Section 210-RICR-30-05-3.9 - Basis for Approving ESI PlansA. Only ESI or group health plans that meet the cost-effectiveness and benefits criteria specified in this Part are approved for the RIte Share Premium Assistance Program. 1. Sources of information for determining cost-effectiveness - Determinations of ESI cost-effectiveness are based on information gathered from the following sources: a. Application materials. When applying for Medicaid, applicants must indicate: current health insurance coverage status; relationship to policy holder; plan name; policy number; eligibility for and type of coverage and individuals covered by the plan. Subchapter 00 Part 3 of this Chapter explains the process for applying for Medicaid through the State's affordable care eligibility system and the manner in which this information is collected and maintained.b. The RIte Share Unit. This EOHHS Unit collects employer data about ESI plans for Medicaid-eligible individuals/households. Information from employers includes data necessary to determine whether the employer's ESI offerings meet EOHHS's cost-effectiveness and benefits criteria.2. EOHHS reserves the right to request additional information about the ESI plan from the Medicaid beneficiary, the policy holder (even if not an eligible Medicaid member), and, where appropriate and necessary, the employer or insurance carrier.210 R.I. Code R. 210-RICR-30-05-3.9
Amended effective 8/6/2019