Small Business Tax Credit
Small businesses with up to 25 full-time employees may be eligible for a tax credit to help with the cost of providing health insurance to employees. To qualify, businesses must pay at least 50 percent of employees’ health insurance premiums and pay annual average wages that are below $50,000 per full-time employee. Learn more about tax credits for small employers.
Health plans that were effective on March 23, 2010 can be "grandfathered." (For Blue Cross, this only applies to self-insured plans.) Grandfathered status exempts these plans from certain—but not all—requirements of federal healthcare reform. A "grandfathered" plan would lose this special status if benefits are significantly reduced or members' costs are significantly increased.
Early Retiree Reinsurance Program
This program provides financial relief to employers so that they can maintain health coverage for retirees who are between the ages of 55 and 64. Funding is now exhausted for the program, and applications are no longer being accepted. On January 1, 2014, early retirees can seek coverage through HealthSource RI, Rhode Island’s health insurance marketplace.
Preventive Care Coverage Without Cost Sharing
Health plans now provide full coverage for many preventive services with no cost sharing (copays, coinsurance, or deductibles) when members visit in-network doctors. Preventive care is healthcare that is aimed at screening for and preventing disease, including:
Learn more about preventive care in this sheet.
Dependent Coverage to Age 26
Dependent coverage is coverage for children of the subscriber who are considered financially dependent. Plans must now cover children until they turn 26. They can be covered whether or not they:
Learn more about dependent coverage in this FAQ.
An insurer or a group plan may only rescind (retroactively cancel) coverage in cases of fraud or if facts were intentionally misrepresented. Insurers must provide 30 days notice if they are planning to rescind coverage.
Internal Appeals and External Reviews
Insurers and group health plans must have processes for customers to appeal coverage or claims determinations. The new law also establishes a consumer's right to appeal coverage decisions to an external review by an outside third party. Blue Cross already had appeals and complaints procedures in place and has brought them into compliance with these new regulations.
No Lifetime Limits
Health plans cannot have lifetime dollar limits on essential health benefits. A lifetime limit is a cap on the total lifetime benefits you may get from your health plan. After a lifetime limit is reached, the health plan will no longer pay for covered services.
No Pre-Existing Condition Exclusions for Children Under 19
All insurers and group health plans are now held to the same standard that Blue Cross has long followed: Coverage will not be denied to children under the age of 19 because of a pre-existing condition. Beginning in 2014, this provision applies to all Americans, regardless of age.
Temporary Pre-Existing Conditions Health Insurance Plan
A Pre-Existing Condition Insurance Plan provides coverage options to individuals who have been uninsured for at least six months and who have a pre-existing condition. The state of Rhode Island chose Blue Cross, the only health insurer in the state that offers guaranteed coverage regardless of health status or pre-existing conditions, to help extend medical coverage to some of the state’s most chronically ill citizens. This plan will end in 2014 when HealthSource RI goes into effect, and no one can be denied coverage due to a pre-existing condition.
All Emergency Services Treated as In Network
You can receive care at any emergency room—even one outside of your plan's network—and have the same cost sharing (copayments or coinsurance) as for in-network care.