Within 31 days of hiring or a qualifying status change Open enrollment (the month of November) * If you are enrolled in the Choice Plus Plan with HSA, you may make changes to your HSA contribution at anytime during the year. Enrollment Process Step 1: Required forms Complete and submit the following form(s) to the OEB: Choice Plus Plan with HSA Health Coverage Enrollment / Status Change form. Optum Bank HSA Application PDF file, less than 1mbmegabytes 2014 Active Plan Health Coverage Enrollment / Status Change form Step 2: Required supporting documentation Supporting documentation must also be submitted with the Health Coverage Enrollment/Status Change Form for the following circumstances: Spouses Dual state-employed spouses If two spouses are both state employees—i.e., an employee answers “Yes” in section 7 of the Health Coverage Enrollment/Status Change Form, they must also complete and attach the Dual State-Employed Spouses Declaration Form. Divorce Per statute, the State employee health plan cannot provide coverage to a non-state-employee former spouse. For all divorces occurring subsequent to December 31, 2013, employees must report the divorce as a status change on the Health Coverage Enrollment/Status Change Form; the non-state-employee former spouse will be dropped from coverage and offered COBRA. Domestic partnerships Employees must attach a completed copy of the Domestic Partnership Form with supporting evidentiary documentation in order to enroll a domestic partner in medical/prescription/dental/vision coverage. Note: The fair market value of the state’s contribution towards the cost of health coverage for a domestic partner is considered imputed income to the employee, and must be reported as taxable income on the employee’s bi-weekly paycheck unless the domestic partner qualifies as a dependent of the employee under the IRS rules and regulations for health plans. Click here to see an example of how to calculate imputed income. Children Employees must attach a copy of their child’s birth certificate to the Health Coverage Enrollment/Status Change Form in order to enroll a child for medical and prescription coverage. Medical Coverage Waiver You may waive the State medical and prescription coverage if you have other coverage. Waiver elections can only occur at the time of hire or during the annual open enrollment period unless a status change occurs during the year. If you had waived coverage and would like to continue to waive coverage for 2019, no further action is needed. To waive coverage for the first time, or if you still want to make dental/vision elections for 2019, please visit the Enrollment page and access OnlinEnroll to make your elections. 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. However, if your alternative coverage is government-subsidized, including Medicaid (e.g., Rite Share, Rite Care, and MassHealth) and coverage purchased through HealthSource RI, you are not eligible to receive this opt-out payment. 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. Premium Rates Classified and unclassified State employees: The Choice Plus Plan and the 2014 Plan are no longer available starting 2019. See below for your 2018 co-shares, or visit the new Medical page to see your 2019 plan options and co-shares. Employees working in higher education: Please refer to your college/university website (URI, RIC, CCRI) for your co-shares. Historical Rates 2018 Co-Share Rates For non-union employees and unions that ratified new CBAs (implemented June 29, 2018, effective January 1, 2018) Choice Plus Plan with HSA 2014 Plan For unions that did not ratify new CBAs Choice Plus Plan with HSA 2014 Plan For RITA and State Police Command Staff (effective July 13, 2018) Choice Plus Plan with HSA 2014 Plan Working Rates (full plan costs) Choice Plus Plan with HSA 2014 Plan 2017 Co-Share Rates Choice Plus Plan with HSA 2014 Plan Working Rates (full plan costs) Choice Plus Plan with HSA 2014 Plan Claims In-Network Claims To view your in-network claims history, please log in to your account at myuhc.com. Out-of-Network Claims To submit claims for out-of-network doctor visits, please fill out and submit the UHC Out-of-Network Claim Form to UHC. Contact Please contact UnitedHealthcare (UHC) if you have questions regarding your medical coverage: Create an account on myuhc.com to view and manage your UHC medical coverage Call Customer Service: 1-866-202-0434 (also found on the back of your UHC ID card) You can reach a Spanish interpreter via the initial prompt. To request an interpreter for another language, press 0. TTY 711.