§ 27-50-10 - Wellness health benefit plan.
SECTION 27-50-10
§ 27-50-10 Wellness health benefit plan.– (a) No provision contained in this chapter prohibits the sale of health benefitplans which differ from the wellness health benefit plans provided for in thissection.
(b) The wellness health benefit plan shall be determined byregulations promulgated by the office of health insurance commissioner (OHIC).The OHIC shall develop the criteria for the wellness health benefit plan,including, but not limited to, benefit levels, cost-sharing levels, exclusions,and limitations, in accordance with the following:
(1) The OHIC shall form an advisory committee to includerepresentatives of employers, health insurance brokers, local chambers ofcommerce, and consumers who pay directly for individual health insurancecoverage.
(ii) The advisory committee shall make recommendations to theOHIC concerning the following:
(A) The wellness health benefit plan requirements document.This document shall be disseminated to all Rhode Island small group andindividual market health plans for responses, and shall include, at a minimum,the benefit limitations and maximum cost sharing levels for the wellness healthbenefit plan. If the wellness health benefit product requirements document isnot created by November 1, 2006, it will be determined by regulationspromulgated by the OHIC.
(B) The wellness health benefit plan design. The health plansshall bring proposed wellness health plan designs to the advisory committee forreview on or before January 1, 2007. The advisory committee shall review theseproposed designs and provide recommendations to the health plans and thecommissioner regarding the final wellness plan design to be approved by thecommissioner in accordance with subsection 27-50-5(h)(4), and as specified inregulations promulgated by the commissioner on or before March 1, 2007.
(2) Set a target for the average annualized individualpremium rate for the wellness health benefit plan to be less than ten percent(10%) of the average annual statewide wage, as reported by the Rhode Islanddepartment of labor and training, in their report entitled "Quarterly Census ofRhode Island 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 premium rates.
(3) Ensure that the wellness health benefit plan createsappropriate incentives for employers, providers, health plans and consumers 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) To the extent possible, the health plans may be permittedto utilize existing products to meet the objectives of this section.
(5) The plan shall be made available in accordance with title27, chapter 50 as required by regulation on or before May 1, 2007.