RI 2026 H7429: Insurance - Accident and Sickness Insurance Policies - Physical Therapy Copay

Plain-English Summary

This legislation prohibits health insurance plans in Rhode Island from charging patients higher copayments, coinsurance, or deductibles for physical therapy services than they charge for primary care physician visits. This requirement applies to individual and group plans issued or renewed on or after January 1, 2027. The bill affects accident and sickness insurance, nonprofit hospital and medical service corporations, and health maintenance organizations. Additionally, insurance carriers must clearly disclose the availability of physical therapy coverage, including any limitations or exclusions within their plans.

For younger readers

This bill creates a new rule for health insurance to help people who need physical therapy. A physical therapist is a health expert who helps you move better if you are hurt or in pain. Sometimes, insurance companies make people pay extra money to see these therapists. This law says that starting in the year 2027, insurance companies cannot charge you more money to see a physical therapist than they charge you to see your regular family doctor. This makes it fairer and cheaper for people to get the help they need to fix their bodies.

Who & Where It Applies

Impacted groups

Physical therapistsHealth insurance companiesPatients requiring physical therapyPrimary care physiciansEmployers offering health benefits

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

None

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Increases access to healthcare by removing financial barriers for patients who need physical therapy but cannot afford high specialist copayments.
Promotes health equity by ensuring that essential rehabilitative care is treated with the same financial priority as primary care, rather than as a luxury service.
Mandates transparency from insurance corporations regarding coverage limitations, empowering consumers to understand their benefits and avoid surprise costs.
The implementation date is delayed until January 1, 2027, leaving patients vulnerable to higher costs for several more years.
Does not cap the actual cost of care; if a plan has high copayments for primary care physicians, physical therapy will still be expensive for low-income residents.
Insurance companies may respond to the lost revenue by raising premiums across the board, which disproportionately hurts the working poor.

For Conservatives

Requires insurance companies to clearly state coverage conditions and exclusions, supporting consumer choice and market transparency.
Supports physical therapists, many of whom are small business owners, by removing artificial financial disincentives for customers to utilize their services.
Encouraging physical therapy can lead to faster recovery and less reliance on disability payments or expensive surgeries, potentially lowering long-term societal costs.
Represents government overreach into the private market by dictating price structures and contract terms to private businesses.
Will likely result in increased insurance premiums for all policyholders as companies pass the costs of lower copays onto the consumer base.
Removes the freedom for insurance providers to create tiered plans based on actuarial data and cost-benefit analysis.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 36 additions

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-96. Physical therapists.

(a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall not impose a copayment, coinsurance, or office visit deductible amount charged to the insured for services rendered by a physical therapist licensed under § 5-40-7 that is greater than the copayment, coinsurance or office visit deductible amount charged to the insured for the services of a primary care physician or osteopath licensed under chapter 37 of title 5.

(b) An insurer shall state clearly the availability of physical therapy coverage under its plan and all related limitations, conditions, and exclusions.

SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-88. Physical therapists.

(a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall not impose a copayment, coinsurance, or office visit deductible amount charged to the insured for services rendered by a physical therapist licensed under § 5-40-7 that is greater than the copayment, coinsurance or office visit deductible amount charged to the insured for the services of a primary care physician or osteopath licensed under chapter 37 of title 5.

(b) An insurer shall state clearly the availability of physical therapy coverage under its plan and all related limitations, conditions, and exclusions.

SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section: 27-20-84. Physical therapists.

(a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall not impose a copayment, coinsurance, or office visit deductible amount charged to the insured for services rendered by a physical therapist licensed under § 5-40-7 that is greater than the copayment, coinsurance or office visit deductible amount charged to the insured for the services of a primary care physician or osteopath licensed under chapter 37 of title 5.

(b) An insurer shall state clearly the availability of physical therapy coverage under its plan and all related limitations, conditions, and exclusions.

SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section: 27-41-101. Physical therapists.

(a) An individual or group health insurance plan or policy delivered, issued for delivery, or renewed in this state on or after January 1, 2027, shall not impose a copayment, coinsurance, or office visit deductible amount charged to the insured for services rendered by a physical therapist licensed under § 5-40-7 that is greater than the copayment, coinsurance or office visit deductible amount charged to the insured for the services of a primary care physician or osteopath licensed under chapter 37 of title 5.

(b) An insurer shall state clearly the availability of physical therapy coverage under its plan and all related limitations, conditions, and exclusions.

SECTION 5. This act shall take effect upon passage.