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S 2463Health Insurance

Insurance - Accident and Sickness Insurance Policies - Physical Therapy Copay

Starting in 2027, insurance plans cannot charge higher copays for physical therapy than for primary care doctor visits.

Held for study
Population
Affected
45
Email Legislator
Introduced Feb 6, 2026Committee Senate Health & Human Services

Plain-English Summary

This legislation regulates how health insurance companies in Rhode Island charge for physical therapy services. Starting January 1, 2027, insurance plans—including those from nonprofit hospital service corporations, medical service corporations, and HMOs—cannot charge a patient a higher copayment, coinsurance, or deductible for a visit to a licensed physical therapist than they would for a visit to a primary care physician. The bill also requires insurance providers to clearly state the availability, limitations, and exclusions of physical therapy coverage within their plans.

For younger readers

When people go to the doctor, they often have to pay a small amount of money called a "copay." Sometimes, seeing a special doctor costs more money. This new rule says that if you go to a physical therapist—someone who helps fix your body when you are hurt—the insurance company cannot make you pay more than you would pay to see your regular doctor. This rule starts in the year 2027. It helps make sure that fixing your muscles and joints isn't too expensive.

Who & Where It Applies

Impacted groups
Physical therapistsPatients requiring physical therapyHealth insurance companiesPrimary care physiciansEmployers offering health plans
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
None
Estimated revenue
None

Bill Analysis

Both viewpoints
For Progressives
  • Increases healthcare equity by ensuring that cost barriers do not prevent lower-income patients from accessing essential rehabilitation services, treating physical recovery as a necessity rather than a luxury.
  • May reduce reliance on opioids and invasive surgeries by making non-pharmacological pain management (physical therapy) more financially accessible to the general population.
  • Protects patients with chronic conditions or disabilities, who require frequent therapy sessions, from facing discriminatory or prohibitive out-of-pocket costs compared to standard medical care.
  • The legislation does not take effect until January 1, 2027, leaving patients to struggle with potentially high costs for physical therapy for several more years.
  • Private insurance companies may simply raise monthly premiums for all policyholders to recoup the lost revenue from lowered copays, which could disproportionately hurt working-class families.
  • Does not address the underlying issue of high deductibles in general; if a patient has a high-deductible plan, the "primary care rate" may still be too expensive for many residents.
For Conservatives
  • Supports small business owners and private practitioners in the physical therapy sector by removing artificial financial disincentives that steer customers away from their services.
  • Encourages market-based, non-addictive solutions to pain management, potentially reducing the societal and law enforcement costs associated with the opioid crisis.
  • Mandates transparency in insurance contracts, ensuring that consumers are fully informed about the limitations and specific coverage details of the products they purchase.
  • Represents government interference in the free market by dictating the specific pricing structures and terms of private contracts between insurers and their customers.
  • Will likely result in increased insurance premiums for all ratepayers as companies pass on the costs of the government-mandated price controls.
  • Violates the principle of corporate freedom by stripping insurance providers of the ability to structure their benefit tiers based on their own risk assessments and business models.

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.