Medical Coverage


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Information below pertains to 2020 coverage options. If you are looking for plan information for 2019, please click here.

Overview

The State of Rhode Island offers eligible active employees three medical plans – Anchor, Anchor Plus and Anchor Choice with HSA. All plans are administered by Blue Cross & Blue Shield of Rhode Island (BCBSRI). Coverage for participating employees is effective on the first day of state employment.

Watch the video and 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.


Coverage Details

Key Plan Features for 2020

Keep in mind the following whether you are enrolled in the Anchor Plan, the Anchor Plus Plan, or the Anchor Choice Plan with HSA:

  1. All three plans cover the same medical services.
  2. All three plans use the same BCBSRI network locally as well as the national Blue Cross and Blue Shield Association network.
  3. All three plans require you to pay 10% of the cost (your coinsurance) for covered medical expenses when you visit a network provider, after you’ve met your deductible.
  4. All three plans have a combined medical and prescription out of pocket maximum (OOPM)
  5. All three plans require you to pick a Primary Care Provider (PCP) to coordinate your care.
    • See the PCP Coordination of Care flyer for key things you should know about the PCP designation and referral processes.
  6. All three plans allows you to save big when you obtain major imaging services at a freestanding facility not affiliated with a hospital group.
    • Before you've met your deductible: Your out-of-pocket cost for imaging services can be much lower if you use a freestanding facility.
    • After you've met your deductible: Your cost for major imaging services is covered in full if you use a freestanding facility.
    • See the Freestanding Facility flyer for more information on how this plan feature work as well as a list of locations around Rhode Island. You can also check and compare imaging costs compare by logging in to bcbsri.com and clicking on “My Cost Calculator.”
  7. All three plans will require prior authorization for select services to ensure they are medically necessary.
    • For medically necessary in-network services, your PCP will need to obtain prior authorization from BCBSRI.
    • For medically necessary out-of-network services, YOU will need to obtain prior authorization from BCBSRI.
    • See the Medical Necessity flyer for more information on how this plan feature works as well as lists of in-network and out-of-network services that require prior authorization.
How Are the Plans Different?

The biggest difference in the three plans is when you pay for coverage. Do you pay more in premiums (co-shares) from your paycheck, or (potentially) more when you seek medical services? It’s important to do the math. There are a number of factors to consider, like your medical needs for the plan year (having a baby or an elective surgery?), your family situation, and your age.


Plan Comparison

Click on the chart below to see how Anchor, Anchor Plus and Anchor Choice compare across specific coverages.

2020 medical and prescription plans comparison
Plan Documents
Document What It Is
Summary of Benefits and Coverage A brief plan outline Anchor
Anchor Plus
Anchor Choice with HSA
Summary Plan Description
("Benefits Booklet")
A comprehensive description regarding the terms of coverage, including exclusions and limitations Coming soon
Coordination of Benefits A brief overview of how plan coverage works when someone has dual coverage. BCBSRI Coordination of Benefits

Need Help Choosing Your Plan?

Visit the Decision Support page for tools such as ALEX®, the State Employee Benefits Guide and benefits videos & presentations that can help you better understand your plan options and make the best choice for you and your family.

Talk to ALEX

Any State employee that satisfies all of the following criteria is eligible to enroll:

The following dependents are also eligible for enrollment:

  • Spouse
  • Domestic partner
    • Imputed Income
      Pursuant to federal guidance, under the State employee health plan the fair market value of any health coverage extended to a domestic partner will be imputed to you as income on your paycheck. This imputed income would be added to the your federal taxable gross wages, State taxable gross wages and social security taxable wages. Additionally, any coverage provided to a domestic partner is paid for on an after-tax basis. You will have additional tax withholdings based on the imputed income and the increased taxable wages due to the reduction in pre-tax contribution. The amount of imputed income is generally around $200 per pay period for medical/prescription, dental and vision coverage, and the amount of the reduction in pre-tax contribution is generally around $100 for the same coverage. This means that you will have additional tax withholdings based on approximately $300 per pay period. Generally, the additional tax withholdings will be in the same proportion as your normal tax withholdings are to your regular pay.
    • Marriage
      If you and your domestic partner get married, it is YOUR responsibility to inform the Office of Employee Benefits in writing immediately. Your failure to do so will prevent you from obtaining refunds of additional tax withholdings based on imputed income. The Office of Employee Benefits will not coordinate such refunds if it is not notified within 31 days of the date of the marriage.
    • Termination of domestic partnership
      If your domestic partnership ends, you will not be able to drop your domestic partner from your coverage until open enrollment (for effect January 1 of the following year) unless your domestic partner experiences a qualifying status change.
    • Addition of new domestic partner
      If you drop your domestic partner, you will not be able to add a new domestic partner for at least 6 months, assuming your new domestic partner meets all eligibility requirements.
  • Children* (Up to the end of the month in which they reach age 26. At that time, COBRA continuation coverage will be offered.)

* Children of domestic partners are not eligible unless they are also the natural/adopted child of the employee, or the employee has legal guardianship.

Enrollment Periods

Employees may enroll in medical coverage during one of the following periods:


Enrollment Process

Step 1: Do your research!

Step 2: Enroll in medical, dental and/or vision coverage online
Visit the Enrollment page for details on how to access the online enrollment system.


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 waive medical coverage, you may elect to receive an opt-out payment if you are eligible to do so. You are ineligible to receive the opt-out payment if:

  1. Your alternative coverage is state-subsidized under a Medicaid program (Rite Care, MassHealth, etc.);
  2. Your alternative coverage was purchased through a health insurance marketplace under the Affordable Care Act (e.g., HealthSource RI); or
  3. Both you and your spouse were hired by the State on or after June 29, 2014 and you are both covered under a State family plan (higher-earning spouse must pay the co-shares and the lower-earning spouse is ineligible to receive the medical waiver opt-out payment).

Medical opt-out payment credit accrues credit at the rate of $38.50 per biweekly pay period. Payments are made once each year, in late November/early December, up to a maximum payment of $1,001. The opt-out payment is taxed like normal wages.

See below for 2020 premium rates—i.e., your co-share.

A co-share is the amount you must pay each pay period for health insurance. Co-shares vary by individual vs. family coverage, as well as by annual salary and full-time/part-time status. Co-shares listed here are for classified and unclassified State employees only. Non-classified union & non-union employees working in higher ed should refer to their college/university website (URI, RIC, CCRI) for their co-shares.


Bi-weekly Co-share Rates

Effective 1/1/2020

› 26 Pay Period Classified & Unclassified Employees
Full-time employees
Individual Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $102,840 20% $55.27 $59.14 $54.87
$102,840 and above 25% $69.09 $73.92 $68.59
Family Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $53,498 15% $116.21 $124.34 $115.37
$53,498 to less than $102,840 20% $154.95 $165.78 $153.83
$102,840 and above 25% $193.68 $207.23 $192.29

Part-time employees***
Individual Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $96,937 20% $55.27 $59.14 $54.87
$96,937 and above 35% $96.72 $103.49 $96.02
Family Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $96,937 20% $154.95 $165.78 $153.83
$96,937 and above 35% $271.16 $290.12 $269.20

* Does not include overtime or other non-salary wages.
** Percent of health plan working rates.
*** If your scheduled work hours are fewer than the full hours specified for your position, you will be classified as a part-time employee. Your co-share amount is determined according to the full-time annual salary for your job specification, not your part-time wages actually earned.

› 20 Pay Period Employees
Full-time employees
Individual Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $102,840 20% $71.85 $76.88 $71.33
$102,840 and above 25% $89.81 $96.09 $89.16
Family Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $53,498 15% $151.07 $161.64 $149.98
$53,498 to less than $102,840 20% $201.43 $215.52 $199.98
$102,840 and above 25% $251.79 $269.40 $249.97

Part-time employees***
Individual Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $96,937 20% $71.85 $76.88 $71.33
$96,937 and above 35% $125.74 $134.53 $124.83
Family Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $96,937 20% $201.43 $215.52 $199.98
$96,937 and above 35% $352.50 $377.16 $349.96

* Does not include overtime or other non-salary wages.
** Percent of health plan working rates.
*** If your scheduled work hours are fewer than the full hours specified for your position, you will be classified as a part-time employee. Your co-share amount is determined according to the full-time annual salary for your job specification, not your part-time wages actually earned.

› RITA & State Police Command Staff
Full-time employees
Individual Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $104,383 20% $55.27 $59.14 $54.87
$104,383 and above 25% $69.09 $73.92 $68.59
Family Coverage
Annual Salary* Percentage** Anchor Anchor Plus Anchor Choice
Less than $54,301 15% $116.21 $124.34 $115.37
$54,301 to less than $104,383 20% $154.95 $165.78 $153.83
$104,383 and above 25% $193.68 $207.23 $192.29

* Does not include overtime or other non-salary wages. Salary band increases pursuant to RITA agreement are effective 6/21/20.
** Percent of health plan working rates.



Printable Rate Tables—2020 Calendar Year

Co-Share Rates
Working Rates (full plan costs)

Historical Rates

› 2019

Co-Share Rates

Working Rates (full plan costs)

› 2018

Co-Share Rates

Working Rates (full plan costs)

› 2017

Co-Share Rates

Working Rates (full plan costs)

In-Network Claims

To view your in-network claims history, please log in to your account at bcbsri.com.

Out-of-Network Claims

Please ask the non-network provider who treated you for an itemized statement (including diagnosis and procedures) and a receipt. The receipt should include the following information:

  • Diagnosis code/description
  • Health service code/CPT code/description of service or item
  • Charge for each service
  • Patient ID number
  • Patient name
  • Provider name
  • Provider address
  • The provider’s letterhead/logo
  • Provider tax ID number
  • Specific date(s) of service

Submit clear black-and-white copies of these items to BCBSRI with a letter explaining your request. Be sure your letter includes your name, address, and member ID number.

Send your copies and letter to:
Blue Cross & Blue Shield of Rhode Island
Attn: CARE Team Claims Department
500 Exchange Street Providence, RI 02903

ID Card
  • Each person enrolled will have their own BCBSRI ID card.
  • The BCBSRI group policy number is 01002826.
  • If you have a designated PCP, their name will be listed on your ID card. Otherwise, “PCP Required” will be shown on your card. If you need to designate or change your PCP, please call the BCBSRI State of Rhode Island Employee CARE Center at (401) 429-2104 or 1-866-987-3705. CARE Center hours are Monday–Friday, 8am–8pm and Saturday, 8am–12pm.
  • For all other assistance with your BCBSRI ID card, please call the BCBSRI CARE Center.

Please contact Blue Cross & Blue Shield of Rhode Island (BCBSRI) or access their suite of helpful resources if you have questions regarding your medical coverage or your health savings account (HSA):

  • Call the State of Rhode Island Employee CARE Center:
    • (401) 429-2104 or 1-866-987-3705
    • CARE Center hours are Monday–Friday, 8am–8pm and Saturday, 8am–12pm.
  • Access your account on bcbsri.com to view and manage your BCBSRI medical coverage.
  • Download the Your Blue Touch RI mobile app for 24/7 info at your fingertips.
  • Sign up for your Blue Wire mobile messaging service, where you can count on important reminders about your health benefits.
  • Visit your Blue StoreSM in East Providence, Lincoln and Warwick. Learn more at bcbsri.com/yourbluestore.
  • Stop by the BCBSRI mobile service unit at certain State locations to get information and speak with representatives. Check back here in early 2020 for when the mobile service unit will be visiting a State location near you.