Employers 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 is HealthSource RI for Employers?
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, Delta Dental, and Guardian. 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. You may also qualify for a tax credit to help pay for insurance.

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

What businesses are eligible to use HealthSource RI for Employers?
HealthSource RI for Employers is open to all Rhode Island-based small businesses. Businesses with 2-50 full-time equivalents are eligible if they meet three requirements:

  • 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
What is the timeline for renewing in HealthSource RI For Employers?
Employers and their brokers will receive a renewal notice about three months before their renewal date. Employers need to make any updates to their coverage and provide an updated Tax and Wage Report by 35 days before their coverage expires. Payment is due by the 23rd of the month for the following month.
Is there any cost to become a certified broker?
No, there is no cost to the broker. The training is free.
How do brokers get certified?
Brokers can register for the next Broker Certification Training on the events portion of our website. During the training, brokers will learn about nuances of the HealthSource RI SHOP program in addition to how to quote and enroll a client.
What are the requirements for a broker to be able to sell through HealthSource RI?
Brokers selling insurance through HealthSource RI must:

  • 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
Does using a broker add any cost to the process?
Absolutely not. If you do not have a broker, you can contact one of our insurance brokers by accessing our list of certified brokers; commissions are included in the rates in the small group market.
How can I find a plan, apply and enroll through HealthSource RI for Employers?
There are several ways to enroll:

  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.
What information is needed in the enrollment process?
When you apply for coverage, you’ll need to provide some information about yourself, each of your eligible employees, and their dependents. Save time by gathering this information beforehand. You will need information such as birthdates, social security numbers, addresses, and e-mail addresses.
When can a business enroll in HealthSource RI for Employers?
We encourage employers to complete their application by the 12th of the month before their coverage start date, and employees should complete their plan selections by the 17th.  By enrolling by the 12th, and paying by the due date of the 23rd, coverage for your employees will be in place for the 1st day of the following month.
How do I get a quote?
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 HSRISHOP@nfphealth.com (HSRISHOP@nfphealth.com)
How many bills are sent if an employer offers multiple carriers to its employees?
Even if your employees choose plans from multiple companies, or you offer both medical and dental plans, you will receive only one simple bill. We take care of paying the carriers.
How can HealthSource RI for Employers help me determine my healthcare budget and potentially save me money?
The healthcare premiums for coverage offered through HealthSource RI for Employers are competitive, and you may qualify for additional tax credits not available outside of HealthSource RI for Employers. This applies to both for-profit and non-profit groups. In addition, you can determine a contribution amount that works for you, while allowing your employees to choose the plans and pricing that work best for them.
How does the small business tax credit work?
Small business tax credits may be available to eligible small employers who purchase employee coverage through the HealthSource RI for Employers.

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.

What is a Health Savings Account?
Health Savings Accounts (HSAs) give U.S. taxpayers enrolled in HSA qualified high deductible health plans a unique way to save for certain healthcare costs. HSA funds are not subject to federal income taxes, so they are considered pre-tax. 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.
Healthcare benefits plans today feature High Deductible Health Plans (HDHP) /HSA programs – part of the Consumer-Directed Healthcare (CDH) trend in health benefits. Your employees share more responsibility for the cost of their health coverage. This allows potential savings opportunities and more choice for your employees.

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

What are some things employees should consider before they pick a plan?
Health insurance plans help employees get health services in different ways. Before they choose a plan, your employees should familiarize themselves with each plan’s 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 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.

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 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.

What kind of plan choices can I offer my 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.

We currently offer three Platinum plans, seven Gold plans, seven Silver plans and three 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.

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.

Some of my employees don’t live in RI – is that a problem?
It depends in part on the plan chosen. Encourage employees who don’t live in Rhode Island to check the provider directories for the plans they are interested in to make sure they include doctors, hospitals, and other health care providers in their home state. These employees should also review each plan’s payment policies regarding out-of-network care. They can find this information while enrolling through HealthSource RI or through the carrier they’ve chosen.
What happens if I don’t offer coverage to my employees?

If you have fewer than 50 full-time equivalent employees, you are not required to offer coverage and there is no penalty for not offering coverage. (Your employees can get health care coverage from Health Source RI’s individual marketplace if they choose to). However, Health Source RI’s SHOP can help you in finding an affordable solution so that you can offer health care coverage to your employees.

If you have 50 or more full-time equivalent employees, you might have to pay penalties each year if you don’t offer coverage to virtually all of your full-time employees, or if the coverage offered doesn’t meet certain minimum standards.

Is there a membership fee?

There are no membership fees associated with using HealthSource RI SHOP.

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.

I am an employer seeking a plan under a religious exemption. What are my options?

HealthSource RI is able to enroll you and your employees in a plan variation that excludes coverage for most abortions when such a plan or plans are offered by insurance carriers. To learn whether a plan variation is available during any given coverage year, please refer to our SHOP Plan Sheet and/or call our HealthSource RI SHOP Team if you are interested in learning more.

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

Employers & Employees: 1-855-683-6757