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Rhode Island - Compensation & Benefit Legislation

RHODE ISLAND - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

RHODE ISLAND - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted children is included in state's newborn health care mandate.

 

Preventive care for children: Yes, to age 19 including mandatory lead screening.

 

(Rhode Island Gen. Laws Sections 23-24.6-9, 27-18-27, 27-18-30, 27-38.1-1, 27-38.1-2, 27-38.1-3)

 

RHODE ISLAND - ALCOHOLISM & DRUG ABUSE

Mandatory coverage.

 

Minimum yearly inpatient coverage: Detoxification: 3 occurrences or 21 days; rehabilitation: 30 days.

 

Minimum yearly outpatient coverage: 30 hours per individual; 20 hours per family member.

 

Minimum lifetime coverage: 90 days intensive rehabilitation.

 

(Rhode Island Gen. Laws Section 27-38-1)

 

RHODE ISLAND - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: State Unemployment Insurance law has no specific provision on cafeteria plans, but employer payments for health and accident and group term life insurance benefits are specifically excluded from wages under state Unemployment Insurance and temporary disability insurance law and may be excluded even when provided through a cafeteria plan. However, employee salary reductions toward such benefits must be counted as wages.

 

RHODE ISLAND - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

Death: Yes, maximum 18 months of continuation coverage.

 

Job Termination: Yes, unless terminated for gross job misconduct. (Maximum 18 months of continuation coverage.)

 

Reduction of Hours: No.

 

Divorce or Legal Separation: Yes. (If stated in divorce decree so long as member spouse participates in the plan.)

 

Medicare Eligibility: No.

 

Other Provisions: Termination of coverage for any other reason.

 

Early Termination of Continuation of Coverage: Becoming eligible for Medicare; becoming eligible for similar benefits, including coverage for pre-existing conditions under another group policy; remarriage; failure to make a timely payment.

 

(Rhode Island General Laws Sections 27-19.1-1, 27-20.4-1, 27-20.4-4, 27-20.4-5).

 

RHODE ISLAND - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. Based on 1986 National Association of Insurance Commissioner Rules model. (Rhode Island Ins. Reg. XLVIII)

 

RHODE ISLAND - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

RHODE ISLAND - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

Who is Covered by Statute: All employers and employees, except those covered by federal Department of Transportation regulations or other federal requirements.

 

Applicant Testing: Employer can require job applicant to submit to drug testing if (1) the given offer is conditioned on a negative drug test, (2) the applicant provides the test sample in private, and (3) positive test results are confirmed by means of GC/MS or technology recognized as being at least as scientifically accurate.

 

Employee Testing: Testing is allowed where a reasonable suspicion of drug use exists.

 

How Test Results are Used: Employees testing positive shall not be terminated on the basis but shall be referred to a substance abuse professional.

 

Enforcement of Statutes: Enforcement is by private civil action; injunctive relief, punitive damages, and attorneys' fees are available to prevailing employee. Criminal sanction; violations are misdemeanors; penalty as noted by statute.

 

Employee Remedies: Employees may obtain attorneys' fees and court costs, damages (including punitive damages), and injunctive relief.

 

Employer Penalties:Employer penalties include criminal sanction (with a fine of up to $1,000 imprisonment for 1 year, or both).

 

Who Pays for Testing: Subsequent tests are a the employee's expense.

 

Employee Assistance Benefits: State has no statutory requirements.

 

Other Requirements: Testing must be conducted in conjunction with a bona fide rehabilitation program.

 

(Rhode Island Gen. Laws Sections 28-6.5-1, 28-6.5-2.)

 

RHODE ISLAND - GROUP HEALTH CODE ADDITIONS (MANDATED)

Alcoholism and Drug Abuse Treatment: Policies must cover inpatient treatment of substance abuse of up to three detoxification occurrences or 21 days per year, whichever comes first; 30 days of intensive rehabilitation services per year with a lifetime maximum of 90 days (one day of rehabilitation service equals one day of residential treatment or two days of partial hospitalization); and 30 hours of outpatient treatment for the patient and 20 hours for family members per year. (Rhode Island Gen. Laws Section 27-38-1.) Coverage for alcohol and substance abuse problems must include treatments ordered as a condition of sentencing by any court in the state of Rhode Island. (H6258, 1995) (Rhode Island Gen. Laws Section 27-38-1.)

 

Coverage Continuation and Conversion: Policies must provide continuation and subsequent conversion rights to employees and their dependents when termination is due to involuntary layoff, reduction in work force, cessation of business, or death of the employee. (Rhode Island Gen. Laws Sections 27-19.1-1a-e.) Policies must provide continuation rights to divorced spouses. (Rhode Island Gen. Laws Section 27-20.4-1.)

 

Diabetes: Group health policies (including HMOs) must include benefits for equipment and supplies needed for the treatment of diabetes as prescribed by a physician or other licensed health care provider. Equipment and supplies used for diabetes treatments which must be covered include blood glucose monitors and blood glucose monitors for the legally blind, data management systems, test strips for glucose monitors and visual reading and urine testing strips, insulin, injection aids, cartridges for the legally blind, syringes, insulin pumps and appurtenances, insulin infusion devices, and organ agents for controlling blood sugar. A list of approved medical equipment and supplies needed for diabetes treatments must be updated periodically. Under health policies, diabetes self-management education sessions may be held at specified locations or in a home setting if an attending physician deems this type of session to be medically necessary. (H8128, 1996) (Rhode Island Gen. Laws Sections 27-18-38, 27-19-34, 27-20-21, 27-41-43.)

 

Infertility: Policies that provide pregnancy-related benefits must cover costs of diagnosis and treatment of infertility. Co-payments of 20 percent may be required for costs solely related to infertility treatment. (Rhode Island Gen. Laws Section 27-18-30.)

 

Long Term Care: Long term care policies must provide home health care benefits that are at least 50 percent of those provided in a nursing facility. Home health care benefits must meet the National Association of Insurance Commissioner's minimum standards for home health care benefits in long term care insurance policies. (Rhode Island Gen. Laws Section 27-34-2-20.)

 

Mammography Screening and Pap Smears: Non-profit hospital and medical service plans must cover screening as described. (Rhode Island Gen. Laws Sections 27-19-20, 27-20-17.)

 

Mastectomy: Health care policies (HMOs included) which provide medical and major medical coverage, must provide benefits for prosthetic devices (initial and subsequent) and or reconstructive surgery to restore and achieve breast symmetry following a mastectomy. (H8842, 1996) (Rhode Island Gen. Laws Sections 27-18-39, 27-19-34, 27-20-21, 27-41-43.) Group insurers (HMOs included must provide hospitalization coverage for mastectomy for a minimum of 48 hours and for auxiliary node dissection for a minimum of 24 hours. Decisions to allow early hospital discharges for these conditions may be made by an attending physician with patient agreement. In case of early discharge, a minimum of one home visit by a physician or a registered nurse is required. (H5280, S38, 1997) (Rhode Island Gen. Laws Section 27-18-40.)

 

Maternity: Health care insurers (HMOs included) must provide hospitalization coverage for a mother and her newly born child for 48 hours following a vaginal birth and for 96 hours following a Caesarean section. Decisions to allow early post-delivery discharge must be made by an attending health care provider in consultation with a mother. In such cases, coverage for post-delivery care must include home visits, parental education, assistance and training in breast or bottle feeding, and necessary clinical tests. (H7239, 1996) (Rhode Island Gen. Laws Sections 27-18-33.1, 27-20-17.1, 2-41-30.1, 29-19-23.1.)

 

Pediatric Preventive Care: Policies covering dependents must cover pediatric preventive care except biologicals used for vaccinations. Co-payment charges for office visits cannot be greater than co-payments for other physician office visits. (Rhode Island Gen. Laws Section 27-38.1-2, 27-38.1-3.)

 

Policies for Small Employers: Employers of 25 of fewer employees who have not provided health insurance for two years are eligible for basic health are coverage of: 20 days per year inpatient hospital care (including care for substance abuse with a lifetime limit of 45 days); outpatient hospital care; emergency care for life-threatening conditions; six well baby exams in a child's first year and immunizations until age eight; four physician office visits per year and laboratory fees, surgery and anesthesia, diagnostic x-rays, and physician care in a hospital inpatient or outpatient setting; prenatal office visits and hospital care for mothers and newborns; newborn metabolic and sickle cell screening; mammography and pap smears; 20 outpatient visits for psychiatric and substance abuse care; and 20 home health care visits per year if rendered in lieu of or to reduce hospital stays. (Rhode Island Gen. Laws Section 27-18.3-1.)

 

Pre-existing Conditions: Insurers (including HMOs) must not limit or prevent coverage because of a pre-existing condition for any individual who has been continuously insured for the previous 12 months immediately prior to their date of application for insurance or coverage; the previous coverage must have covered the pre-existing condition. Individuals seeking new policies must provide documentation showing prior coverage for the pre-existing condition during the specified time period. (H6542, 1995) (Rhode Island Gen. Laws Section 27-18-37.)

 

Providers: Midwives: Costs for services must be covered if the provider is licensed, the service with within the provider's scope of services, and the service is covered by the policy. (Rhode Island Gen. Laws Section 27-18-31.) Obstetricians and Gynecologists: Effective January 1, 1998, health care insurers (including HMOs) which provide coverage for obstetrical and gynecological care must allow a woman to receive an annual routine visit to an in-network obstetrician or gynecologist without prior referral from a primary care provider. (S149, H6254, 1997) (Rhode Island Gen. Laws Sections 27-18-40, 27-19-36, 27-20-31, 27-41-45.)

 

Second Surgical Opinion: Insurers must make available to individual policyholders with inpatient surgical coverage for second surgical opinions. (Rhode Island Gen. Laws Section 27-39-2.)

 

RHODE ISLAND - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

RHODE ISLAND - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: No.

 

Percent of employees who must elect coverage (if employees pay part of premium): No statutory requirement.

 

Percent of employees who must be covered if employer pays all of premium: No statutory requirement.

 

Minimum number of employees in group plan: No statutory requirement.

 

Employer prohibited as beneficiary: No.

 

Grace period (days): No statutory requirements. Mandatory conversion: No.

 

Other provisions: None.

 

RHODE ISLAND - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Columbus Day (or 2nd Monday in October), Sunday. Other: A holiday appointed by the Governor, General Assembly, President, or Congress. If a holiday falls on a Sunday, following Monday is a holiday. (Rhode Island Gen. Laws Sections 25-1-2, 25-2-1, 25-2-4, 25-2-9, 25-2-12, 25-2-14, 25-2-15, 25-2-17, 25-2-20, 25-2-24, 25-2-26, 25-2-35)

 

RHODE ISLAND - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

RHODE ISLAND - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Violator is guilty of a misdemeanor.

 

Other Requirements: Employer is not required to compensate employee during jury service, unless included in contract of collective bargaining agreement. (Rhode Island Gen. Laws Section 9-9-28.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: State reports no statutory requirements.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: State reports no statutory requirements.

 

RHODE ISLAND - LEAVES OF ABSENCE

Employers Subject to Leave Laws: Employers with at least 50 employees.

 

Criteria for Eligibility: Must be employed for at least 30 hours per week for 12 consecutive months with same employer.

 

Maximum length of leave: 13 weeks in any 2 calendar years.

 

Paid Leave: If employer provides paid leave less than 13 weeks, balance of leave may be unpaid.

 

Acceptable Reasons for Leave: Birth/adoption of a child; serious illness of child, spouse, parent, mother-in-law, father-in-law, or employee.

 

Employment Guarantees After Leave: Entitled to reinstatement in the position held prior to the leave or an equivalent position.

 

Use of Vacation or other Time-off Benefits: State reports no statutory requirements.

 

Certification Required: Employer may require certification of an illness.

 

Effect Of Leave on Other Benefits: Health benefits continue during leave; no loss of benefits accrued during leave.

 

Effect of Seniority Accrual During Leave: Seniority benefits accrue during leave.

 

Minimum Requirements for Notification to Employer: At least 30 days prior notice is required, except for emergencies.

 

Conditions for Denial of a Request For Leave: State reports no statutory requirements.

 

(Rhode Island Gen. Laws Sections 28-48-1 - 28-48-4.)

 

See U.S. Federal Family and Medical Leave Act

 

RHODE ISLAND - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

RHODE ISLAND - MANDATED PROVIDERS

Chiropractors, podiatrists, nurse practitioners, and nurse midwives. Mandatory coverage for osteopaths; mandatory coverage for psychiatric and mental health nurse clinical specialists practicing in a private, nonprofit ambulatory care facility, mental health counselors, certified registered nurse anesthetists, and family therapists. Direct access to obstetrician/gynecologist. (Rhode Island Gen. Laws Section 5-29-6, 5-30-11, 5-37-1, 27-18-25, 27-18-31, 27-18-34, 27-18-35, 27-18-44, 27-18-45)

 

RHODE ISLAND - MENTAL HEALTH CARE

Mandatory coverage for serious mental illness under same conditions as other illnesses. (Rhode Island Gen. Laws Section 27-38.2-1)

 

RHODE ISLAND - MINIMUM WAGE

$6.15 per hour.

 

See U.S. Minimum Wage

 

RHODE ISLAND - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All new hires and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: W-4 with additional required information, or State form.

 

Filing deadline: Within 14 days of hire.

 

Employer information to be included: Name, address, and federal EIN.

 

Employee information to be included: Name, address, SSN, availability of health insurance for dependents, date of eligibility for such insurance, and payroll address.

 

Penalty for failure to report: $20 per day for each failure to report. $500 if failure is result of conspiracy between employee and employer.

 

(Rhode Island Gen. Laws Sections 2415-24-1 through 2415-24-9)

 

RHODE ISLAND - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: yes, to age 19 including mandatory lead screening. (Rhode Island Gen. Laws Sections 23-24.6-9, 27-18-27, 27-18-30, 27-38.1-1, 27-38.1-2, 27-38.1-3)

 

RHODE ISLAND - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

RHODE ISLAND - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, plan shall not limit benefits for losses incurred more than 12 months following the effective date of coverage due to a existing condition. (Rhode Island Gen. Stat. Ann. Section 27-18-37.)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

RHODE ISLAND - PROTECTED CLASSIFICATIONS

Age:   Yes, age 40 and over.

Race:   Yes.

Color:   Yes.

National Origin:   Yes.

Ancestry:   Yes.

Religion:   Yes.

Sex:   Yes.

Pregnancy:   Yes.

Sexual Harassment:  Yes (by executive order).

 

(R.I. Gen. Laws Sections 28-5-6, 28-5-7; R.I. Ex. Or. 85-13, Sections 1, 2.)

 

RHODE ISLAND - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

RHODE ISLAND - SHORT TERM DISABILITY CODE ADDITIONS

Covered Employers: 1 or more employees.

 

Employer Contribution: None.

 

Covered Employees: Employee must earn a minimum of 200 times the minimum hourly wage in any one calendar quarter for the base period.

 

Employee Contribution: 1.2% of first $38,000 in wages.

 

Weekly Benefit Amount: 4.26% of employee's highest calendar quarter wages in base year, not to exceed 85% of state average weekly wage for preceding year. Dependent allowance of $10.00 per week up to 5 dependents. Average weekly benefits range from $42-$428.

 

Waiting Period: 7 consecutive days.

 

Coordinated with Workers' Compensation: Yes.

 

Responsible Agency:       

Department of Employment and Training

101 Friendship Street

Providence, RI 02901

 

RHODE ISLAND - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Payday; if employment terminated because of relocation or merger, or liquidation, payment must be made within 24 hours.

 

Date due if employee resigns: Not specified.

 

Wages: Yes. (Wages include accrued vacation for employees having completed at least one year of service.)

 

Vacation Pay: Yes.

 

Holiday: Yes. (If employee is separated from payroll as a result of employer liquidating, merging disposing of business, or moving out of the state.

 

Sick leave: No.

 

Severance: Yes. (Buyer of company must pay 2 weeks of severance pay for each year of service to employees with 3 or more years of service who are terminated; within 2 years after transfer of control; within 1 year preceding transfer of control; during period when buyer increases ownership of voting securities from 5% to 50%.)

 

(Rhode Island Gen. Laws Sections 28-7-19.2, 28-14-4)

 

RHODE ISLAND - UNEMPLOYMENT TAX

See TERMINATION & SEVERANCE PAY (above)

 

RHODE ISLAND - VACATION PAY

Employer Contributions:

 

 

Voluntary Contribution Provision: No.

 

(Rhode Island Gen. Laws Sections 28-42-38, 28-42-38.1, 28-43-8, 28-43-8.1, 28-43-8.3.)

 

RHODE ISLAND - VOTING TIME OFF

State reports no statutory requirements.

 

RHODE ISLAND - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employers of 4 or more employees, partners, sole proprietors and employers in hazardous occupations.

 

Public Employers: Mandatory as to state and city of Providence, (Note: Members of the National Guard must be on active duty in order to be eligible for benefits.) elective as to cities or towns.

 

Exceptions: Agriculture, domestic service. Excludes van pooling recipients except driver. Professional hockey teams are exempt.

 

Special Coverage Provisions: Voluntary as to agriculture, domestic service, and employers of less than 4 employees, except those in hazardous occupations. Excludes employer-sponsored social or athletic activity.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)