Learn the Basics | HealthSource RI
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Learn the insurance basics

Get the facts. Know the terms. Enjoy the benefits.

There’s plenty to learn about us, and plenty more to learn about healthcare.

Check out our FAQs for some simple answers to your questions. Use our glossary to find definitions of common health insurance words.

Whether you’re seeking a health insurance plan for you or your whole family, it’s important to consider more than just the amount of your monthly premiums. Be sure to also consider the following:

How you get your healthcare

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 or she belongs to your plan’s provider network.

Keep in mind that some health plans charge you less if your PCP belongs to a Patient Centered Medical Home. Also be aware that some types of health insurance plans require a referral from your PCP before you can see a specialist.

Healthcare services

All health plans must cover the same basic set of healthcare services. These include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity care
  • Newborn care
  • Mental health and substance use treatment services (including counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative 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.

Preventive services & screenings

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)

Please refer to our Glossary to learn about important health insurance terms.

Other Programs

The following organizations may be able to provide you or your family with financial assistance for health insurance and healthcare services.

Rhode Island Department of Human Services

The Department of Human Services offers a wide range of programs, services, and benefits to Rhode Islanders. Economic Supports include the Supplemental Nutrition Assistance Program (SNAP); Medicaid eligibility; RIWorks; the Child-Care Assistance Program (CCAP); Long-Term Care; the Low Income Home Energy Assistance Program (LIHEAP) and Weatherization Assistance Program (WAP); General Public Assistance; and Federal Community and Social Services Block Grants. The Office of Child Support Services establishes paternity, locates parents, and creates, changes, and enforces child support orders. The Office of Rehabilitation Services manages vocational rehabilitation, disability determination, and services for the blind and visually impaired.

The Division of Elderly Affairs administers nutrition, information, home care, and protective services for elders. The Division of Veterans Affairs helps veterans through the RI Veterans Home, Veterans Services, and the RI Veterans Cemetery.

The Department of Human Services (DHS) offers resources and creates opportunities for families, adults, children, elders, individuals with disabilities, and veterans. People can get information and access services by visiting a DHS field office or the DHS website.

Visit www.dhs.ri.gov for more info.

The Executive Office of Health and Human Services

Under state law, the Executive Office of Health and Human Services (EOHHS) serves as “the principal agency of the executive branch of state government” responsible for managing the departments of: Health (DOH); Human Services (DHS); Children, Youth and Families (DCYF); and Behavioral Healthcare, Developmental Disabilities and Hospitals (DBDDH).

The EOHHS is designated by state law as the Medicaid single state agency and, in this capacity, administers the State’s major publicly funded healthcare program. RI Medicaid, as the program is known, provides health coverage to low income uninsured adults, families with children, and elders and persons with disabilities and special needs that otherwise might not be able to afford or obtain the services and support they need to lead healthy, safe and independent lives.

Visit www.eohhs.ri.gov for more info.

HealthSource RI connects you with health and dental insurance from these companies:
Blue Cross Dental