§ 27-18.5-8 - Wellness health benefit plan.
SECTION 27-18.5-8
§ 27-18.5-8 Wellness health benefit plan.– All carriers that offer health insurance in the individual market shallactively market and offer the wellness health direct benefit plan to eligibleindividuals. The wellness health direct benefit plan shall be determined byregulation promulgated by the office of the health insurance commissioner(OHIC). The OHIC shall develop the criteria for the direct wellness healthbenefit plan, including, but not limited to, benefit levels, cost sharinglevels, exclusions and limitations in accordance with the following:
(1) Form and utilize an advisory committee in accordance withsubsection 27-50-10(5).
(2) Set a target for the average annualized individualpremium rate for the direct wellness health benefit plan to be less than tenpercent (10%) of the average annual statewide wage, dependent upon theavailability of reinsurance funds, as reported by the Rhode Island departmentof labor and training, in their report entitled "Quarterly Census of RhodeIsland Employment and Wages." In the event that this report is no longeravailable, or the OHIC determines that it is no longer appropriate for thedetermination of maximum annualized premium, an alternative method shall beadopted in regulation by the OHIC. The maximum annualized individual premiumrate shall be determined no later than August 1st of each year, to be appliedto the subsequent calendar year premiums rates.
(3) Ensure that the direct wellness health benefit plancreates appropriate incentives for employers, providers, health plans andconsumers to, among other things:
(i) Focus on primary care, prevention and wellness;
(ii) Actively manage the chronically ill population;
(iii) Use the least cost, most appropriate setting; and
(iv) Use evidence based, quality care.
(4) The plan shall be made available in accordance with title27, chapter 18.5 as required by regulation on or before May 1, 2007.