Employers Frequently Asked Questions

HealthSource RI for Employers is Rhode Island’s full service health insurance marketplace for businesses with 2-50 employees. As one of the nation’s top performing small business exchanges, HealthSource RI for Employers offers multi-carrier medical and dental options from trusted partners at Blue Cross & Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island, Blue Cross Dental, and Delta Dental. We can also connect employers with ancillary products from Colonial Life and Principal.

Whichever plan you choose, your employees will get essential health benefits, including doctor visits, hospitalizations, maternity care, ER visits, and prescriptions. 

Our goal is to lower costs, promote health, and eliminate obstacles to getting health care coverage for employees of small businesses.

• is a Rhode Island based small employer or has a primary worksite in Rhode Island
• offers coverage to all full-time employees (generally those working 30 or more hours per week on average)
• has at least one employee enrolled in medical or dental coverage

You can call our Broker line at 1-855-683-6755 and connect with our Broker team to learn more. During the training, brokers will learn about nuances of the HealthSource RI SHOP program in addition to how to quote and enroll a client.

• Have a license to sell health insurance in the state of Rhode Island
• Complete a HealthSource RI Broker Certification Training Program
• Pass the examination at the Broker Certification Training Program
• Secure appointments from local health insurance carriers

1. You can apply online,
2. Or meet with an insurance broker face-to-face. You can get help from insurance brokers by accessing our list of certified brokers
3. You can also apply over the phone by contacting one of our Business Engagement Specialists at 1-855-683-6757 who will also meet with you face-to-face.
4. All enrollment help is free of charge.

Use our “Get a Quote” function on the home page, or,

• Contact one of our insurance brokers by accessing our Certified Broker listing on our home page, or,
• Call HealthSource RI for Employers at 1-855-683-6757, or,
• Email us at Employers@HealthSourceRI.com 

Generally, you must have fewer than 25 Full Time Equivalents (FTEs) with an average annual wage of less than $50,000 (indexed annually) to qualify. You must pay a minimum of 50% of the premium cost of single coverage for all employees (uniformity rules apply). The credit is determined on a sliding scale based on the number of FTEs and average annual wages.

For more details, please talk to your broker or call a member of our Business Engagement Team at 1-855-683-6757.

Health Savings Accounts (HSA) are owned by your employees. Employees contribute pre-tax funds (up to an allowable limit for that calendar year) for out-of-pocket medical expenses incurred before the HDHP deductible is reached and balances grow tax-free. The money must be spent on IRS-qualified medical expenses or the money will be taxable.

How it works

1. Enroll in a qualified high deductible health insurance plan (HDHP) eligible for a Health Savings Account (HSA). HealthSource RI SHOP offers a variety of these HDHP plans, they are designated with a checkmark on our plan summaries and online.
2. Open and activate an HSA with an IRS-qualified trustee (this is usually your financial institution). Be sure to find out if your trustee has a minimum balance requirement.
3. Either you or your employees will make contributions to the HSA as needed—without exceeding annual contribution limits (these change each year, so consult the IRS website for the current year). You can also invest your HSA funds in financial opportunities offered through your trustee.
4. Use your trustee’s preferred payment method—such as a debit card and/or checks—to pay for qualified medical expenses.
5. Save all your receipts and complete the necessary tax forms to claim your deductions (IRS Form 8889).

Want to know more? Check out our Health Savings Accounts FAQs

If seeing a particular doctor (Primary Care Physician, or PCP) is important to your employees, they should make sure that doctor belongs to their plan’s provider network.

Keep in mind that some health plans charge your employees less if their primary care physician belongs to a Patient Centered Medical Home. Also be aware that some types of health insurance plans require a referral before patients can see a specialist.

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity care
• Newborn care
• Mental health and substance use treatment services (including counseling and psychotherapy)
• Prescription drugs
• Rehabilitative (to gain a lost ability) and habilitative (to gain a new ability) services and devices
• Laboratory services
• Preventive and wellness services
• Chronic disease management
• Pediatric services

When choosing a plan, it’s critical to keep in mind what—if any—specialized services you and/or your employees family members use and what—if any—health conditions their family members have that require frequent doctor, specialist, or pharmacy visits.

Is vision care covered?

HealthSource RI SHOP plans do not currently offer full vision coverage for adults, but do cover yearly medical exams. They also cover vision coverage and eyeglasses for children of your employees. However, we can now connect you to low-cost ancillary benefits like vision, life, accident and medical bridge.

For more details, please talk to your broker or call us to talk to one of our team members at 1-855-683-6757.

Are oral and dental care covered?

Yes. You can purchase separate dental insurance plans through HealthSource RI. You can offer separate dental insurance, but are not required to contribute.

Is preventative care free? What counts as preventative care?

No matter which plan you choose, there are certain medical services you can receive for free, including:

• Blood pressure screening
• Breast cancer screening and mammography
• Cervical cancer screening (pap test)
• Cholesterol screening
• Colorectal cancer screening
• Depression screening
• Obesity screening and counseling
• Adult immunizations (such as flu shots, Hepatitis A and B, and pneumonia vaccines)

Take a moment to review a complete list of free medical services.

There are four basic categories of coverage offered through Health Source RI SHOP – Platinum, Gold, Silver and Bronze – Under the ACA, all plans are offered in these four basic options called metal levels. These categories describe whether employees pay more for health insurance every month or more when they receive medical services.

We currently offer Platinum, Gold, Silver, and Bronze plans.

Platinum plans require the highest monthly premium but allow employees to spend less on co-payments, co-insurance, and deductibles if they get sick or need a particular healthcare service. If an employee or someone in their family has a chronic health condition and requires many healthcare services, a Platinum plan may be the best choice.

Gold plans have smaller monthly premiums, but require employees to spend a little more in co-payments or co-insurance than they might with a Platinum plan. Employees will also pay a higher deductible with a Gold plan than with a Platinum plan. If an employee needs surgery or gets sick and doesn’t want to pay the higher monthly premiums of a Platinum plan, a Gold plan may be the best choice.

Silver plans have lower monthly premiums than Gold plans, but require employees to spend more money when they visit the doctor than either a Gold or Platinum plan. If an employee is healthy and doesn’t expect to see a doctor or specialist very often—or if he or she doesn’t take many prescription medications—a Silver plan may be the best choice.

Bronze plans offer the least expensive monthly premium, but require employees to spend more money for healthcare services before their insurance will start paying the bill. If an employee is generally very healthy and can set money aside to pay for a large medical expense, a Bronze plan may be the best choice.

Additionally, we can now connect you to low-cost ancillary benefits like vision, life, accident and medical bridge.

For more details, please talk to your broker or call us to talk to one of our team members at 1-855-683-6757.

HealthSource RI currently offers your employees plans for individuals and their families from two insurance providers: Blue Cross & Blue Shield of Rhode Island, and Neighborhood Health Plan of Rhode Island. Dental plans are also available from Blue Cross & Blue Shield of Rhode Island, and Delta Dental.

We can help you find the coverage that’s most similar to what you already have—or help you find a plan that better meets your needs and budget.

We can also connect employers with ancillary products from Colonial Life and Principal.