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Essential Plan 4 was created as a result of legislation intended to provide a low-cost insurance option for small group employers regardless of their employees' health status or claims experience.
- Coverage. Most eligible services are covered 80 percent at our allowance, less any coinsurance and/or copayments. There is no coverage
for ambulance, prescription drugs, private duty nursing, durable medical equipment, physical therapy, and occupational therapy.
- Participating network. The Essential Plan 4 network includes all hospitals in Rhode Island. For medical services to be considered, they must be rendered by a doctor of medicine or osteopathy. There is no pharmacy network.
- Coverage in-network. Eligible services are covered at 80 percent of our allowance, less any coinsurance and/or copayments. Members will
not be billed for covered charges beyond our allowance.
- Coverage out-of-network. Members may seek care from any non-participating provider and still receive coverage at 80 percent of our
allowance for covered services, less any coinsurance and/or co-payments. Non-participating providers may charge more than our allowance. Members will be responsible for any remaining balances. Preauthorized outpatient/office mental health care and outpatient chemical dependency services are covered at 50 percent of our allowance.
- BlueCard Program. With our BlueCard Traditional program, a member's Blue Cross card is recognized at any BCBSRI participating
Traditional provider nationwide. In most cases, claims are filed by the provider and paid based on the local plan's allowance. Members will not be balance billed beyond applicable copayments. Preauthorization recommendations exist.
For benefit details on either of these options, please refer to the "Comparison of Health Plans" benefit matrix within your renewal packet.
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