Medical Coverage (2019)

What's New in 2019

Keep the following things in mind as you choose among the Anchor, Anchor Plus and Anchor Choice with HSA plans:

1. All three plans cover the same medical services.
2. All three plans use the same UHC network.
3. All three plans require you to pay 10% of the cost (your coinsurance) for covered medical expenses when you visit a network provider, after you’ve met your deductible.
4. All three plans have a combined medical and prescription out of pocket maximum (OOPM)
5. New! All three plans require you to pick a Primary Care Physician (PCP) to coordinate your care.
   • See PCP Coordination of Care for key things you should know about the PCP designation and referral processes.
6. New! All three plans feature place of service tiering for imaging.
   • You are highly recommended to obtain major imaging services at a freestanding facility not affiliated with a hospital group.
     • Before you've met your deductible: Your out-of-pocket cost for imaging services is typically lower if you use a freestanding facility.
     • After you've met your deductible: Your cost for major imaging services is covered in full if you use a freestanding facility.
   • To find a free-standing facility, visit myuhc.com and choose a facility that is marked as "Freestanding Facility": 
7. New! All three plans will only cover services that are medically necessary.
   • In-network: Your PCP will coordinate medical necessity by obtaining prior authorization from UHC for certain services.
   • Out-of-network: You are responsible for coordinating medical necessity by obtaining prior authorization from UHC for certain services.

What Are the Differences?

The biggest difference in the three plans is when you pay for coverage. Do you pay more in premiums from your paycheck, or (potentially) more when you seek medical services? It’s important to do the math. There are a number of factors to consider, like your medical needs for the coming year (having a baby or an elective surgery?), your family situation, and your age.

Plan Comparison

Click on the chart below to see how Anchor, Anchor Plus and Anchor Choice compare across specific coverages.

Need Help Choosing Your Plan?

Visit the Decision Support page for tools such as ALEX^®, the State Employee Benefits Guide and benefits videos & presentations that can help you better understand your plan options and make the best choice for you and your family.

Any State employee that satisfies all of the following criteria is eligible to enroll:

• Holds a non-seasonal position
• Scheduled to work at least 20 hours per week
• Not on leave without pay (LWOP)

The following dependents are also eligible for enrollment:

• Spouse
• Domestic partner
  • If your domestic partner does not meet the definition of a dependent pursuant to Internal Revenue Code Section 152 (as modified by Section 105(b)), federal law requires that the fair market value of any State health coverage extended to your domestic partner must be imputed to you as income on your paycheck and must be reflected on the W-2 issued to you by the State of Rhode Island. For example, if you were a 26 pay-period employee covering your domestic partner under the State medical, dental and vision plans, your imputed income would be around $200 per pay period and be deducted from each paycheck.
  • If you get married, or if your domestic partnership ends, it is YOUR responsibility to inform the Office of Employee Benefits in writing immediately. Your failure to do so will prevent you from obtaining refunds of co-shares paid and/or imputed income tax withheld. The Office of Employee Benefits will not coordinate such refunds if it is not notified within 31 days of the date of the change.
• Children* (Up to the end of the month in which they reach age 26. At that time, COBRA continuation coverage will be offered.)

* Children of domestic partners are not eligible unless they are also the natural/adopted child of the employee, or the employee has legal guardianship.

Enrollment Periods

Employees may enroll in medical coverage during one of the following periods:

• Within 31 days of hiring or a qualifying status change
• Open enrollment

Enrollment Process

Step 1: Do your research!

• Review the detailed benefits information on the "Coverage Information" tab
• Talk to ALEX and watch informative benefits videos
• Read the 2019 State of Rhode Island Benefits Guide
• Review your coverage and expenses from 2018:
  • www.myuhc.com
  • www.caremark.com

Step 2: Enroll in medical, dental and/or vision coverage online

Visit the Enrollment page for details on how to access the online enrollment system.

Medical Coverage Waiver

You may waive the State medical and prescription coverage if you have other coverage. Waiver elections can only occur at the time of hire or during the annual open enrollment period unless a status change occurs during the year. If you waive medical coverage, you may elect to receive an opt-out payment if you are eligible to do so. You are ineligible to receive the opt-out payment if:

1. Your alternative coverage is state-subsidized under a Medicaid program (Rite Care, MassHealth, etc.);
2. Your alternative coverage was purchased through a health insurance marketplace under the Affordable Care Act (e.g., HealthSource RI); or
3. Both you and your spouse were hired by the State on or after June 29, 2014 and you are both covered under a State family plan (higher-earning spouse must pay the co-shares and the lower-earning spouse is ineligible to receive the medical waiver opt-out payment).

Medical opt-out payment credit accrues credit at the rate of $38.50 per biweekly pay period. Payments are made once each year, in late November/early December, up to a maximum payment of $1,001. The opt-out payment is taxed like normal wages.

See below for 2019 premium rates—i.e., your co-share.

A co-share is the amount you must pay each pay period for health insurance. Co-shares vary by individual vs. family coverage, as well as by annual salary and full-time/part-time status. Co-shares listed here are for classified and unclassified State employees only. Non-classified union & non-union employees working in higher ed should refer to their college/university website (URI, RIC, CCRI) for their co-shares.

In-Network Claims

To view your in-network claims history, please log in to your account at myuhc.com.

Out-of-Network Claims

To submit claims for out-of-network doctor visits, please fill out and submit the UHC Out-of-Network Claim Form to UHC.

Please contact UnitedHealthcare (UHC) if you have questions regarding your medical coverage:

• Create an account on myuhc.com to view and manage your UHC medical coverage
• Call Customer Service: 1-866-202-0434 (also found on the back of your UHC ID card)
  • You can reach a Spanish interpreter via the initial prompt. To request an interpreter for another language, press 0. TTY 711.

Please contact Optum Bank if you have questions regarding your health savings account (HSA):

• Call Customer Service: 866-234-8913
• Visit www.optumbank.com