Form Review

For the individual and small group market plans, OHIC reviews benefit coverage documents that includes certificate of coverage and schedule of benefits. These documents include information about what the plan covers, the networks offered, and member cost sharing structure (including co-pays, coinsurance and deductibles). OHIC reviews these documents to ensure compliance with state and federal laws.

Rhode Island's Essential Health Benefits Benchmark Plan for plan year 2020 and beyond

Beginning in 2014, the federal Affordable Care Act required health plans sold in the individual and small group markets to offer a comprehensive package of items and services, known as “essential health benefits.” According to federal regulations, Rhode Island chose Blue Cross Blue Shield’s Small Group Vantage Blue plan sold in 2012 as RI’s benchmark plan for use in the 2014-2016 plan years. For plan years 2017-2019, the Office of the Health Insurance Commissioner retained the existing plan but the one sold in plan year 2014.

For plan year 2020 and beyond, the Office of the Health Insurance Commissioner, upon review and in collaboration with CMS/CCIIO, has decided to retain RI’s existing EHB Benchmark Plan which is Blue Cross Blue Shield of RI’s 2014 Small Group Vantage Blue.

The document listed below exhibits the Benchmark Plan selection of the State of Rhode Island for Essential Health Benefits purposes. Please note: Language clarifying the inclusion of Methadone coverage was added after the original 2014 EHB plan selection. This clarification intended to affirm continued compliance with federal parity obligations and allay consumer concerns regarding the appearance of non-compliance in the original benchmark plan documents.


MetLife Federal Dental Plan