Employees Frequently Asked Questions

Get the answers you need.

There’s plenty to know about us, and plenty more to know about healthcare. Check below for some simple answers to common questions. Don’t see your question here? Just contact one of our experts for more information.

What are some things I should consider before I pick a plan?
Health insurance plans help you get health services in different ways. Before you choose a plan, familiarize yourself with its provider network and the rules it has for picking a doctor. Provider networks include PPOs (Preferred Provider Organizations), HMOs (Health Maintenance Organizations) and tiered networks.

If seeing a particular doctor (Primary Care Physician, or PCP) is important to you, make sure he/she belongs to your plan’s provider network.
Keep in mind that some health plans charge you less if your primary care physician belongs to a Patient Centered Medical Home. Also be aware that some types of health insurance plans require a referral before you can see a specialist.

What if I have a disabled adult child over the age of 26?
If you have a dependent that would normally age off your coverage once they reach the age of 26, HealthSource RI will require the Disability Certification letter written by their doctor to prevent a termination. Please do not hesitate to contact HealthSource RI or your broker if you need further assistance.
How long can my children stay on my coverage?
Under the Affordable Care Act, adult children can stay on your coverage until they reach the age of 26. You and your employer will receive notification prior to their 26th birthday to allow time for you and your adult child to review available options.
What information is needed in the enrollment process?

You will need to provide the following information:

  • Legal name including spouse and/or any dependents that needs to be covered
  • Date of birth including spouse and/or any dependents that needs to be covered
  • Social Security # (for employee only)
  • Email address (for employee only)
  • Home address

After you have been added to the group, you will receive an auto-generated email from HealthSource RI (healthsourceri.com) with a username and password which will allow you to log into your employee account. Once you are logged into your employee account, you will have the ability to shop the different plans available. Please refer to the Plans & Benefits summary for your review.

When do I enroll in HealthSource RI for Employers?
You will enroll during your employer’s annual renewal or open enrollment period (this information will be provided to you).
Will I pay more through HealthSource RI?
The health care coverage premiums for coverage offered through HealthSource RI SHOP are competitive and priced the same as they are outside the Health Benefits Exchange (HealthSource RI).

  • Call our HealthSource RI SHOP Department at 855-683-6757, or,
  • Email us at HSRI_BETeam@connextions.com (HSRI_BETeam@connextions.com)
What is a Health Savings Account?
Health Savings Accounts (HSAs) give U.S. taxpayers enrolled in many high deductible health plans a unique way to save for certain healthcare costs. HSA funds are not subject to federal income taxes. You can use them to pay for qualified medical expenses at any time—without incurring federal tax liabilities or penalties. You can also invest them to earn interest on your balance. Any unused funds will accumulate year to year.

How it works

  1. Enroll in a qualified high deductible health insurance plan eligible for a Health Savings Account (HSA).
  2. Open and activate an HSA with an IRS-qualified trustee. Be sure to find out if your trustee has a minimum balance requirement.
  3. Make contributions to your HSA as you see fit—without exceeding your annual contribution limit. 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

What will my health insurance cover through HealthSource RI for Employers?
All health plans must cover the same basic set of healthcare services which include the following:

  • 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 or your family members use and what—if any—health conditions you or your family members have that require frequent doctor, specialist, or pharmacy visits.

Is vision care covered?

HealthSource RI for Employers 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.

 

Are oral and dental care covered?

Yes. Your employer can purchase separate dental insurance plans through HealthSource RI.
Do I get preventative care for 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.

What kind of plan choices are offered to employees?
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.

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.

Which health insurance companies offer small business coverage through HealthSource RI for Employers?
HealthSource RI currently offers your employees plans for individuals and their families from three 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, Delta Dental, and Guardian.

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.

I don’t live in RI – is that a problem?
It depends in part on the plan chosen. If you don’t live in Rhode Island, check the provider directories for the plans you are interested in to make sure they include doctors, hospitals, and other health care providers in your home state. You should also review each plan’s payment policies regarding out-of-network care. You can find this information while enrolling through HealthSource RI or through the carrier you’ve chosen.
Sole Proprietor: Can a husband and wife (only) business or sole proprietor be considered eligible?
In 2016, businesses of one will no longer qualify to purchase employer health insurance.

If you are a company without enrolled employees (other than yourself, a spouse, or other owner) you will have to purchase health insurance through the individual marketplace.

Please call 1-855-840-4774 for more information or to enroll.

What should a terminated employee do – elect COBRA or enroll in HealthSource RI for individuals and families?
Terminated employees should consider HealthSource RI for individuals and families as they may be eligible for an advanced premium tax credit (APTC) to help pay for the cost of coverage (Medicaid may also be another option).  For terminated employees who are unsure when another job and income may be available, the subsidized cost of care might be particularly helpful.  The terminated employee should always compare the available options under both COBRA and HealthSource RI for individuals and families.

For more information, see our COBRA fact sheets for employers and employees.

HealthSource RI for Employers connects you with health and dental insurance from these companies:

Employers & Employees: 1-855-683-6757