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The UnitedHealthcare Pledge PlanSM, a HEALTHpact plan, brings affordable health care benefits to employers and employees facing rising insurance rates, copayments, and deductibles. HEALTHpact is a unique health insurance product developed by the State of Rhode Island specifically for small businesses with 50 or fewer employees, designed to give comprehensive benefits at affordable rates. This innovative benefits package keeps health care costs low, and employees healthy, by rewarding employees who commit to keeping themselves healthy. 
The UnitedHealthcare Pledge Plan provides its members with extensive health care coverage, including:

  • In-network access to physicians throughout Rhode Island and Bristol County, Massachusetts
  • Comprehensive coverage, including office visits, prescription drugs, hospital services, behavioral health, preventive care, and more
  • Copayments for Primary Care Physician (PCP) and Specialist visits
  • Three-tier pharmacy coverage

Basic and Advantage Levels of Benefits 
The Pledge Plan has two levels of benefits: Basic and Advantage.  While the Basic and Advantage levels provide the same coverage, the Advantage level significantly reduces the member’s out-of-pocket costs.  For example, the deductible for family coverage in the Advantage level is $1,500 vs. $10,000 in the Basic level.

To qualify for Advantage-level benefits, members must commit to the enrollment requirements within their designated time frames and adopt the 5 HEALTHpact Principles:

  • Select a Primary Care Physician (PCP)
  • Complete a Health Risk Appraisal Form
  • Pledge to maintain or achieve a healthy weight
  • Pledge to stay smoke-free or participate in smoking cessation programs
  • Participate in disease management programs as appropriate

Please call 1-800-573-0414 or view the enrollment materials below for more information.

Benefit Summaries and Certificate of Coverage 
UnitedHealthcare Pledge Plan Certificate of Coverage
UnitedHealthcare Pledge Plan Basic-level Benefit Summary
UnitedHealthcare Pledge Plan Advantage-level Benefit Summary
UnitedHealthcare Pledge Plan Basic-level Pharmacy Benefit Summary
UnitedHealthcare Pledge Plan Advantage-level Pharmacy Benefit Summary

Enrollment Requirements for Advantage-level Benefits
Enrollment Package Contents
Instructions to Qualify for Advantage-level Benefits
Health Risk Appraisal Form Instructions
Health Risk Appraisal Privacy Statement
Sample Health Risk Appraisal Form
Member Pledge Form
Advantage-level Benefits Checklist

Ongoing Participation Requirements for Advantage-level Benefits
Instructions for Ongoing Participation in Advantage-level Benefits
Primary Care Physician Checklist for Adults
Primary Care Physician Checklist for Adolescents
Participation Commitment Form
Consumers Right to Know About Health Plans in Rhode Island

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