Rhode Island's group health questions focus on several state laws:

• Extended medical benefits for laid-off employees (27-19.1-1).
• Continued coverage for a former spouse after divorce (27-20.4).
• Preexisting-condition credit when a group plan is replaced.
• The coordination of benefits birthday rule.
• Small employer rating.
• Stop-loss limits.

Federal COBRA, HIPAA, ERISA and general group mechanics are in the national Group Health Insurance guide.

Extended medical benefits (27-19.1-1)

• An employee who loses group coverage because of an involuntary layoff may continue it for up to 18 months, but no longer than the period of continuous employment, or until eligible under another group plan.
• The employee elects within 30 days after qualifying.
• Who gets paid: members leaving groups of 50 or fewer pay the carrier or the plan's agent or producer. Members of larger groups pay the employer, unless the workplace has closed.
• When it ends: the member and dependents may use any conversion option in the plan.
• Posting: employers with group plans must post a conspicuous notice of continuation options.

Former spouses (chapter 27-20.4)

• If the divorce judgment so orders, a former spouse stays on the member's family plan until either party remarries or the time set in the judgment ends (27-20.4-1).
• A former spouse who loses coverage because of a remarriage may buy an individual policy from the same plan without evidence of insurability within 30 days (27-20.4-2).

Replacing a group contract (27-20.4-4)

• When an employer's whole group contract is replaced, a person covered under the old contract for fewer than 90 days may face a preexisting or waiting period of no more than 90 days. They get credit for time already satisfied.

Coordination of benefits

• Insurers coordinating benefits must exchange information to avoid duplicate payment (27-20.6-2).
• Birthday rule for children covered by both married parents: the plan of the parent whose birthday falls earlier in the calendar year is primary. If the birthdays match, the plan that covered a parent longer is primary (230-RICR-20-30-2.6).

Small employers (chapter 27-50)

• Small employer: no more than 50 eligible employees on at least half its working days in the prior quarter.
• Eligible employee: normally works 30 hours a week. An employer may uniformly include employees working at least 17.5 hours.
• Rating:
  • Rates come from an adjusted community rate that may vary only for age and family composition.
  • For each plan, the highest premium for a family composition type can't exceed the lowest by more than four times.
• Renewal:
  • Renewal is at the employer's option. One exception is failing the carrier's minimum participation rules.
  • A carrier leaving the small group market gives 180 days' notice.

Other group rules

• Stop-loss policies may not have a specific attachment point below $20,000 or an aggregate point below 120% of expected claims (27-8.2-3).
• A producer selling a plan that isn't fully insured must tell buyers it lacks insurance (27-42-6).
• HMO option: employers averaging 25 or more employees must offer a qualified HMO where available (27-41-27).

Common exam traps

• Layoff continuation: up to 18 months, but never longer than the time employed. Elect within 30 days.
• Former spouse coverage lasts until remarriage or the judgment's deadline. Then there are 30 days to buy an individual policy without proof of insurability.
• Birthday rule: earlier birthday in the year = primary.
• Small employer: up to 50. Part-timers may count from 17.5 hours. Rate bands are 4:1.